Can Acupuncture Improve IVF Outcomes in Women With Diminished Ovarian Reserve?

For women undergoing in vitro fertilization (IVF),

diminished ovarian reserve can make an already

complex fertility journey even more challenging. A

lower ovarian reserve may mean fewer follicles

responding to stimulation, fewer eggs retrieved,

and fewer embryos available for transfer.

Acupuncture is increasingly used alongside fertility

treatment, but an important question remains:

Can acupuncture meaningfully improve IVF

outcomes in women with diminished ovarian reserve?

A 2026 systematic review and meta-analysis published in Frontiers in Endocrinology examined this question by combining evidence from 11 randomized controlled trials involving 885 women with diminished ovarian reserve undergoing IVF or intracytoplasmic sperm injection (ICSI).

The findings were encouraging, particularly for clinical pregnancy.

​

Key Takeaways

• The analysis included 11 randomized controlled trials and 885 women with diminished ovarian reserve undergoing IVF/ICSI.

• Acupuncture was associated with a higher clinical pregnancy rate, with an absolute risk difference of approximately 25 percentage points.

• Clinical pregnancy had the strongest evidence in the review, rated moderate certainty.

• The pooled analysis also found higher embryo implantation and live birth rates.

• Women receiving acupuncture had, on average, 1.72 more oocytes retrieved and 1.50 more optimal embryos.

• Researchers are investigating several possible mechanisms, including changes in uterine and ovarian blood flow, neuroendocrine regulation, ovarian cellular signaling, inflammation, oxidative stress, and stress regulation.

​

What Is Diminished Ovarian Reserve?

Diminished ovarian reserve, often abbreviated as DOR, refers to a reduced quantity or reproductive potential of the remaining follicles in the ovaries.

Clinicians commonly evaluate ovarian reserve using measures such as:

AMH — Anti-Müllerian Hormone

AFC — Antral Follicle Count

FSH — Follicle-Stimulating Hormone

Women with diminished ovarian reserve may still ovulate and may still become pregnant naturally or through assisted reproductive technology.

DOR does not mean that pregnancy is impossible.

However, during IVF, diminished ovarian reserve can make treatment more difficult because fewer follicles may respond to ovarian stimulation, potentially resulting in fewer eggs and embryos.

The 2026 review focused specifically on women with DOR undergoing IVF or ICSI.

​

What Did the 2026 Meta-Analysis Study?

Researchers systematically searched eight medical databases for randomized controlled trials published through February 28, 2026.

A total of:

11 randomized controlled trials

involving:

885 women with diminished ovarian reserve

were included.

Of these:

439 received acupuncture-related interventions

and:

446 were in control groups.

The studies evaluated several reproductive outcomes, including:

• clinical pregnancy

• embryo implantation

• live birth

• number of eggs retrieved

• number of optimal embryos

• estradiol levels

• ovarian stimulation medication use

The acupuncture protocols varied considerably between studies and included manual acupuncture, electroacupuncture, and transcutaneous electrical acupoint stimulation (TEAS).

This variation is important because the meta-analysis does not identify one single acupuncture protocol as the optimal treatment for IVF.

​

What Happened to Clinical Pregnancy Rates?

Clinical pregnancy was the primary outcome of the review and produced the strongest evidence.

Nine randomized trials involving 661 women reported clinical pregnancy outcomes.

The pooled analysis found:

Clinical pregnancy rate: approximately 25 percentage points higher in the acupuncture groups

The risk difference was:

RD = 0.25

with a 95% confidence interval of:

0.18 to 0.32

and:

P < 0.00001

Importantly, statistical heterogeneity was very low:

I² = 0%

meaning the clinical pregnancy results were relatively consistent across the included studies.

Using another statistical measure, the relative risk was approximately:

RR = 1.93

This should not be interpreted as meaning acupuncture guarantees pregnancy or nearly doubles an individual patient's personal chance of becoming pregnant.

Rather, it means that when the included trials were pooled together, clinical pregnancy occurred more frequently in the acupuncture groups.

The researchers rated the certainty of evidence for clinical pregnancy as:

Moderate Certainty

This was the strongest evidence rating among the major reproductive outcomes examined.

​

What About Embryo Implantation?

The pooled analysis also found a higher embryo implantation rate in women receiving acupuncture-related treatment.

The reported absolute risk difference was approximately:

+30 percentage points

with:

P < 0.00001.

This is an encouraging finding, particularly because implantation is one of the critical stages between embryo transfer and establishment of a clinical pregnancy.

However, only a smaller number of studies reported this outcome, and the certainty of evidence was rated:

Low Certainty

Therefore, the implantation result should be considered promising rather than definitive.

​

What About Live Birth?

Live birth is ultimately one of the most meaningful outcomes in fertility research.

The pooled analysis found that women receiving acupuncture had a higher live birth rate:

Risk difference: +22 percentage points

with:

P = 0.01.

This appears particularly encouraging.

​

Did Acupuncture Affect the Number of Eggs Retrieved?

Yes — another interesting finding involved the number of oocytes, or eggs, retrieved during IVF.

Women receiving acupuncture had, on average:

1.72 more oocytes retrieved

than women in the control groups.

The difference was statistically significant:

P < 0.00001.

Researchers also found approximately:

1.50 more optimal embryos

in the acupuncture groups.

Again, however, these outcomes were based on relatively small samples and substantial variation among studies.

The certainty of evidence was therefore rated very low.

These results should be viewed as interesting signals rather than proof that acupuncture increases egg production or improves egg quality.​

​

How Might Acupuncture Support IVF in Women With Diminished Ovarian Reserve?

The clinical results tell us what was observed.

They do not necessarily tell us why it happened.

Researchers have proposed several possible biological pathways that may help explain how acupuncture could interact with reproductive physiology.

These mechanisms remain under investigation and should not be considered proven explanations for the pregnancy outcomes observed in this meta-analysis.

​

1. Can Acupuncture Improve Blood Flow to the Uterus and Ovaries?

Healthy reproductive tissues depend on adequate circulation to deliver oxygen, nutrients, hormones, and other signaling molecules.

For this reason, one area of fertility acupuncture research has focused on:

uterine blood flow

endometrial blood flow

and:

ovarian perfusion.

Some clinical studies have reported changes in ultrasound measures of uterine or endometrial blood flow following acupuncture.

From a biological perspective, researchers have proposed that changes in vascular resistance and autonomic nervous system activity could influence circulation to reproductive tissues.

This has led to the hypothesis that acupuncture may help create a more favorable environment for follicular development or endometrial receptivity.

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2. Could Acupuncture Influence the Ovarian Environment?

In diminished ovarian reserve, the challenge is not simply the number of remaining follicles.

The biological environment surrounding developing follicles also plays an important role in how follicles grow and respond during ovarian stimulation.

Experimental and clinical research has explored whether acupuncture or electroacupuncture may influence:

oxidative stress

inflammatory signaling

ovarian cellular function

and:

signaling pathways involved in follicular development.

The 2026 meta-analysis itself found associations with more retrieved oocytes and more optimal embryos, but these findings had very low certainty.

Therefore, it would be premature to say that acupuncture “improves egg quality.”

A more accurate interpretation is that researchers are investigating whether acupuncture may influence the physiological environment in which follicles develop.

​

3. The Brain–Hormone–Ovary Connection

The ovaries do not function independently.

Reproductive activity is partly regulated through communication among:

the hypothalamus in the brain

↓

the pituitary gland

↓

the ovaries

This network is commonly called the:

Hypothalamic–Pituitary–Ovarian Axis

Neural signals help regulate hormones involved in follicular development, ovulation, and ovarian function.

Acupuncture and electroacupuncture are being investigated for their effects on neural and neuroendocrine signaling, including pathways involving reproductive hormone regulation.

This does not mean acupuncture can replace fertility medications, restore a depleted supply of follicles, or reverse ovarian aging.

Instead, neuroendocrine regulation is one possible pathway researchers are exploring to understand how acupuncture may interact with reproductive physiology.

​

4. Stress, Anxiety and the Autonomic Nervous System

IVF can be physically and emotionally demanding.

Women undergoing fertility treatment may experience anxiety, sleep disruption, uncertainty, repeated testing, medication side effects, and significant emotional stress.

Acupuncture has also been studied for its effects on:

stress

anxiety

autonomic nervous system activity

and:

overall emotional well-being.

Reducing stress does not guarantee implantation or pregnancy.

However, helping patients manage the physical and emotional burden of fertility treatment may still be clinically meaningful.

Researchers have also proposed autonomic nervous system regulation as one possible link between acupuncture, vascular function, hormonal signaling, and reproductive physiology.

​

A Simple Way to Think About the Research

Current research suggests several possible pathways:

Acupuncture / Electroacupuncture

↓

Neural and autonomic nervous system signaling

↓

Possible effects on reproductive hormone regulation

At the same time:

Acupuncture

↓

Possible changes in uterine and ovarian circulation

And:

Acupuncture

↓

Possible effects on oxidative stress, inflammation and ovarian cellular signaling

Together, these pathways may influence:

the reproductive environment during IVF

​

Does Acupuncture Increase AMH?

This is another common question among women with diminished ovarian reserve.

AMH is widely used as a marker of ovarian reserve, and some studies have reported changes in AMH and other ovarian-reserve-related measurements after acupuncture.

However, AMH should not be thought of as a simple “fertility score.”

More importantly:

Acupuncture has not been proven to restore the number of eggs remaining in the ovaries.

A temporary or modest change in a laboratory marker should not be interpreted as reversal of ovarian aging or restoration of ovarian reserve.

For women with low AMH or diminished ovarian reserve, decisions about IVF timing and ovarian stimulation should continue to be made with a reproductive endocrinologist.

Acupuncture, when used, should be considered an adjunctive approach rather than a replacement for fertility treatment.

​

Is Acupuncture the Same as TEAS?

Not exactly.

An important detail in this meta-analysis is that the included interventions were not identical.

Some studies used traditional needle acupuncture.

Others used electroacupuncture, where a small electrical current is applied through acupuncture needles.

Others used:

Transcutaneous Electrical Acupoint Stimulation — TEAS

TEAS applies electrical stimulation to acupuncture points through electrodes placed on the skin and does not require needle insertion.

The meta-analysis found positive clinical pregnancy signals in both TEAS and non-TEAS acupuncture subgroups.

​

Is There an Ideal Acupuncture Protocol for IVF?

At present, this review cannot answer that question.

Across the 11 trials, researchers used different:

• acupuncture points

• numbers of points

• treatment schedules

• treatment durations

• stimulation methods

• IVF protocols

Some treatments lasted weeks, while others extended across multiple menstrual cycles.

This variation means the meta-analysis can help answer:

“Is acupuncture-related treatment associated with different IVF outcomes?”

​

What About Safety?

Safety reporting was limited across the included trials.

Only a minority of studies systematically reported adverse events.

Reported acupuncture-related effects were generally mild, including discomfort or bruising, and no clear signal of serious treatment-related complications emerged from the available data.

Fertility acupuncture should be provided by a properly licensed practitioner who understands the timing and medical context of IVF treatment.​

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What Does This Research Mean for Patients Considering IVF?

For women with diminished ovarian reserve undergoing IVF or ICSI, this 2026 meta-analysis provides encouraging evidence that acupuncture may be associated with improved reproductive outcomes.

The most convincing finding involved:

Clinical pregnancy

where the evidence was rated moderate certainty.

Positive signals were also observed for:

embryo implantation

live birth

number of eggs retrieved

and:

number of optimal embryos.

The study therefore supports viewing acupuncture as a potential complementary therapy during fertility treatment, rather than as a replacement for IVF or as a guarantee of pregnancy.​

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The Bigger Picture: Acupuncture and Modern Fertility Research

Fertility acupuncture research is gradually moving beyond the simple question:

“Does acupuncture work for infertility?”

Infertility is not a single condition.

Diminished ovarian reserve, PCOS, endometriosis, male-factor infertility, recurrent implantation failure, unexplained infertility, and age-related fertility decline involve very different biological challenges.

Modern research is increasingly asking more specific questions:

Which patients might benefit?

At what stage of fertility treatment?

Which outcomes change?

What biological mechanisms may be involved?

And how strong is the evidence?

The 2026 DOR meta-analysis is valuable because it focuses on a clearly defined population — women with diminished ovarian reserve undergoing IVF or ICSI — rather than treating all infertility as one condition.

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Our Perspective

The findings of this meta-analysis are encouraging, particularly the moderate-certainty evidence showing a higher clinical pregnancy rate among women with diminished ovarian reserve receiving acupuncture-related treatment during IVF/ICSI.

At the same time, reproductive medicine requires careful interpretation of evidence.

A statistically significant finding does not mean every patient will experience the same result, and promising biological mechanisms — including blood flow, neuroendocrine regulation, ovarian cellular signaling, and stress regulation — should not be presented as proven explanations until stronger evidence is available.

At Balance Art Acupuncture, we believe acupuncture is best considered as part of an integrative approach to fertility care — working alongside, rather than replacing, evaluation and treatment provided by reproductive endocrinologists and fertility specialists.

Our goal in reviewing emerging research is to help patients understand both what the evidence suggests and what remains uncertain.

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Original Research

Xu L, Liang X, Wang W, Zhang R, Lin G, Cao K, Sun P, Fan L.

Clinical evidence of acupuncture for infertile women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis.

Frontiers in Endocrinology. 2026;17:1840157.

DOI: 10.3389/fendo.2026.1840157

Read the original peer-reviewed study in Frontiers in Endocrinology

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About the Author

Run Guo, L.Ac., DAOM
Licensed Acupuncturist | Clinician & Educator
Balance Art Acupuncture | Vienna, Virginia

Run Guo, L.Ac., DAOM, is a licensed acupuncturist with more than 15 years of clinical practice and university-level teaching experience in acupuncture and related integrative health approaches. His clinical practice provides more than 10,000 patient visits annually, giving him extensive experience in the real-world application of acupuncture across a broad range of patient needs.

Alongside his clinical work, Run Guo has been involved in university-level education in acupuncture for more than a decade, combining hands-on clinical experience with an academic perspective on the field.

Through Balance Art Acupuncture's Research & Insights series, he reviews emerging peer-reviewed research in acupuncture, electroacupuncture, neuroscience, reproductive health, immunology, and modern biomedical science, translating complex scientific findings into clear, evidence-informed, and balanced information for patients and the general public.