Acupuncture for IVF Success: What the Research Says About Timing and Protocols
If you’re preparing for IVF, you may have heard that acupuncture can help. This blog answers the most common questions we hear about acupuncture and IVF, including how it works, which cycles may benefit, how many sessions are helpful, and when to start treatment.
We’ll start with a look at how the research has shaped today’s acupuncture protocols—but first, here’s a snapshot of the key takeaways:
Key Takeaways from the Research
Research shows that acupuncture during IVF cycles:
Improves outcomes for fresh, frozen and donor cycles
Is safe - and may even lower miscarriage rates
Works best with a higher “dose” of treatments
Significantly improves live birth rates with 9-12 treatments before embryo transfer
Is most effective when started 1-3 months before embryo transfer, rather than only on transfer day
What the Research Shows
Acupuncture has a long history in supporting fertility, and in 2002 a landmark study put acupuncture on the map for improving IVF outcomes by nearly 20% (Paulus et al., 2002). The study protocol, known as the Paulus protocol, involved two acupuncture treatments on the day of fresh embryo transfer on site at the IVF clinic - one treatment before the transfer and one treatment after the transfer. Several follow up studies and meta-analyses continued to find that embryo transfer acupuncture increased pregnancy rates (Xie et. al., 2019; Smith et. al., 2019).
Over the years, research expanded to include the outcome of live birth rate rather than just pregnancy rates. Studies also looked at the impact of several acupuncture visits over time rather than just on the day of embryo transfer, reflecting how acupuncture is actually practiced in the clinic. Research innovated alongside the evolving field of IVF looking at the impact of acupuncture on frozen embryo transfers (FET) and donor egg cycles. Early studies just looked at fresh transfers with patients’ own eggs.
Dr. Lee Hullender Rubin’s 2015 study looked at the impact of Whole Systems Traditional Chinese Medicine (WS-TCM) on IVF outcomes. Visits included a “whole systems” approach with a personalized TCM diagnosis and multiple modalities - acupuncture, Chinese herbal medicine, dietary and lifestyle recommendations. This was a novel and very exciting study as it reflected how acupuncture is practiced in the real world. A typical treatment plan was 12 visits weekly and increased to twice a week from IVF suppression medications to egg retrieval. Previous studies looked at the impact of acupuncture alone, with only one protocol that was not based on an individual’s TCM diagnosis.
Dr. Rubin’s research found that the WS-TCM was associated with more live births than two standardized acupuncture treatments on the day of embryo transfer or usual IVF care without any acupuncture. An average of 12 WS-TCM visits for non-donor cycles and 11 visits for donor cycles were associated with greater odds of live birth. The live birth rate was 27% higher in the WS-TCM group compared to the IVF alone group. More live births were associated with WS-TCM compared with embryo transfer acupuncture only as well. Fewer miscarriages occurred in the WS-TCM group. The WS-TCM group had more women diagnosed with diminished ovarian reserve and more likely lower quality embryos compared to the other two groups. Therefore it’s possible that this study underestimated the benefit of WS-TCM for live birth outcomes.
The research is clear - more acupuncture yields better results, for fresh transfers, frozen transfers and donor egg cycles. In a recent meta-analysis with 38 randomized controlled trials with almost 6,000 participants, acupuncture over more than one menstrual cycle was important for both fresh cycles and frozen cycles (Xia et. al., 2024). This echoes what an earlier study found - 9 electro-acupuncture sessions plus embryo transfer day acupuncture improved IVF outcomes (Magarelli et al., 2009). Another meta-analysis found that acupuncture increased live births by 30%. Acupuncture was 42% more effective in increasing live births when women had previously failed at least one cycle. (Xie et. al., 2019).
Acupuncture is a safe and effective way to improve IVF outcomes. It does not increase miscarriage rates. In fact, one study found that acupuncture reduced the miscarriage rate by 43% (Smith et. al., 2019).
How Acupuncture Supports IVF
Studies show several pathways for acupuncture’s effect on reproduction. A 2014 paper summarizes the following mechanisms (Cochrane et. al., 2014):
Increase vasodilation and blood flow to the uterus and ovaries
Thicken uterine lining
Floods the body with endorphins which mitigates the stress response
Release of neurotransmitters which can promote ovulation, regulate menses and increase fertility
Decrease insulin and increase insulin clearance
Improve egg quality
Timing Your Treatments for the Best Results
In our clinic, we recommend starting care as early as possible—ideally 3 months before egg retrieval or embryo transfer. This is the key window when factors like nutrition, exercise, acupuncture, herbs, and blood flow can have the greatest impact on egg quality and uterine receptivity.
We understand that a three month foundation is not always possible for our patients. Research (and our experience!) shows that treatment in the month before retrieval or transfer can still make a difference.
When patients start with a three-month foundation we start with weekly visits and build to twice a week during stimulation for retrieval cycles, and two weeks before embryo transfer. If starting acupuncture one month or less before a retrieval or transfer, we recommend acupuncture twice a week. Every treatment plan is tailored to our patients’ unique needs and cycles.
What a Typical IVF Acupuncture Plan Looks Like
To make the most impact on an IVF cycle, we time acupuncture with each phase of your menstrual and IVF cycle.
For Retrieval and Fresh Transfers:
1–3 months before retrieval and transfer: 1x/week—address underlying factors like blood sugar and hormone balance, support egg quality and increase blood flow to ovaries and uterus to support lining and endometrial receptivity
During stimulation: 2x/ week—support follicular growth, prepare endometrium, reduce medication side effects can calm the nervous system
Embryo transfer: 1-2x day before and/or day of—calm nervous system, encourage blood flow and receptivity and reduce cramping
Two-week wait: 1x/week—reduce anxiety and lingering side effects of IVF cycle, support implantation and calm the nervous system
After pregnancy positive test: 1x/week during first trimester—support early pregnancy physiology and reduce side effects of early pregnancy (fatigue, nausea, etc.)
For Frozen Embryo Transfers:
2-3 months before transfer: 1x/week—address underlying factors like blood sugar and hormone balance, increase blood flow to uterus to support lining and endometrial receptivity; may overlap with GnRH agonists
Estrogen priming or follicular phase: 1-2x/week—increase blood flow to uterus to support lining, support endometrial receptivity, calm the nervous system, reduce medication side effects
Embryo transfer: 1-2x day before and/or day of—calm nervous system, encourage blood flow and receptivity and reduce cramping
Two-week wait: 1x/week—reduce anxiety and lingering side effects of IVF cycle, support implantation and calm the nervous system
After pregnancy positive test: 1x/week during first trimester—support early pregnancy physiology and reduce side effects of early pregnancy (fatigue, nausea, etc.)
Beyond IVF Success - Feeling Like a Whole Person
Acupuncture doesn’t just support IVF success—it helps you feel like a whole person during what can be an overwhelming journey. Many of our patients say the best part of their cycle is their time with us -easing side effects, navigating the emotional ups and downs, and having a safe space to simply exhale. Some even share that they wouldn’t have the stamina or focus to get through IVF without this kind of support.
