Background:

2

Currently

more and more infertility couples are opting for combined acupuncture to improve success rate of

in vitro

fertilization (IVF). However

evidence from acupuncture for improving IVF pregnancy outcomes remains a matter of debate.

Objective:

2

To quantitatively summarized the evidence of the efficacy of acupuncture among women undergoing IVF by means of systematic review and meta-analysis.

Methods:

2

Four English (PubMed

Web of Science

EMBASE

and Cochrane Register of Controlled Clinical Trials) and Four Chinese databases (Wanfang Databases

Chinese National Knowledge Infrastructure

Chinese Science and Technology Periodical Database

and SinoMed) were searched from database inception until July 2

2023. Randomized controlled trials (RCTs) that evaluated the acupuncture's effects for women undergoing IVF were included. The subgroup analysis was conducted with respect to the age of participants

different acupuncture types

type of control

acupuncture timing

geographical origin of the study

whether or not repeated IVF failure

and acupuncture sessions. Sensitivity analyses were predefined to explore the robustness of results. The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR)

and the secondary outcomes were ongoing pregnancy rate and miscarriage rate. Random effects model with

I

2

statistics were used to quantify heterogeneity. Publication bias was estimated by funnel plots and Egger's tests.

Results:

2

A total of 58 eligible RCTs representing 10

968 women undergoing IVF for pregnant success were identified. Pooled CPR and LBR showed a significant difference between acupuncture and control groups [69 comparisons

relative risk (RR) 1.19

95% confidence intervals (CI) 1.12 to 1.25

I

2

=0]

extremely low evidence; 23 comparisons

RR 1.11

95%CI 1.02 to 1.21

I

2

=14.6

low evidence

respectively). Only transcutaneous electrical acupoint stimulation showed a positive effect on both CPR (16 comparisons

RR 1.17

95%CI 1.06 to 1.29;

I

2

=0

moderate evidence) and LBR (9 comparisons

RR 1.20

95%CI 1.04 to 1.37;

I

2

=8.5

extremely low evidence). Heterogeneity across studies was found and no studies were graded as high-quality evidence.

Conclusion:

2

Results showed that the convincing evidence levels on the associations between acupuncture and IVF pregnant outcomes were relatively low

and the varied methodological design and heterogeneity might influence the findings. (Registration No. PROSPERO CRD42021232430)