The science behind acupuncture for fertility and pregnancy
Reviewed by Lee Hullender Rubin, DAOM, MS, LAc, FABORM,
Written by Talia Shirazi, PhD
last updated: Aug 26, 2021
14 min read
Here's what we'll cover
Here's what we'll cover
This article was updated on August 26, 2021. It has been reviewed by
Acupuncture is considered a form of integrative medicine. It's most commonly used to treat pain, but there are a wide range of conditions that acupuncture can address — including reproductive health and fertility-related conditions. Here, we're diving into the science behind acupuncture for fertility and pregnancy outcomes.
Before we get started, it's important to understand that the science behind acupuncture is not clear-cut: integrative health approaches like acupuncture and herbal medicine are studied less than other practices, though they deserve equal attention. While fertility science is evolving, there are still really big gaps in the research.
That said, even if an aspect of treatment isn't validated by large-scale, randomized trials (one of the things we look for when evaluating the science behind different practices), it can still have great benefits for you as an individual. Ultimately, personal experience can be just as valuable as scientific evidence.
Main takeaways
Acupuncture is a popular form of traditional East Asian Medicine (EAM), which aims to fix problems with energy flow that may be affecting your health. Specific acupuncture points have specific functions with some designated for reproductive health.
While new data emerges every year, there's still nowhere near enough research on fertility-specific acupuncture’s effect on fertility and reproductive health-related conditions. Some studies suggest that acupuncture of any kind (not just fertility-specific acupuncture) may increase live birth rates in patients doing IVF treatment. Others demonstrate that it helps ease fertility-related stress and anxiety. There are no significant short- or long-term negative effects of acupuncture.
Here's what the American Society for Reproductive Medicine has to say: "Acupuncture proponents have recommended it for a variety of medical conditions that affect fertility. These include polycystic ovary syndrome (PCOS), fibroids, endometriosis, and issues with ovarian reserve and sperm quality. It may also help relieve some of the side effects associated with fertility drugs (such as bloating and nausea). Acupuncture has been shown to promote relaxation. While some medical studies have shown acupuncture to be helpful in treating these fertility problems, other studies have not."
Dr. Lee Hullender Rubin, DAOM, MS, LAc, FABORM, is a licensed acupuncturist, herbalist, and clinical researcher that specializes in research on acupuncture and fertility. She says, "Acupuncture is a drug-free treatment that impacts multiple body systems to support menstrual regularity, ovulation, and ultimately, fertility. In essence, acupuncture promotes self-healing and is quite safe when provided by a licensed acupuncturist."
Modern Fertility medical advisor Dr. Temeka Zore, MD, FACOG, a reproductive endocrinologist who specializes in infertility (REI), says she discusses acupuncture with patients who've had lots of stress or anxiety while trying to conceive — as well as those who've had unsuccessful past in-vitro fertilization (IVF) attempts. "The pros of acupuncture are that the individual may feel more relaxed and have a reduction in anxiety and stress levels," she explains. But the "direct benefits will vary on the individual."
OB-GYN Dr. Jenn Conti, MD, MS, MSc, Modern Fertility medical advisor and adjunct clinical assistant professor at Stanford University School of Medicine, takes this approach to acupuncture: "Anything non-harmful that also aids in stress reduction during what can often be a very stressful process is fine by me.
Acupuncture 101
The first mention of acupuncture was in China about 2,000 years ago, though it’s believed people have been using acupuncture techniques as early as about 4,000 years ago. There are several different forms of acupuncture seen across the world today, but here we’ll focus on the type that’s most commonly used in the US: traditional Chinese acupuncture.
According to traditional East Asian Medicine (EAM), we all have an internal energy (called “qi”) that flows throughout our bodies, keeping everything healthy and functioning as normal. Health issues may arise if our internal energy gets blocked and isn’t able to flow properly. This is where acupuncture comes in: Acupuncture needles are placed at specific points in the body, depending on what health issue you’re experiencing, to help unblock that energy and send your body back to its normal healthy state.
Licensed acupuncturist Amanda Moler, LAc, ABORM sees clients for fertility-specific treatment at her San Francisco-based clinic, Anchor Acupuncture & Wellness — where she says 80% of their clients are there for fertility. "Where the practice of Chinese medicine truly shines is in its unique ability to reach beyond these metrics behold our patients as part of nature: Beautiful complex ecosystems of body, mind, and spirit, worthy of reverence," Moler explains. "When I meet my patients from this inclusive, holistic perspective, all kinds of healing can happen — on the way to pregnancy or perhaps even paving the way for new life to take root."
Other explanations about acupuncture’s effects come from biologists and neuroscientists. Once your muscles sense needles being inserted, they send signals to the spinal cord and brain, which then receive these signals and may respond by changing the production and release of certain chemical compounds. For example, muscles may send signals to the brain and spinal cord in response to acupuncture that lead to an increase in endorphin production, which contributes to the pain-relieving effect of acupuncture that many people report.
Before we dive in: Caveats on the research we’ll review
Before getting into what scientific studies suggest on the effect of acupuncture on reproductive health, there are some important caveats to keep in mind when evaluating these studies.
First off, studying treatments that are meant to be very tailored to the individual is hard. According to Dr. Conti, "One central issue is that we don't have the right methods to evaluate its efficacy in Western medicine because, as an Eastern medicine tool, it is designed to be personalized to the individual, which precludes it from the type of rigorous population-based studies that are the standard in Western medicine."
Following this, Dr. Rubin says: "One way we can assess how well acupuncture 'works' is by comparing it to treatments already used for a condition in a comparative effectiveness study. For example, one study out of the UK compared the usual treatment of medication for depression to usual treatment plus acupuncture, or usual treatment plus cognitive behavioral therapy (CBT). In that study, the authors found adding acupuncture or CBT were both superior to the usual treatment of depression. If we could design and implement studies like this, we could better learn if acupuncture was as effective or better than current treatments."
When people work with an acupuncturist, they’ll get a treatment regimen personalized to them. But, in most randomized controlled trials, all people in the treatment arm of the study are supposed to get the exact same treatment. This means we have way more studies on the effect of ovulation-inducing meds like clomiphene citrate (Clomid) or letrozole (Femara) than we do studies of acupuncture on ovulation, for example.
The logistical and financial challenges to implementing a personalized acupuncture protocol in large-scale studies of reproductive outcomes also mean that most of the time, the acupuncture interventions we see in trials aren’t the same as the acupuncture interventions you’d see in the real world.
Some historical perspective: In the early 2000s, a few studies came out (like this and this) asserting that fertility-specific acupuncture done before and after embryo transfer increased pregnancies and live birth rates. Their acupuncture protocols weren’t originally designed to improve outcomes -- they were designed to lessen stress and pain around embryo transfers.
But, because researchers did see a hint of a positive effect of acupuncture on outcomes, many clinics rushed to offer acupuncture to their patients. Scientists who wanted to follow-up on this research used the same acupuncture treatment protocol (a couple of sessions centered around the time of embryo transfer), and these sorts of studies comprise the majority of studies included in the meta-analyses we’ll talk about below.
These days, the acupuncture protocols offered by clinics look considerably different: Rather than all people getting a few acupuncture sessions around the time of embryo transfer, people can start acupuncture treatment earlier in the IVF process, and will often receive considerably more than 3 sessions. This means that the majority of published research on acupuncture and fertility outcomes uses a treatment protocol that doesn’t quite match what you’d receive in the real world. This leaves us with a big blind spot: we have very few studies of the links between acupuncture and fertility that have real-world significance.
Licensed acupuncturists and fertility researchers like Dr. Lee Hullender Rubin, for example, are actively doing work to change that.
"We knew that people who went to acupuncture to support their fertility treatments were getting a different treatment than those in the published trials. Unfortunately, doing an RCT wasn't possible to assess this specific type of acupuncture's impact on birth outcomes," says Dr. Rubin. "I had to start looking at the next best thing -- observational research. I reviewed five years of data from people who added acupuncture to their fertility treatment. We found the additional treatment was associated with a two-fold increase in the chance of having a baby. We could use more research like this to determine if what we found also occurs in other clinics."
Lots of studies in this space compare the effects of acupuncture to something called ‘sham acupuncture.’ Sham acupuncture can take on many forms, but commonly it looks like researchers placing needles in places that aren’t known acupuncture points. In theory, comparing sham acupuncture to real acupuncture should give us an idea of how well real acupuncture can influence reproductive outcomes.
But there’s one small problem: Sham acupuncture might not be as good of a control as we previously thought. Some evidence suggests that sham acupuncture actually does have some of the same downstream physiological effects as acupuncture. For example, in trials for selective serotonin reuptake inhibitors (SSRIs), we’d never choose a placebo control that also impacts serotonin action in the brain in the same way that SSRIs do. Instead, we’d choose one that doesn’t have known physiological effects, so that we could really isolate the effect of a treatment that affects serotonin action. If we chose a placebo control that also impacted serotonin and compared it to the SSRI in the treatment group, we might mistakenly conclude that SSRIs have no effect -- when in reality, if we compared SSRIs to something like a sugar pill, we would see differences and we would conclude that SSRIs work.
As we detail the published findings in this space, we’ll make sure to point out these caveats as necessary. Acupuncture research is evolving as we write, with these caveats increasingly being addressed. Our team is excited to keep tabs on the research here, and we'll always update our content as more clinical info emerges.
Studies on acupuncture and fertility
We dug into existing research to understand the effects of fertility-specific acupuncture for a variety of fertility-related issues and conditions. Below, you'll find our biggest takeaways broken down by topic.
Acupuncture and fertility stress
Fertility and conception can be stressful, whether it’s alone or with a partner, or with or without using medical interventions. A few studies have looked at the impact on acupuncture and stress around the time of ART procedures, generally finding that it can lower stress levels (as compared to no intervention at all).
Similarly, acupuncture (compared to usual care) may also lower levels of fertility-related stress in people diagnosed with infertility. Though there isn’t clear evidence that these reductions in stress directly translate to improved reproductive outcomes, taking care of your mental health is always a good thing.
At Moler's clinic, she sees this benefit firsthand: "In this process, perceptions of stress diminish, anxieties transform into confidence, sleep improves — and fertility naturally is optimized," she explains.
Acupuncture and fertility outcomes
Outcomes in assisted reproductive technology (ART): When it comes to acupuncture and fertility, perhaps the *most* research has been done in the sub-realm of ART outcomes specifically. This is likely because this is where effects of acupuncture were first studied. We have a handful of large controlled clinical trials (like this one) and several systematic reviews and meta-analyses (like this one) which seem to converge on similar conclusions — but more research is still needed.
When compared to usual care (which can mean different things for different clinics), acupuncture may increase pregnancy rates by about 32%, live birth rates by about 30%, and decrease miscarriage rates by about 43%. Put another way, it looks like adding acupuncture to whatever your clinic would normally do for patients may have a positive effect.
There’s also some evidence of a dose-response relationship here, with more acupuncture sessions translating into larger positive effects. This is an important finding because in the real world, it’s common to have numerous sessions with an acupuncturist before positive effects are detected.
The story looks a bit different when we look at comparisons between real and sham acupuncture. Because real and sham acupuncture have some overlap in their physiological effects, it’s perhaps not so surprising that when we compare reproductive outcomes in people who get just a few sessions of real acupuncture to people who get a few sessions of sham acupuncture, there are no differences in live birth rates, implantation rates, clinical pregnancy rates, or any other metric of ART "success" (see here, here, and here for recent meta-analyses).
Because of some of the limitations and caveats we pointed out in the previous section, it’s difficult to make bold, confident claims about the effects of acupuncture on ART outcomes, and what the exact mechanisms of action for what any potential positive effects may be. What we can say more confidently is that there’s no evidence of acupuncture having negative effects.
Outcomes in non-assisted reproduction (aka "natural" conception): There aren’t any published studies on whether acupuncture is beneficial for people attempting to conceive without using medical intervention. Because of this, we can’t say whether time to pregnancy, pregnancy rates, implantation rates, ovulation frequency, live births, or miscarriage rates are affected by acupuncture use in this group.
Acupuncture and reproductive health conditions
Polycystic ovary syndrome (PCOS): Recent reviews and analyses of all the available data on acupuncture’s effect on hormone levels and ovulation on people with PCOS are not very supportive. When comparing PCOS-specific acupuncture to sham acupuncture, there are no differences in live birth or clinical pregnancy rates, nor are there differences in the frequency of ovulation or miscarriages. That being said, there are some smaller studies with acupuncture treatment regimens that do approximate the treatment regimens we’d see in the real world finding positive effects of acupuncture on hormone levels and ovulation in people with PCOS.
There are no studies that directly compare hormone levels, ovulation frequency, or other reproductive outcomes in people with PCOS who get acupuncture vs. those who get other known efficacious treatments (like clomiphene citrate or letrozole), meaning we can’t make comparisons between these two groups.
Uterine fibroids: There are no randomized controlled trials on the effect of acupuncture on uterine fibroids, so be skeptical (but open-minded!) of people who confidently assert such claims.
Endometriosis: There are no large, reliable studies on the effect of acupuncture on endometriosis. But there is some evidence that acupuncture can be helpful in treating endometriosis-related pain, which makes sense with the fact that acupuncture is used primarily for its pain-relieving purposes in the US. Still, most of the currently published studies in the acupuncture-and-endometriosis-pain space have some room for improvement.
Acupuncture and male-factor fertility
Just as acupuncture may have effects on the brain and the body in people with ovaries, there’s research suggesting that it may have similar effects on people with sperm. But when it comes to whether acupuncture affects partner pregnancy rates, sperm quantity, or sperm quality, the jury’s still out. While meta-analyses of studies on the topic suggest that there could be a positive effect, there simply hasn’t been enough research for a clear picture to emerge. The one thing we can say is that these outcomes aren’t negatively impacted by acupuncture, and that the prevalence of any unwanted side effects is super low.
Acupuncture and other fertility factors
Fertility hormones: Some acupuncturists advertise their services as a way to "balance" or "fix" hormones implicated in fertility — and, in general, we have reason to believe that acupuncture-induced signals make their way to the brain and affect areas like the hypothalamus (which is at the top of the control center for the production of many fertility hormones). Dialing up or down the activity of the hypothalamus can therefore affect levels of hormones like FSH and LH, which are crucial for ovulation (which is crucial for conception!).
Direct evidence from large-scale studies of acupuncture affecting reproductive hormones in people is scant, probably in no small part because of the logistical and financial challenges of studying personalized treatments in the context of large-scale studies. But studies of female rats do find that acupuncture affects almost all reproductive hormones. Specifically, one recent study found that acupuncture administered to female rats (we hope they dimmed the lights and played relaxing music for them, as we do for humans!) every three days for a total of 15 days altered almost all reproductive hormones they looked at. TBD on how applicable this is to humans, who are a different species and have different treatment regimens.
Thyroid function: Hormones related to thyroid function may impact fertility outcomes, meaning thyroid function may be an important thing to keep in check for people who are trying to conceive. Some reviews have suggested a beneficial impact of acupuncture on thyroid function. However, most of the original articles cited are not in English (unsurprisingly, most articles on TCM are written in Chinese) or easily downloadable in the US — so we were unable to evaluate these articles at this time.
What's it like to get acupuncture?
If you decide you want to get acupuncture, you might have some questions about what the experience will feel like. Before getting started, an acupuncturist will usually ask you questions about your lifestyle, your reason for wanting to do acupuncture, and your health history. They might also take a look at your tongue for additional clues about your mental and physical state. Based on your concerns and their assessment of your physical state, the acupuncturist will insert needles that are about as thin as a strand of hair in specific areas (also known as “meridians”) believed to aid in the treatment of specific conditions.
Once they’ve put the needles in the right areas, the acupuncturist will typically dim the lights, put on some calming music, and leave the room, usually for about 20-30 minutes. Some people take this time to think and relax, while others fall asleep.
Your treatment plan — how often you have sessions, how long they last, where needles are placed, and how many sessions you have overall — will depend on your specific concerns and how you are changing over time. For example, while some people using acupuncture for back pain need just a few sessions to see improvement, others may need more.
Are there any side effects?
Generally, there shouldn’t be. Some people may report a bit of pinching or pain at the needle insertion sites; if this is something you experience, you should tell your acupuncturist, who will make accommodations to ease that discomfort. Some people also may get small bruises at the insertion sites. Before acupuncturists switched to single-use disposable needles, there was a risk of infection — if needles weren’t cleaned properly between clients, people could get infected with things that clients previous to them had — but this is no longer a significant concern.
You can reduce the likelihood of unwanted side effects by making sure the acupuncturist you choose is trained and licensed. The American Society for Reproductive Medicine (ASRM) recommends finding an acupuncturist that is certified by one of the two main organizations for acupuncturists in the US (this and this). For people who feel more comfortable having an acupuncturist with training in both Western medicine and acupuncture, you can check out this list.
Does insurance cover acupuncture?
The answer is a giant “it depends.” Some insurers only cover acupuncture for specific conditions, some only cover it after first-line treatments haven’t worked, some only cover it for up to a certain number of sessions, and some won’t cover it at all, for any reason. It’s likely we see these differences in coverage among insurers because for many cases, there just isn’t enough data to firmly support the use of acupuncture as an effective, first-line treatment. (Of course, that doesn’t mean acupuncture doesn’t work, but rather that if it does, we just need more evidence for it.)
However, according to Dr. Zore, "Most acupuncturists will work with your finances and schedule to try to make acupuncture accessible."
Here’s what our community members say
Since everyone's experience with fertility-specific acupuncture is unique, we talked to four Modern Community members to find out what it was like for them.
Kat, 30, tried fertility acupuncture in what she calls a "kitchen sink" approach to conceiving. "I find acupuncture very relaxing, and it was always a really nice opportunity to take time for myself and take care of my physical and emotional well-being," she explains. At first, the acupuncture didn't seem particularly effective for Kat — but she left the second appointment feeling like it was helping her physically and emotionally: "My uterine lining did thicken enough to transfer and sustain my current pregnancy and it really helped with relaxing in the lead up to my [frozen embryo] transfer." She's since stopped because the process felt a little uncomfortable while pregnant. That said, Kat would recommend it to "everyone who has something specific [to treat] in mind."
After not getting a period for five months, Ashley, 33, decided to try acupuncture based on a recommendation from a fellow community member. For Ashley, acupuncture caused anxiety around what it might do to her body, and it hurt a little: "Most people say the needles don't hurt, but for me, I do feel pain when the needles get to a certain depth," she explains. Ashley isn't sure the treatment is doing anything for her menstrual cycle. While she did get her period three days after the first appointment, it's now been 74 days since her last one. "I am currently about to freeze my eggs, and it has been very stressful trying to decide if I should continue to see if I get a natural cycle or just move forward with taking Provera to induce a bleed so that I can continue with the egg freezing process," Ashley says. Still, she recommends acupuncture — as long as there's an understanding that it may or may not work.
For Jenn, who's 40, acupuncture felt like a good option after trying to get pregnant for six months. She loves it: "I feel calmer, less stressed, less irritable, and have fewer PMS symptoms since starting — which was about a month ago," she says. "My digestion is better, aches, pains and inflammation are lessening, and I feel an overall boost in health. My period cycles are also improving, length and blood quality." Jenn "100% recommend[s]" acupuncture for anyone who's trying to conceive.
Ashlee, who's currently pregnant, is 27. She and her husband are both in the military and found that trying to conceive with limited time availability was stressful. A friend recommended acupuncture, which Ashlee already had experience with: "I had done acupuncture before to help with aches and pains, and it had also helped me relax. So I thought, if nothing else, it would help me relax and bring joy to the process of trying." Ashlee had a consultation before starting treatment, and the acupuncturist kept tabs on how she was feeling throughout. "I sent my Modern Fertility results in, and went over my health history, worries, concerns, and hopes," she says. In the end, Ashlee "felt that it was very effective with my nerves. It helped me relax and brought a little bit of me time back to the process." She would definitely recommend it to others.
The bottom line
Acupuncture is increasingly being sought after in the US to treat a wide range of conditions, including conditions related to fertility.
Because there haven’t been enough rigorous studies of acupuncture’s effect on fertility-related outcomes and reproductive health with treatment regimens that mirror what we’d expect to see in the real world, we don't have the data to fully confirm its benefits.
What we can say is that there’s emerging data suggesting there may be benefits, and there's no evidence that acupuncture has negative impacts. And, even if acupuncture does not directly affect reproductive function, it could be key to helping some people with the stress and anxiety that can surround fertility.
If you’re curious to try it out, you can use this or this directory to find a certified practitioner near you.
DISCLAIMER
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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