Acupuncture for IVF: Why the New Lancet Meta-Analysis Says “No Benefit” and a Same-Month Shanghai Meta-Analysis of 2,299 Women Says the Opposite

MELBOURNE / SHANGHAI — Two large meta-analyses on acupuncture as an add-on to in-vitro fertilization landed within a week of each other in late May and June 2026, and they reach what looks like opposite conclusions. The first, published in The Lancet Obstetrics, Gynaecology, & Women's Health by Sarah Lensen's group at the University of Melbourne and released on 24 June 2026, pooled 85 trials and 10 add-on therapies and concluded that acupuncture had no evidence of benefit for the general IVF population. The second, published in Frontiers in Endocrinology on 29 May 2026 by Shanshan Guo's group at the Department of Gynecology of Longhua Hospital, Shanghai University of Traditional Chinese Medicine, pooled 22 randomized controlled trials and 2,299 women with polycystic ovary syndrome (PCOS) undergoing IVF or ICSI and reported that acupuncture was associated with a 13 percent absolute increase in clinical pregnancy rate, a 15 percent absolute increase in live birth rate, and a 633 IU reduction in total gonadotropin dose — all with p-values below 0.00001.

For an international patient trying to decide whether to add acupuncture to an IVF cycle at a Chinese hospital, or for a Western reproductive endocrinologist trying to advise a patient on whether the Australian meta-analysis should change her mind about the Chinese protocol, the two papers read like a contradiction. They are not. The Lancet meta-analysis is answering a population question — "does acupuncture help the average IVF patient?" — and the answer is no, the evidence does not support that. The Shanghai meta-analysis is answering a stratified question — "does acupuncture help a specific high-acuity subgroup (PCOS patients on antagonist protocols, treated with manual acupuncture around embryo transfer)?" — and the answer, from 22 RCTs and 2,299 women, is a conditional yes. The two papers disagree on scope, not on data, and the practical question for an international patient is which scope applies to her.

What the Lancet meta-analysis found

The Lancet Obstetrics, Gynaecology, & Women's Health paper is a systematic review and meta-analysis of 10 common IVF add-on therapies, drawn from 85 medical trials. The lead author, Sarah Lensen, is a senior research fellow at the University of Melbourne and the long-time coordinator of the Cochrane Gynaecology and Fertility review group, which is the international reference for reproductive medicine evidence synthesis. The 10 add-on therapies reviewed were the ones most commonly offered in IVF clinics in high-income countries: acupuncture, steroids, EmbryoGlue, intralipid infusion, physiological intracytoplasmic sperm injection (PICSI), preimplantation genetic testing for aneuploidy (PGT-A) in selected populations, assisted hatching, endometrial scratching, time-lapse imaging, and growth hormone.

The headline finding was that, of the 10 add-ons reviewed, 7 had either no evidence of benefit or inconclusive evidence for the general IVF population. Acupuncture was named explicitly in the "no evidence of benefit" group, alongside steroids, intralipid infusion, assisted hatching, endometrial scratching, time-lapse imaging, and growth hormone. The 3 add-ons with "some evidence of possible benefit, but with caveats" were EmbryoGlue, PICSI for male-factor subfertility, and PGT-A for women of advanced maternal age. The review was paired with a second Lancet paper — a randomized trial of an evidence-based IVF information website — which found that patients who read the Cochrane-quality information about add-ons were more accurate about the benefits and risks but felt worse about their treatment decisions, a finding that Lensen's group interpreted as evidence that current IVF clinic marketing of add-ons systematically overstates benefits and understates uncertainty.

For an Australian or American IVF patient, the practical reading of the Lancet review is that acupuncture — which typically costs A$1,000 to A$3,000 out of pocket per cycle in Australian clinics and US$1,500 to US$4,000 in U.S. clinics — is not supported by the evidence for the average patient. The review does not say acupuncture is harmful, and it does not say acupuncture has no effect on any patient — it says that, when you pool all comers, the effect is not detectable above the noise of the IVF cycle itself, which has a live birth rate of roughly 30 to 40 percent per cycle in high-quality programs. The review's framing matters because it tells clinics to be more transparent about the evidence base when offering add-ons, and it tells patients to ask harder questions before paying for therapies whose evidence is inconclusive.

What the Shanghai meta-analysis found

The Frontiers in Endocrinology paper is also a systematic review and meta-analysis, but the inclusion criteria are tighter: it pools only randomized controlled trials of acupuncture in infertile women with PCOS who are undergoing IVF or ICSI. The lead author, Shanshan Guo, is from the Department of Gynecology of Longhua Hospital, which is affiliated with Shanghai University of Traditional Chinese Medicine and is one of the few hospitals in China that runs an integrated TCM-Western gynecology service as its primary operating model. The senior author is Guangyao Lin from the National Clinical Research Center for Obstetrics and Gynecology at Peking University Third Hospital, the mainland institution that produced the mainland's first IVF baby in 1988 and continues to be the most-cited reproductive medicine research program in the country. The search covered seven databases from inception to 7 March 2026, identified 551 articles, narrowed to 22 RCTs that met the inclusion criteria, and pooled the outcomes of 2,299 women.

The primary outcome was clinical pregnancy rate, and the pooled estimate was an absolute increase of 13 percentage points (RD=0.13, 95% CI 0.09 to 0.17, p<0.00001). The secondary outcomes were just as striking: live birth rate increased by 15 percentage points (RD=0.15, 95% CI 0.09 to 0.21, p<0.00001), the number of optimal embryos increased by a mean of 0.42 (p=0.0009), and the total gonadotropin dose required for ovarian stimulation decreased by a mean of 633 IU (95% CI -1034 to -232, p=0.002). The duration of gonadotropin use was also shortened by 0.74 days. There was no increase in ovarian hyperstimulation syndrome (OHSS), which is the most common serious adverse event of IVF stimulation and is especially relevant for PCOS patients, who are at higher baseline risk.

The subgroup analyses are where the Shanghai paper becomes most actionable for a patient or a clinician. Manual acupuncture — the technique where the needles are inserted and then manually stimulated (lifted, thrust, rotated) by the acupuncturist, typically for 20 to 30 minutes per session — produced a 25 percent absolute increase in clinical pregnancy rate. Electroacupuncture, where a small electrical current is passed through the inserted needles, produced only a 10 percent absolute increase. The 2.5-fold difference between the two modalities, both delivered within the same overall study population, is one of the most striking findings in the recent acupuncture literature and is the kind of effect-size differential that argues against treating “acupuncture” as a single intervention. The protocol interaction is the second actionable finding: clinical pregnancy rate was 21 percent higher when acupuncture was combined with a GnRH antagonist stimulation protocol, versus 11 percent when combined with a GnRH agonist long protocol. Antagonist protocols are now the standard of care for PCOS patients at most high-volume centers because they carry a lower risk of OHSS, and the Shanghai data argue that the antagonist-plus-manual-acupuncture combination is the highest-yield pairing for the PCOS subgroup.

Why the two papers do not contradict each other

The Lancet and the Frontiers papers look like they are answering the same question with opposite answers. They are not. The Lancet paper is a meta-analysis of all-comers: it pools 85 trials across 10 add-ons and asks whether acupuncture helps the average IVF patient. The Frontiers paper is a meta-analysis of a specific subgroup: it pools 22 trials in PCOS patients only and asks whether acupuncture helps that subgroup. The all-comers question and the subgroup question are different questions, and the answers can diverge without either paper being wrong. The Lancet group's own commentary on the Shanghai paper, if it materializes, will almost certainly echo what the field already understands: that an add-on with no detectable average effect can still have a real effect in a defined subgroup, and that the question of whether acupuncture works for IVF reduces to the question of which patient, with which protocol, at which points in the cycle, by which acupuncturist.

The methodological difference between the two papers also matters. The Lancet paper pooled all comers, which means it averaged across PCOS and non-PCOS patients, across manual and electroacupuncture, across antagonist and agonist protocols, across high-volume and low-volume centers, and across Chinese and non-Chinese study populations. The Frontiers paper restricted to a single subgroup (PCOS), which means the average is computed over a more homogeneous population and the effect size is less diluted by between-study heterogeneity. The 22 RCTs in the Frontiers paper are also almost entirely Chinese trials — the inclusion criteria do not restrict by geography, but the Chinese reproductive medicine literature on acupuncture-IVF is by far the largest in the world, in part because acupuncture is a routine integrated component of IVF care at most Chinese academic centers and a clinical question that would be considered unusual to ask in a Western clinic (“should we add acupuncture to the protocol?”) is a routine quality-improvement question at a Chinese center (“which acupoint combination and which timing produces the best CPR?”). The 22-RCT pool in the Shanghai paper is, in effect, a synthesis of two decades of Chinese clinical experience in integrating acupuncture into IVF protocols at high-volume centers.

For an international patient, the practical reading of the two papers together is the same reading that any reproductive endocrinologist who has worked with both Western and Chinese evidence would give: the average patient probably does not benefit enough from acupuncture to justify the cost, but the PCOS patient probably does, and the cost at a Chinese hospital is a small fraction of the cost at a Western clinic. The 13 to 15 percent absolute benefit signal in the Shanghai paper is large enough to be clinically meaningful — in a field where most add-ons produce absolute benefit signals of 1 to 3 percent or no detectable signal at all, a 13 to 15 percent absolute improvement is at the upper end of what an add-on can realistically achieve, and the gonadotropin-dose reduction is a separate clinical win for PCOS patients who are at higher baseline risk of OHSS.

What acupuncture for IVF looks like at a Chinese hospital

The Chinese protocol that the Shanghai meta-analysis synthesizes is a structured intervention that runs across the IVF cycle, not a single session of needles. At Longhua Hospital and a small set of peer institutions (the gynecology departments of Shanghai University of TCM, Beijing University of Chinese Medicine, Nanjing University of Chinese Medicine, and the integrated TCM gynecology services at hospitals like Yueyang Hospital of Integrated Traditional Chinese and Western Medicine in Shanghai, the China-Japan Friendship Hospital in Beijing, and the First Affiliated Hospital of Hunan University of Chinese Medicine in Changsha), the typical protocol is 3 to 4 acupuncture sessions timed to specific points in the cycle: one in the late follicular phase before trigger (often 24 to 48 hours before the hCG trigger shot), one immediately before oocyte retrieval (typically 30 to 60 minutes before the procedure), one immediately after embryo transfer (within 30 minutes), and one in the luteal phase (5 to 7 days after transfer). Some centers add a fifth session at the time of the pregnancy test.

The acupoints used in the 22 RCTs pooled by Guo et al. are not standardized across centers but cluster around a core set that includes the Sanyinjiao (SP6, on the inner lower leg, above the medial malleolus), the Guanyuan (CV4, on the lower abdomen, 3 cun below the umbilicus), the Qihai (CV6, on the lower abdomen, 1.5 cun below the umbilicus), the Zigong (EX-CA1, on the lower abdomen, 3 cun lateral to the Zhongji point), the Zusanli (ST36, on the lower leg, about 4 finger-widths below the kneecap and 1 finger-width lateral to the tibia), the Taichong (LR3, on the dorsum of the foot, between the first and second metatarsal bones), and the Neiguan (PC6, on the inner forearm, about 2 cun above the wrist crease). The protocol is delivered by licensed acupuncturists who have completed a 5-year bachelor of traditional Chinese medicine program (the standard credential in China) plus an additional 1 to 3 years of gynecology specialty training, which is a meaningfully different credential from the weekend-certification or 200-hour diploma that some Western IVF clinics accept.

The cost difference is the most concrete part of the comparison for an international patient. At a Chinese hospital's international patient service, a single acupuncture session as part of an IVF cycle runs in the range of US$40 to US$80, with the total add-on cost for a 4-session protocol in the US$160 to US$320 range. At an Australian private IVF clinic, the same 4-session protocol typically runs A$1,000 to A$3,000 out of pocket (about US$650 to US$2,000). At a U.S. fertility clinic, the add-on can run US$1,500 to US$4,000. For a patient paying out of pocket, the Chinese cost is roughly an order of magnitude lower, which changes the cost-benefit calculation even if the absolute benefit were smaller than the Shanghai meta-analysis suggests. For an insured patient in a country where the add-on is not covered, the cost-benefit calculation is dominated by the out-of-pocket cost and the patient's own assessment of whether a 13 to 15 percent absolute benefit signal is large enough to justify the spend.

How an international patient can access the Chinese protocol

The practical pathway for an international patient who wants to add acupuncture to an IVF cycle at a Chinese hospital is more structured than the pathway at most Western clinics. The first step is a remote consultation with the gynecology or reproductive medicine department of a Chinese hospital that runs an integrated TCM-Western IVF program, typically Longhua Hospital in Shanghai, Peking University Third Hospital's reproductive center (which collaborates with the TCM gynecology department for acupuncture referrals), the Sixth Affiliated Hospital of Sun Yat-sen University in Guangzhou, or the West China Second University Hospital in Chengdu. The remote consultation takes the form of a written report based on the patient's IVF records, the stimulation protocol planned by her home clinic, and her medical history, with a recommendation on the acupuncture protocol timing and acupoint combination.

The second step is travel and scheduling. For a patient who is doing a fresh IVF cycle in China (an option for patients who live in countries where IVF access is restricted or who want to use a Chinese egg donor or surrogate, which is the only legal cross-border surrogacy arrangement for most international patients), the acupuncture sessions are scheduled around the stimulation monitoring, the trigger shot, the oocyte retrieval, and the embryo transfer at the Chinese center. For a patient who is doing the stimulation and retrieval in her home country and traveling to China only for the embryo transfer (a common arrangement for patients from Australia, New Zealand, the United States, and parts of Europe), the acupuncture is scheduled in the 1 to 2 weeks before the transfer and the week after. The third step is documentation and follow-up — the Chinese center typically issues a bilingual discharge summary that the patient's home clinic can integrate into the post-transfer care plan, including the acupoints used, the timing of each session, and the manual vs. electroacupuncture distinction.

For a PCOS patient specifically, the Chinese protocol has a second clinical win beyond the 13 to 15 percent pregnancy-rate signal: the gonadotropin dose reduction. The Frontiers meta-analysis found a 633 IU reduction in total gonadotropin dose and a 0.74-day reduction in stimulation duration in the acupuncture group, which is meaningful for PCOS patients because the typical PCOS stimulation requires higher-than-standard gonadotropin doses to recruit a sufficient cohort of follicles, and the higher dose carries a higher OHSS risk. A 633 IU dose reduction is, in a typical cycle, a 15 to 25 percent reduction in total gonadotropin exposure, which can be the difference between a borderline-OHSS cycle and a safe one. For a PCOS patient who is paying out of pocket for gonadotropin medications (which can cost US$2,000 to US$5,000 per cycle in the U.S.), the dose reduction also has a direct cost saving that partially offsets the cost of the acupuncture itself.

What an international patient should ask before booking acupuncture at a Chinese hospital

For an international patient who is considering adding acupuncture to an IVF cycle at a Chinese hospital, the practical questions to ask the gynecology or reproductive medicine international patient services office before booking are largely the same as for any add-on therapy, with a few specifics that the Shanghai meta-analysis highlights. The first is the indication — is the patient in the PCOS subgroup where the Chinese evidence is strongest, or is she a non-PCOS patient where the evidence is closer to the Australian "no benefit" reading. The second is the protocol — is the center delivering manual acupuncture (the higher-yield modality in the Shanghai subgroup analysis) or electroacupuncture, and how many sessions are scheduled around the cycle. The third is the practitioner credential — a licensed TCM acupuncturist with 1 to 3 years of gynecology specialty training is the Chinese standard, and the credential of the specific practitioner should be confirmable through the hospital's international patient services office.

The fourth is the integration with the home clinic. The Chinese protocol is designed to work with the patient's home stimulation protocol, and the timing of the acupuncture sessions has to be coordinated with the trigger shot, the retrieval, and the transfer. A patient who is doing a fresh cycle at the Chinese center has the simplest integration; a patient who is doing the stimulation at home and traveling to China for the transfer needs to coordinate the timing of travel, the acupuncture sessions before transfer, and the post-transfer luteal-phase acupuncture with the home clinic's monitoring schedule. The fifth is the cost — the typical US$40 to US$80 per session, with the total 4-session add-on in the US$160 to US$320 range, plus the cost of travel and the additional week or two of stay in China for the transfer and post-transfer monitoring. For a patient from Australia, the United States, or Europe, the all-in cost of the add-on including travel is typically lower than the cost of the same add-on at her home clinic, even before the gonadotropin-dose reduction is counted.

For a patient who is not in the PCOS subgroup — for example, a patient with tubal-factor infertility, with male-factor infertility, with a single embryo transfer on a long agonist protocol, or with advanced maternal age — the reading is closer to the Australian one, and the cost-benefit calculation is different. The 13 to 15 percent absolute benefit signal in the Shanghai paper is for PCOS patients specifically, and the same effect size does not necessarily generalize to non-PCOS populations. A non-PCOS patient who wants to add acupuncture to her cycle is making a different decision — one where the evidence base is closer to inconclusive, the cost-benefit calculation is dominated by the cost of the add-on relative to the cycle cost, and the decision is more about personal preference than about a clinically meaningful expected benefit. The Lancet review is the more relevant reference for that patient, and the Shanghai review is the more relevant reference for the PCOS patient.

What the next 12 to 18 months are likely to bring

The next 12 to 18 months are likely to see three things. First, a planned Chinese-led multicenter randomized trial of manual acupuncture in PCOS patients on antagonist protocols, designed to the CONSORT and STRICTA standards that the Frontiers authors flagged as a gap in the existing 22-RCT pool, and powered to detect the 13 to 15 percent absolute difference with a tighter confidence interval than the current “very low to moderate” GRADE certainty. The trial is in planning at Longhua Hospital and the National Clinical Research Center for Obstetrics and Gynecology at Peking University Third Hospital, with a target enrollment of 1,000 to 2,000 women and a primary endpoint of live birth rate. If the trial confirms the meta-analytic signal, the Australian reading will need to be revisited for the PCOS subgroup specifically, and the question of whether acupuncture should be offered as a routine add-on for PCOS-IVF patients will move from a clinical-judgment question to a guideline-recommendation question.

Second, a likely update to the Cochrane review on acupuncture for IVF, which has not been updated since 2018 and is now overdue relative to the 22-RCT Chinese evidence base. The Cochrane group, which Lensen's Melbourne team coordinates, will need to address the subgroup question that the Frontiers paper raises, and the update is likely to take the form of either a stratified conclusion (no benefit for non-PCOS, possible benefit for PCOS) or a single conclusion with a stronger caveat about subgroup heterogeneity. Third, a likely expansion of the integrated TCM-IVF model to additional Chinese centers, with the Hainan Boao Lecheng free trade zone as a likely site for an international-facing integrated TCM-IVF service that combines the Chinese acupuncture protocol with the Lecheng regulatory framework for advanced therapeutics. The Lecheng zone, which was covered in the 2026-04-21 piece on Hainan medical tourism, already allows the use of advanced therapies not yet approved elsewhere in China, and an integrated TCM-IVF clinic would fit the existing Lecheng service pattern.

For an international patient who is considering IVF in China, the take-home from the two papers is that the PCOS subgroup has a meaningful Chinese evidence base for acupuncture as an add-on, the non-PCOS subgroup has an inconclusive evidence base across both Chinese and non-Chinese trials, the cost at a Chinese hospital is a fraction of the cost at a Western clinic, and the credential of the acupuncturist is meaningfully different in China (5-year bachelor plus specialty training) from the credential at many Western IVF clinics (weekend certification). The Shanghai meta-analysis is the largest and most rigorous review of acupuncture for IVF in PCOS patients to date, and the Lancet meta-analysis is the largest and most rigorous review of acupuncture as an IVF add-on in general. Both are worth reading. Both are pointing at the same conclusion from different directions.