Acupuncture Points used in IVF Clinical Trials
April 20, 2013
Note: Acupuncture protocols used in clinical studies are generally simplified, short, and standardized procedures, because the protocols are developed not only with consideration of its potential efficacy but also by considering its experimental design, budgets, time constraint, and other methodological factors. They are compromised acupuncture protocols, and often far from those commonly used in clinical practice.
Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.
Fertility and sterility 2002; 77(4): 721-4.
One hundred sixty patients who were undergoing IVF and who had good quality embryos were randomly divided into the following two groups: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).
Each patient in the experimental group received an acupuncture treatment 25 minutes before and after embryo transfer. The needles were left in position for 25 minutes and then removed.
Before embryo transfer, the following Acupoints were used:
PC6 (Neiguan), SP8 (Diji), LR3 (Taichong), GV20 (Baihui), and ST29 (Guilai).
After embryo transfer, the following Acupoints were used:
ST36 (Zusanli), SP6 (Sanyinjiao), SP10 (Xuehai), and LI4 (Hegu).
Auricular acupuncture at the following points, without rotation: ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi), and ear point 34 (Naodian). Two needles were inserted in the right ear, the other two needles in the left ear. The four needles remained in the ears for 25 minutes. The side of the auricular acupuncture was changed after embryo transfer. The locations of acupuncture points used in this study are shown in Figures 1 and Figure 2.
Their results showed that clinical pregnancies were documented in 34 out of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.
Since this preliminary study, a number of studies e.g. 2-7 have attempted to replicate their findings using the same or similar acupuncture around embryo transfer protocols (German Acupuncture Protocol), however, the results were equivocal. A systematic review published in 2008,8 reported a non-significant impact of German acupuncture protocol, based on the meta-analysis of 8 trials on acupuncture during IVF. An updated meta-analysis of 9 trials by the same research group further confirmed their original finding.9 (about Systematic Review and Meta-Analysis)
Despite the less than impressive follow-up data since the highly publicized initial study by Paulus, et al.,1 the German protocol has been widely used among acupuncturists. In fact, it quickly became a “gold standard” acupuncture protocol during IVF cycle.
In my view however, the German acupuncture protocol is a typical example of the standardized, compromised acupuncture used in many acupuncture trials, which does not reflect the practice of classical acupuncture and traditional Chinese medicine.
Update November 2018: A systematic review study on the German acupuncture protocol has been published in October 2018.  Based on the results of meta-analysis of previous clinical trials using the German method, the authors do not recommend using this protocol with IVF procedure as this particular acupuncture protocol might negatively impact the pregnancy rate.
 Schwarze JE et al.: Does acupuncture the day of embryo transfer affect the clinical pregnancy rate? Systematic review and meta-analysis. JBRA Assist Reprod. 2018 Nov 1;22(4):363-368
Figure 1: German Acupuncture Protocol Points before Embryo Transfer
Figure 2: German Acupuncture Protocol Points after Embryo Transfer
1. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and sterility 2002; 77(4): 721-4.
2. Dieterle S, Ying G, Hatzmann W, Neuer A. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertility and sterility 2006; 85(5): 1347-51.
3. Domar AD, Meshay I, Kelliher J, Alper M, Powers RD. The impact of acupuncture on in vitro fertilization outcome. Fertility and sterility 2009; 91(3): 723-6.
4. Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertility and sterility 2006; 85(5): 1352-8.
5. Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertility and sterility 2006; 85(5): 1341-6.
6. So EW, Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC. A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Human reproduction (Oxford, England) 2009; 24(2): 341-8.
7. Craig L CA, Hansen K, Marshall L, Soules M. Acupuncture lowers pregnancy rates when performed before and after embryo transfer. Fertility and sterility 2007; 88(Suppl 1): S40.
8. El-Toukhy T, Sunkara SK, Khairy M, Dyer R, Khalaf Y, Coomarasamy A. A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG : an international journal of obstetrics and gynaecology 2008; 115(10): 1203-13.
9. Sunkara SK, Coomarasamy A, Khalaf Y, El-Toukhy T. Acupuncture and in vitro fertilization: updated meta-analysis. Human reproduction 2009; 24(8): 2047-8.
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Related Article: Infertility and Acupuncture FAQ: Acupuncture and Assisted Reproductive Technologies
I will be undergoing IVF. When should I start acupuncture and how often should I receive treatment?
My IVF cycle has already started. Is it too late to start acupuncture?
What happens after the embryo transfer? Shall I continue acupuncture?