Discrepancies between clinical evidence and doctor-patient priorities in acupuncture-assisted in vitro fertilization-embryo transfer: a clinical survey

To summarize and evaluate the existing evidence on acupuncture-assisted in vitro fertilization-embryo transfer (IVF-ET), to survey clinicians and patients regarding gaps between the evidence and clinical concerns, and to identify directions for future clinical research.

Randomized controlled trials (RCTs) of acupuncture-assisted IVF-ET were retrieved from CNKI, SinoMed, VIP, WanFang, PubMed, Embase, and Cochrane Library from inception through December 31, 2024. Two researchers independently screened the literature and extracted data. The methodological quality of the included studies was assessed using the Risk of Bias (ROB) 1.0 tool. Questionnaires, developed based on prior research and expert discussions, were distributed to clinicians and patients. Discrepancies between the evidence and clinical priorities were analyzed across the population, intervention, comparison and outcome dimensions.

A total of 143 RCTs with potential risks of bias were included. Questionnaires were completed by 103 clinicians and 108 patients. Comparisons reveal that elderly patients (>35 years old), patients with long-standing infertility (>5 years), and patients undergoing frozen embryo transfer are more focused on by clinicians, but the evidence supporting these concerns is limited. In acupuncture modalities, filiform needles have strong evidence and high recognition；moxibustion and ear acupuncture attract patients’ attention but have limited evidence, while transcutaneous electrical acupoint stimulation shows the opposite pattern. Regarding acupuncture timing and frequency, doctors focus on the pre-oocyte retrieval, the retrieval-to-transfer, and post-embryo transfer periods, with low evidence in some periods. High-evidence scenarios (≥3 pre-oocyte retrieval, 1 post-embryo transfer) receive moderate-to-low doctors’ attention. For control measures, comparisons with Western and Chinese medicine attract doctors’ attention but with limited evidence；blank controls show the opposite trend. In terms of outcomes, live birth rate attracts attention but has limited evidence. Mental health outcomes have little evidence and show substantial disparities between doctor and patient priorities. Complications have weak evidence yet high doctors’ focus. Clinical pregnancy rate aligns more closely with doctor-patient attention.

Future studies should enhance the quality of RCTs, broaden the range of included samples, and perform stratified analyses. High-quality trials are needed to evaluate the efficacy and safety of different interventions, determine the optimal acupuncture timing and frequency, and design clinically relevant control groups. Outcome measures should be expanded, and long-term follow-up should be emphasized to advance acupuncture’s value in assisted reproduction.