Clinical evidence of acupuncture for infertile women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis

Background Diminished ovarian reserve (DOR) is a major cause of infertility and remains a core challenge in reproductive medicine. Although previous studies have suggested that acupuncture may improve reproductive outcomes in infertile women with DOR undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), findings remain inconsistent. This meta-analysis therefore aimed to synthesize evidence from randomized controlled trials (RCTs) to evaluate the efficacy of acupuncture in these women undergoing IVF/ICSI. Methods Eight databases were systematically searched for eligible RCTs up to February 28, 2026. The findings were presented in forest plots, with one primary outcome and ten secondary outcomes. Sensitivity analyses were carried out to assess the robustness of the pooled estimates. Subgroup analyses were conducted to explore whether the efficacy of acupuncture on the primary outcome was associated with the type of acupuncture or the number of acupoints adopted per treatment. Evidence grading was performed using the GRADEpro GDT. Results 11 RCTs involving 885 infertile women with DOR undergoing IVF/ICSI were finally included in the meta-analysis. The pooled evidence showed that acupuncture remarkably increased clinical pregnancy rate by 25% (risk difference RD = 0.25, 95% CI: 0.18 to 0.32; p 0.00001), live birth rate by 22% (RD = 0.22, 95% CI: 0.05 to 0.40; p = 0.01), and embryo implantation rate by 30% (RD = 0.30, 95% CI: 0.20 to 0.41; p 0.00001). In addition, acupuncture effectively improved the number of oocytes retrieved (MD = 1.72, 95% CI: 1.03 to 2.41; p 0.00001), the number of optimal embryos (MD = 1.50, 95% CI: 1.42 to 1.58; p 0.00001), and E 2 on the day of hCG trigger (MD = 318.48, 95% CI: 137.16 to 499.80; p = 0.0006). Subgroup analysis further substantiated the value of acupuncture in improving clinical pregnancy rate. Sensitivity analyses confirmed the robustness of the pooled estimates. Evidence certainty for all assessed outcomes ranged from very low to moderate. Conclusions Based on this pooled clinical evidence, acupuncture may be a beneficial intervention for improving clinical outcomes in women with DOR undergoing IVF/ICSI, although confirmation by future rigorously designed RCTs is warranted. Systematic Review Registration https://www.crd.york.ac.uk , identifier CRD420261330054.