Introduction

Infertility is an important public health issue and approximately from 9% to 18% of couples worldwide suffering from infertility (1-3). For achieving pregnancy, in vitro fertilization (IVF) has become a widespread treatment option. Despite many recent technological advances, the average success rate of IVF was only 36% reported by the Centers for Disease Control and Prevention of USA at 2016 (4). Acupuncture has been used as an attractive and most frequently adjuvant therapy based on its low side-effects and convenience (5). A study conducted in USA showed that 22% couples had used acupuncture (6). However, evidence from acupuncture in improving IVF birth outcomes still remains a matter of debate.
Since the first randomized clinical trial (RCT) was published in 1999 (7), nearly 50 RCTs have emerged to explore acupuncture’s impact on IVF outcomes. However, the conclusions in inconclusive. Even if many systematic reviews and meta-analyses still revealed both positive effects (8-15) and negative benefits of acupuncture assisting IVF success (16-24). Different searching databases and literature selection criteria may partly contribute to the unconfirmed results. For example, some analyses (11, 14, 16, 17) just included English language literature. Several analyses did not cover all the acupuncture types or control (12, 14, 22). In addition, most of meta-analyses considered clinical pregnancy rate (CPR) as a primary outcome and neglected the live birth rate (LBR). LBR was an accepted primary outcome in IVF trials (25, 26) and its related results need to be further updated. The conflicted results might be not due to the ineffectiveness of acupuncture but rather to the methodological flaws confound acupuncture IVF RCTs. Therefore, taken together with the continuously added new evidence, this study aimed to evaluate the impact of acupuncture on IVF outcomes for both CPR and LBR based on RCTs by conducting a comprehensive literature covered English and Chinese involving all common acupuncture methods.