Acupuncture for Fertility and Reproductive Health

The Reproductive Axis Through Two Lenses

Reproduction is the body’s most complex coordination task — requiring the precise interplay of the hypothalamus, pituitary, ovaries (or testes), thyroid, adrenals, immune system, and uterine environment. When any node in this network fails, fertility suffers. Western reproductive medicine excels at identifying and correcting specific failures — blocked tubes, anovulation, low sperm count — but often struggles with the cases where “everything looks normal” and conception still does not occur. These are the cases of unexplained infertility, and they account for 15-30% of infertile couples.

Chinese medicine has treated fertility for over two thousand years, with classical texts (the Huang Di Nei Jing, circa 200 BCE) dedicating extensive sections to menstrual regulation, conception, pregnancy, and postpartum recovery. The TCM approach to fertility is not focused on isolated hormones or single organs — it addresses the entire reproductive ecology: the quality of Qi and Blood, the regularity of the menstrual cycle as a reflection of organ harmony, the warmth and receptivity of the uterus, and the constitutional reserves (Kidney Essence) that underlie reproductive capacity.

Modern research has increasingly validated this approach, with acupuncture now offered as a complementary treatment in many IVF clinics worldwide.

The Landmark Studies

Paulus et al. 2002 — The Study That Changed Everything

Paulus, Zhang, Strehler, El-Danasouri, and Sterzik (2002, Fertility and Sterility) published the first randomized controlled trial examining acupuncture as an adjunct to IVF embryo transfer. 160 patients undergoing IVF were randomized to receive either acupuncture (25 minutes before and 25 minutes after embryo transfer) or no acupuncture.

Results:

• Acupuncture group: 42.5% clinical pregnancy rate
• Control group: 26.3% clinical pregnancy rate
• Absolute difference: 16.2 percentage points — a relative increase of 62%

The protocol used specific points selected for their effects on uterine blood flow and relaxation:

• Pre-transfer: PC-6, SP-8 (Diji), LR-3, GV-20, ST-29 (Guilai) — to calm the patient, relax the uterus, and increase pelvic blood flow
• Post-transfer: ST-36, SP-6, SP-10 (Xuehai), LI-4, ear Shenmen — to support implantation, nourish Blood, and maintain uterine receptivity

This study was paradigm-shifting — it brought acupuncture into the mainstream fertility conversation and spawned dozens of subsequent trials.

Manheimer et al. 2008 — The BMJ Meta-Analysis

Manheimer, Zhang, Udoff, Haramati, Langenberg, Berman, and Bouter (2008, British Medical Journal) conducted a systematic review and meta-analysis of acupuncture as an adjunct to IVF, pooling data from 7 trials with 1,366 women. They found:

• Pooled odds ratio for clinical pregnancy: 1.65 (95% CI: 1.27-2.14) — a 65% increase in the odds of pregnancy with acupuncture
• The effect was statistically significant and clinically meaningful
• Subgroup analysis suggested the benefit was greatest when acupuncture was performed on the day of embryo transfer (consistent with the Paulus protocol)

Subsequent Research and Debate

The field has evolved since these landmark studies. Not all subsequent trials have replicated the dramatic effects of Paulus 2002. Some high-quality studies (Smith et al., 2018, JAMA) found no significant benefit of acupuncture applied only at the time of embryo transfer. However, these studies have been critiqued for:

1. Sham acupuncture as comparator: Many “negative” trials compared real acupuncture to sham acupuncture (needling at non-classical points). But sham acupuncture is not physiologically inert — it still activates afferent nerves, releases adenosine, and modulates autonomic function. The difference between real and sham may be smaller than the difference between either and no treatment.

2. Insufficient treatment course: The Paulus protocol (two sessions on transfer day only) may be insufficient. TCM traditionally treats fertility over months, not sessions. Trials that used extended protocols — starting acupuncture weeks before IVF — have generally shown more positive results.

3. Lack of individualization: TCM treatment is pattern-based. A standardized protocol applied to all patients ignores the foundational principle of individualized diagnosis. A patient with Kidney Yang Deficiency needs warming, tonifying treatment; a patient with Liver Qi Stagnation needs soothing, moving treatment. Applying the same points to both dilutes the signal.

Zheng et al. (2012, Acupuncture in Medicine) conducted a systematic review noting that individualized acupuncture protocols showed stronger effects than standardized protocols — supporting the TCM principle of pattern differentiation.

TCM Patterns in Female Infertility

Kidney Yang Deficiency (Most Common in Secondary Infertility and Advanced Maternal Age)

Presentation: Low basal body temperature (BBT), especially in the luteal phase (failure to sustain a temperature rise after ovulation). Cold lower abdomen and feet. Low libido. Fatigue. Frequent clear urination. History of recurrent miscarriage (insufficient “warmth” to hold the pregnancy). Long menstrual cycles (>35 days). Scanty pale menstrual blood. Low back ache. Pale, swollen, wet tongue. Deep, slow, weak pulse.

FM Correlation: Low progesterone (luteal phase deficiency), hypothyroidism (low FT3), HPA Stage 3 (low cortisol, low DHEA), low vitamin D (immunomodulatory and reproductive hormone precursor).

Treatment:

• Points: KI-3 (Taixi), KI-7 (Fuliu), GV-4 (Mingmen), BL-23 (Shenshu), CV-4 (Guanyuan), ST-36 (Zusanli), SP-6 (Sanyinjiao)
• Moxa: Essential. Direct moxa on GV-4, CV-4, and ST-36. Moxa warms the Kidney Yang and the uterus (“warm the palace” — Nuan Gong).
• Herbal: You Gui Wan (Restore the Right Kidney Pill) — the classical formula for Kidney Yang Deficiency. Contains Shu Di Huang, Shan Yao, Shan Zhu Yu, Gou Qi Zi, Tu Si Zi, Lu Jiao Jiao, Du Zhong, Rou Gui, Zhi Fu Zi, Dang Gui.
• FM Support: Progesterone (bioidentical, luteal phase), thyroid optimization (FT3 optimal), vitamin D (50-80 ng/mL), CoQ10 (600mg — for mitochondrial support in oocyte maturation; Bentov et al., 2014, Fertility and Sterility)

Kidney Yin Deficiency (Common in Perimenopause, Premature Ovarian Insufficiency)

Presentation: Short menstrual cycle (<25 days), scanty menstrual blood (dark red), night sweats, hot flashes, malar flush, dry vagina, tinnitus, dizziness, anxiety, insomnia, red tongue with no coating, thin rapid pulse.

FM Correlation: Declining ovarian reserve (elevated FSH, low AMH), estrogen decline, premature ovarian aging.

Treatment:

• Points: KI-3, KI-6 (Zhaohai), SP-6, LR-3, HT-6 (Yinxi), CV-4, BL-23, BL-52 (Zhishi)
• No moxa (moxa is warming — contraindicated in Yin Deficiency Heat patterns)
• Herbal: Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) — the foundational Kidney Yin formula. For pronounced Heat signs: Zhi Bai Di Huang Wan (with Zhi Mu and Huang Bai added)
• FM Support: DHEA (25-75mg, per Gleicher et al., 2010, Reproductive Biology and Endocrinology — shown to improve ovarian response in diminished ovarian reserve), melatonin (3mg at bedtime — antioxidant protection for oocytes), omega-3 fatty acids, vitamin E

Liver Qi Stagnation (Most Common in Stress-Related Infertility)

Presentation: Irregular menstrual cycle (variable length), PMS (irritability, breast tenderness, bloating, headache), clotty menstrual blood with cramps, emotional sensitivity, sighing, tension in ribs and flanks, wiry pulse.

FM Correlation: Elevated cortisol disrupting GnRH pulsatility, estrogen dominance from impaired hepatic conjugation, hypothalamic amenorrhea in severe cases (chronic stress shutting down the reproductive axis — an evolutionary survival mechanism).

Treatment:

• Points: LR-3, LI-4, PC-6, GB-34, LR-14, CV-3 (Zhongji), SP-6, Yintang
• Herbal: Xiao Yao San (Free Wanderer Powder), or for more pronounced stagnation with Heat: Dan Zhi Xiao Yao San (with Mu Dan Pi and Zhi Zi added)
• FM Support: DIM/I3C (estrogen metabolism), calcium-D-glucarate (glucuronidation support), B6 (progesterone support), magnesium glycinate (cortisol modulation), stress management

Blood Stasis (Common in Endometriosis, Fibroids, PCOS)

Presentation: Painful menstruation with dark clots, fixed abdominal pain, history of endometriosis/fibroids/ovarian cysts, purple tongue with dark spots, choppy or firm pulse.

FM Correlation: Endometriosis (ectopic endometrial tissue), uterine fibroids (leiomyomas), PCOS (ovarian cysts), hypercoagulability, elevated estrogen driving tissue proliferation.

Treatment:

• Points: SP-10, SP-6, LR-3, LI-4, ST-29, CV-3, BL-17 (Geshu — Influential Point for Blood), BL-32 (Ciliao — sacral point for pelvic blood circulation)
• Herbal: Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) — the classical formula for Blood Stasis in the lower abdomen. Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood) for more severe stasis.
• FM Support: Serrapeptase (fibrinolytic enzyme), nattokinase, omega-3 (anti-inflammatory), NAC (antioxidant, mucolytic — shown to improve endometriosis outcomes)

Dampness/Phlegm (Common in PCOS)

Presentation: Overweight or obesity, irregular or absent periods, acne, hirsutism, excessive cervical mucus or vaginal discharge, heavy sensation in limbs, greasy tongue coating, slippery pulse.

FM Correlation: PCOS with insulin resistance, elevated androgens, anovulation, metabolic syndrome.

Treatment:

• Points: ST-40, SP-9, SP-6, CV-12, CV-3, ST-29, LR-3
• Herbal: Cang Fu Dao Tan Tang (Atractylodes and Cyperus Guide Out Phlegm Decoction) — specifically designed for Phlegm obstruction of the uterus causing infertility
• FM Support: Inositol (myo-inositol 4g + D-chiro-inositol 100mg — shown in RCTs to improve ovulation rates and insulin sensitivity in PCOS; Unfer et al., 2012, Gynecological Endocrinology), berberine (comparable to metformin for insulin sensitization), chromium picolinate, NAC

Acupuncture Protocol for IVF Support

Phase-Based Treatment (Aligned with Menstrual Cycle)

Menstrual Phase (Days 1-4): Move Blood, Shed the Old

• Points: SP-10, SP-6, LR-3, LI-4, CV-3, ST-29
• Goal: Ensure complete shedding of the endometrium, promote blood circulation, resolve any stasis from the previous cycle

Follicular Phase (Days 5-12): Nourish Yin and Blood, Build the Follicle

• Points: KI-3, KI-6, SP-6, ST-36, CV-4, BL-23, LR-8 (Ququan)
• Goal: Support follicle development by nourishing Kidney Yin and Blood. In IVF, this corresponds to the stimulation phase.
• Herbal: Liu Wei Di Huang Wan or Zuo Gui Wan
• Moxa: Gentle moxa on ST-36 and CV-4

Ovulation Phase (Days 12-16): Move Qi and Blood, Transform Yin to Yang

• Points: LR-3, LI-4, KI-3, SP-6, CV-4, GV-20
• Goal: Promote the LH surge, support follicle rupture and egg release, begin the transition from yin (follicular) to yang (luteal) phase
• Electroacupuncture: 2 Hz at SP-6 bilaterally — Stener-Victorin et al. (2000, Human Reproduction) demonstrated that low-frequency EA at SP-6 and other pelvic points reduces uterine artery impedance (increased uterine blood flow) and modulates sympathetic tone to the ovaries

Luteal Phase (Days 16-28): Warm Yang, Support Implantation

• Points: KI-3, KI-7, GV-4, BL-23, CV-4, ST-36, SP-6
• Moxa: On GV-4, CV-4, ST-36 — warming the Kidney Yang supports progesterone production and uterine receptivity
• Goal: Support the corpus luteum (progesterone production), warm the uterus for implantation, nourish Blood to build the endometrial lining
• Herbal: You Gui Wan or Bu Shen Cu Pai Luan Tang

Embryo Transfer Day (if IVF):

• Pre-transfer (25 min): PC-6, SP-8, LR-3, GV-20, ST-29, auricular Shenmen — relax the patient, reduce uterine contractility, increase pelvic blood flow
• Post-transfer (25 min): ST-36, SP-6, SP-10, LI-4, auricular Shenmen — support implantation, nourish Blood, calm the Shen

Treatment Frequency

• Natural conception support: 1-2x/week for minimum 3 months (corresponding to the 90-day maturation cycle of both oocytes and sperm). Treatment should begin at least 3 months before planned conception.
• IVF support: 1-2x/week beginning 6-8 weeks before egg retrieval, plus transfer-day protocol.
• Male factor support: 1-2x/week for 3 months (spermatogenesis cycle is approximately 74 days).

Male Fertility

TCM addresses male fertility primarily through the Kidney system — Kidney Jing (Essence) directly produces sperm. Kidney Yang governs motility and vitality; Kidney Yin governs sperm count and morphology.

Common Patterns:

• Kidney Yang Deficiency: Low motility, low volume, erectile dysfunction, fatigue, cold extremities
• Kidney Yin Deficiency: Low count, abnormal morphology, premature ejaculation, night sweats
• Damp-Heat in the Lower Jiao: Infection (prostatitis, epididymitis), varicocele, elevated scrotal temperature

Key Points for Male Fertility: KI-3, CV-4, GV-4, BL-23, ST-36, SP-6, CV-6 (Qihai)

Evidence: Dieterle et al. (2009, Fertility and Sterility) conducted an RCT showing that acupuncture improved sperm motility and morphology in subfertile men. Pei et al. (2005, Fertility and Sterility) found that acupuncture improved sperm ultrastructural integrity.

Menstrual Regulation

Beyond fertility, acupuncture is profoundly effective for menstrual disorders — dysmenorrhea, amenorrhea, irregular cycles, menorrhagia, and PCOS. The WHO recognizes dysmenorrhea as an indication for acupuncture based on controlled clinical trials.

Dysmenorrhea Protocol (Primary):

• SP-6, SP-8, CV-3, CV-4, ST-29, LR-3, LI-4
• Electroacupuncture: 2 Hz between SP-6 and SP-8 bilaterally — Ma et al. (2013, Complementary Therapies in Medicine) demonstrated significant pain reduction with this protocol
• Treatment: Begin 5-7 days before expected menses, continue through Day 2-3. Monthly for 3-6 cycles.

PCOS Protocol:

• Stener-Victorin et al. (2000, 2008) published multiple studies demonstrating that low-frequency electroacupuncture improves ovulation frequency, reduces testosterone, improves insulin sensitivity, and normalizes LH/FSH ratios in PCOS.
• Points: SP-6, SP-9, ST-29, CV-3, CV-6, LR-3, ST-36
• EA: 2 Hz, 30 minutes, 2-3x/week during anovulatory phase
• Duration: 10-16 weeks for ovulatory response

Cross-Connections

• For herbal formulas used in reproductive protocols: see chinese-herbal-formulas-classical-protocols.md
• For the Kidney system underlying reproductive function: see zang-fu-organ-theory-functional-medicine-bridge.md
• For HPA axis impact on fertility: see ../functional-medicine/adrenal-hpa-axis-protocol.md
• For emotional aspects of infertility: see ../emotional-healing/
• For vagal regulation in fertility: see acupuncture-anxiety-depression-vagal-tone.md

References

• Bentov, Y., Hannam, T., Jurisicova, A., Esfandiari, N., & Casper, R. F. (2014). Coenzyme Q10 supplementation and oocyte aneuploidy in women undergoing IVF-ICSI treatment. Fertility and Sterility, 101(2), 441-446.
• Dieterle, S., Li, C., Greb, R., Barber, R., Krüger, J., & Sterzik, K. (2009). A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertility and Sterility, 92(4), 1340-1343.
• Gleicher, N., Weghofer, A., & Barad, D. H. (2010). Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening (PGS). Reproductive Biology and Endocrinology, 8, 140.
• Ma, Y. X., Ma, L. X., Liu, X. L., et al. (2013). A comparative study on the immediate effects of electroacupuncture at Sanyinjiao (SP6), Xuanzhong (GB39) and a non-meridian point on the pain of primary dysmenorrhea. Complementary Therapies in Medicine, 21(3), 143-152.
• Manheimer, E., Zhang, G., Udoff, L., Haramati, A., Langenberg, P., Berman, B. M., & Bouter, L. M. (2008). Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. British Medical Journal, 336(7643), 545-549.
• Paulus, W. E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility, 77(4), 721-724.
• Pei, J., Strehler, E., Noss, U., et al. (2005). Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and Sterility, 84(1), 141-147.
• Stener-Victorin, E., Waldenström, U., Andersson, S. A., & Wikland, M. (2000). Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Human Reproduction, 15(6), 1234-1239.
• Stener-Victorin, E., Jedel, E., & Mannerås, L. (2008). Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. Journal of Neuroendocrinology, 20(3), 290-298.
• Unfer, V., Carlomagno, G., Dante, G., & Facchinetti, F. (2012). Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology, 28(7), 509-515.
• Zheng, C. H., Huang, G. Y., Zhang, M. M., & Wang, W. (2012). Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis. Fertility and Sterility, 97(3), 599-611.