The efficacy of acupuncture on endometrial receptivity in infertile women: an overview of systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE

Endometrial receptivity (ER) enhancement is crucial in managing infertility. Although systematic reviews (SRs) have investigated acupuncture's potential to improve ER in infertile women, the evidence remains fragmented due to insufficient quality assessment. This overview aimed to rigorously evaluate the reporting quality, methodological rigor, risk of bias, and evidence confidence of existing SRs, while synthesizing clinical evidence on acupuncture's efficacy and safety for ER enhancement in infertility.

SEARCH STRATEGY

Seven databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang) were systematically searched from inception to March 1, 2025, using combined subject headings and free-text terms ("acupuncture therapy," "endometrial receptivity," "infertility," "systematic review").

INCLUSION CRITERIA

SRs investigating acupuncture's therapeutic effects on ER in infertile women were eligible.

DATA EXTRACTION AND ANALYSIS

Two independent reviewers performed study selection and data extraction. Methodological quality, reporting completeness, bias risk, and evidence certainty were evaluated using validated tools: AMSTAR 2, ROBIS, PRISMA-A, and GRADE.

RESULTS

From 524 screened records, 10 SRs (published 2019-2023, encompassing 7-25 RCTs each) were included. Methodological quality assessed by AMSTAR 2 showed that all 10 SRs exhibited critically low quality. Reporting quality assessed by PRISMA-A showed that overall completeness >70%, but deficiencies in protocol registration (50%) and funding disclosure (10%). Risk of bias assessed by ROBIS showed that only one SR had low risk of bias. As to the evidence confidence, among the 55 evaluated outcomes, 92.72% (51/55) were low/very low quality (2 high, 2 moderate, 24 low, 27 very low). Descriptive analyses suggested that combining acupuncture with other treatments (medications, Chinese herbal medicine, and IVF-ET) may improve pregnancy and ovulation rates, with a high to moderate quality of evidence.

CONCLUSION

Current evidence supporting acupuncture for ER enhancement is predominantly low quality, limited by critical methodological weaknesses and heterogeneity. While combination therapies show preliminary promise, definitive conclusions require high-quality RCTs with standardized outcome measures.

SYSTEMATIC REVIEW REGISTRATION

This study was registered in PROSPERO (CRD42024497881).