Efficacy of acupuncture for recurrent implantation failure: a systematic review and meta-analysis of randomized controlled trials

Background: Recurrent implantation failure (RIF) presents significant clinical and psychological challenges. While acupuncture is a potential adjunctive therapy during embryo transfer (ET), comprehensive evidence regarding its multidimensional effects remains limited. This study systematically evaluates acupuncture's impact on pregnancy outcomes, endometrial receptivity, and psychological status in RIF patients. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing acupuncture + ET with ET alone in patients with RIF. Eight major databases were searched from inception through October 2025. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: = 0.003, respectively). However, the certainty of evidence ranged from very low to moderate due to methodological limitations and high heterogeneity. Conclusion: Acupuncture may be a promising adjunctive therapy for RIF patients undergoing ET. However, the current evidence is constrained by significant methodological limitations. These results support the clinical integration of acupuncture into multidisciplinary RIF management but should be further confirmed by multicenter, rigorously blinded trials with standardized protocols and long-term outcome assessments. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1237224, the Unique Identifier is PROSPERO CRD420251237224.