| Objective To systematically evaluate the efficacy and safety of acupuncture in treating pregnancy outcomes of patients with recurrent implantation failure (RIF) during in vitro fertilization-embryo transfer, providing evidence-based basis for clinical practice. Methods This review adhered to the PRISMA 2020 guidelines and was registered with PROSPERO. A computerized literature search was conducted on databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Chinese Journal Database (VIP) for randomized controlled trials (RCTs) on acupuncture for RIF, from database inception until August 1, 2025. The Cochrane Risk of Bias tool was used to assess the methodological quality of the included studies. Meta-analysis was performed using RevMan 5.4 software. Sensitivity analysis was conducted by sequentially excluding each study, and a funnel plot was generated to assess publication bias. Results Seventeen RCTs involving 1500 RIF patients were included. The meta-analysis results demonstrated that, compared to the control group, adjuvant acupuncture significantly improved the clinical pregnancy rate (RR=1.74, 95% CI [1.51, 2.00], P<0.00001), live birth rate (RR=2.20, 95% CI [1.63, 2.98], P<0.00001), embryo implantation rate (RR=1.54, 95% CI [1.33, 1.79], P<0.00001), and biochemical pregnancy rate (RR=1.60, 95% CI [1.33, 1.92], P<0.00001) in RIF patients. There was no statistically significant difference in the incidence of adverse reactions between the two groups (RR=0.58, 95% CI [0.24, 1.40], P=0.23). Sensitivity analysis indicated robust data, although potential publication bias was suggested. Conclusion Adjunctive acupuncture intervention, based on conventional treatment, can significantly improve reproductive outcomes in RIF patients with a favorable safety profile. However, future large-sample, multi-center, high-quality RCTs are warranted for further validation. |