Effects of acupuncture and moxibustion therapy on endometrial receptivity of infertile women with in vitro fertilization–embryo transfer: status quo and countermeasures

Background: fertilization-embryo transfer (IVF-ET) is a core assisted reproductive technology (ART) for infertile couples, but poor endometrial receptivity (ER) severely impairs embryo implantation and reduces success rates, imposing significant psychological and economic burdens. Acupuncture and moxibustion have been validated to improve ER via multiple mechanisms, yet no reviews systematically summarize clinical evidence on their subtypes and underlying pathways to guide future research. Objective: This study aims to comprehensively synthesize recent advances in acupuncture and moxibustion for enhancing ER in IVF-ET patients, promoting clinical application and research awareness. Methods: A systematic literature search was conducted across PubMed, Web of Science, CNKI, and WanFang databases (January 2020-June 2025), supplemented with seminal studies. After screening, 214 studies were included for qualitative synthesis; methodological quality was assessed using RoB 2.0 (RCTs) and NOS (non-RCTs). Results: Acupuncture (traditional manual, electroacupuncture, and TEAS) and moxibustion (wheat, herbal cake, and warm uterus moxibustion) improve ER by regulating endometrial thickness, blood flow (e.g., reduced PI/RI), hormone levels (E2 and P), and type A endometrium ratio. Combined therapies (e.g., warm needling + acupuncture) further enhance efficacy. Mechanisms involve modulating autophagy (AMPK/mTOR pathway), pinopode-related molecules (LIF, integrin αvβ3), non-coding RNAs (miR-449a, circRNAs), and VEGF-mediated angiogenesis. Conclusion: Acupuncture and moxibustion are promising adjunctive therapies for ER enhancement in IVF-ET, but high-quality, standardized RCTs are needed to confirm efficacy, standardize protocols, and reduce bias.