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Acupuncture for insomnia, anxiety, IBS, fertility

Acupuncture has been tested in randomised trials for four quite different concerns, and the picture differs for each. For irritable bowel syndrome and for live birth after IVF, the best sham-controlled evidence found no benefit over sham acupuncture. For insomnia and anxiety, recent meta-analyses report improvements in self-rated sleep and anxiety scores compared with sham, but the trials are small, heterogeneous and partly at high risk of bias, and sham needling itself has a sizeable placebo effect, so certainty is low. Serious adverse events are rare when sterile single-use needles are used by trained practitioners.

  • Mind
  • Sleep

Evidence retrieved up to

What the research shows

In randomised trials of adults with insomnia, acupuncture was associated with modest improvements in self-rated insomnia severity compared with sham acupuncture, but the evidence is low certainty and sham needling itself improves self-rated sleep scores.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteBenefit

Who this is about

adults with insomnia

Practical note

Graded low: a 2026 meta-analysis of 12 RCTs found a small sham-controlled improvement in the Insomnia Severity Index (mean difference 1.82 points) and very high heterogeneity on some outcomes; the earlier Cochrane review of 33 trials judged all trials at high risk of bias with likely publication bias, and a 2026 meta-analysis of 36 sham arms found a measurable placebo response. Trials used needle acupuncture, electroacupuncture or acupressure over several weeks.

Safety note

The 2012 Cochrane review found adverse effects were rarely reported and minor. Needling carries rare but serious risks when sterile technique or training is lacking.

Sources

In randomised trials of adults with anxiety, manual acupuncture was associated with lower anxiety symptom scores than sham acupuncture or usual care in the short term, but results vary widely between trials and the evidence is low certainty.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteBenefit

Who this is about

adults with anxiety symptoms or anxiety disorders

Practical note

Graded low: two 2026 meta-analyses (20 RCTs with 1462 participants, and 12 RCTs with 1240 participants) agree on direction, but heterogeneity against sham was extreme (I2 94 percent), the effect sizes against sham are larger than is usual for blinded comparisons, one review searched English-language trials only, and the benefit compared with usual care or wait list was not maintained at follow-up.

Safety note

Adverse events in the anxiety trials were mainly transient discomfort, minor bleeding or local pain, with no serious events reported. Anxiety disorders call for assessment by a health professional.

Sources

In sham-controlled randomised trials of adults with irritable bowel syndrome, acupuncture did not improve symptom severity or quality of life more than sham acupuncture; apparent benefits came from unblinded comparisons.

Moderate certaintyFurther research may change the size of the effect.
Take care: see the safety noteNo clear effect

Who this is about

adults with irritable bowel syndrome

Practical note

Graded moderate, matching the Cochrane authors: the sham-controlled trials were at low risk of bias but few and small (4 RCTs, 281 participants for symptom severity). Unblinded Chinese trials comparing acupuncture with antispasmodic drugs favoured acupuncture, but the authors graded that evidence low and noted it may reflect expectations; NCCIH reports a 2019 review of 41 studies reaching the same conclusion on sham comparisons.

Safety note

One adverse event (fainting during acupuncture) was reported across the nine IBS trials that recorded adverse events.

Sources

Among women undergoing IVF, acupuncture given around ovarian stimulation and embryo transfer did not increase live birth rates compared with sham acupuncture.

Moderate certaintyFurther research may change the size of the effect.
Take care: see the safety noteNo clear effect

Who this is about

women undergoing in vitro fertilisation

Practical note

Graded moderate: one large multicentre sham-controlled RCT (848 women; live birth 18.3 percent with acupuncture versus 17.8 percent with sham) and a 2021 review of 6 sham-controlled studies cited by NCCIH found no difference in pregnancy or live birth. A 2025 meta-analysis pooling sham and wait-list controls reported small gains in biochemical and clinical pregnancy rates, which lowers consistency. The JAMA trial gave one treatment during stimulation and two around embryo transfer.

Safety note

A 2025 meta-analysis found a higher early miscarriage rate in acupuncture groups during IVF (RR 1.51); the signal is unconfirmed but is a reason for caution. Fertility treatment decisions belong with the treating fertility team.

Sources

In trials of acupuncture for sleep, anxiety and bowel symptoms, reported adverse events were mostly minor and transient, while serious harms such as infections and punctured organs have occurred when acupuncture was delivered improperly.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteRisk

Who this is about

adults receiving acupuncture

Practical note

Graded low: adverse events were inconsistently and sparsely reported in the trials, and the serious harms come from case reports summarised by NCCIH rather than from trial counts.

Safety note

Sterile single-use needles and a trained, registered practitioner are the main safeguards described; the trial data are too small to rule out rare serious events.

Sources