No need to test your fear of needles.

When you’re struggling to get pregnant, it can be difficult to know where to draw the line — maybe one more, slightly stranger effort will make the magic happen. But a new study helps clarify what assists fertility and what won’t: Acupuncture, alone or with clomiphene (a medicine used to induce ovulation), does not appear to be effective in treating infertility in women with polycystic ovary syndrome (PCOS), according to an international team of researchers. The finding casts doubts on previous, smaller trials that have suggested that acupuncture may improve fertility in women struggling with infertility.

“Our hypothesis was that women who received acupuncture with clomiphene would do much better than women who received only active acupuncture or only clomiphene, but we found that acupuncture added very little,” said Richard S. Legro, professor of obstetrics and gynecology at Penn State College of Medicine. “We thought we would see the two interventions interacting for the benefit of the patient, but we didn’t see that, which was surprising.”

PCOS, which affects an estimated 5% to 10% of women of reproductive age globally, is the most common cause of female infertility. Data around PCOS in India is lacking, but most estimates put it higher than the global average — somewhere between 9% to 20% of Indian women are thought to have PCOS.

Clomiphene is a first-line treatment used to induce ovulation in women with PCOS, but it has downsides. For a significant number of women, it does not lead to improved ovulation or live births; when it does induce ovulation, it frequently results in pregnancy with multiples who face much higher negative outcomes, including death.

As an alternative, women are increasingly seeking out the traditional Chinese medical practice of acupuncture for fertility issues, but unlike clomiphene, little is known about acupuncture’s efficacy or risks related to infertility. So, researchers conducted a randomized, multicenter, clinical trial that included 1,000 Chinese women with PCOS at 21 sites in China. The women were divided into four groups in which they received one of four interventions: clomiphene plus active acupuncture; clomiphene plus control acupuncture (also called placebo acupuncture or mock acupuncture); placebo medication plus active acupuncture; or placebo medication plus control acupuncture. The women were given active or control acupuncture twice a week, in addition to clomiphene or placebo medication for five days per ovulation cycle, for up to six months. Neither the patient nor their physician knew the type of medication and acupuncture received.

After following all of the 926 women who completed the trial for 10 months beyond the trial period for pregnancy outcomes, the researchers found that active acupuncture, with or without clomiphene, compared to control acupuncture and placebo medication, did not increase live births.

“There is an impression out there that acupuncture, in addition to conventional treatment, improves success rates. But this study showed that acupuncture added nothing beyond medication,” said Legro, who noted that this large trial is one of the highest quality acupuncture trials to address fertility outcomes.

Legro explained that the findings are relevant to women all over the world, not just Chinese women with PCOS.

“The take-home message is that when acupuncture is used to treat infertility, it does not improve the chances of having a baby,” he said.

Legro did note that the method of acupuncture explored in the study did not fully mimic traditional Chinese medicine, which could include herbal mixtures in additional to acupuncture treatment.

This study was published in the Journal of the American Medical Association. Researchers on the project included Xiao-Ke Wu, Elisabet Stener-Victorin, Hong-Ying Kuang, Hong-Li Ma, Jing-Shu Gao, Liang-Zhen Xie, Li-Hui Hou, Zhen-Xing Hu, Xio-Guang Shao, Jun Ge, Jin-Feng Zhang, Hui-Ying Xue, Xiao-Feng Xu, Rui-Ning Liang, Hong Xia Ma, Hong-Wei Yang, Wei-Li Li, Dong-Mei Huang, Yun Sun, Cui-Fang Hao, Shao-Min Du, Zheng-Wang Yang, Xin Wang, Ying Yan, Xiu-Hua Chen, Ping Fu, Cai-Fei Ding, Ya-Qin Gao, Zhong-Ming Zhou, Chi Chiu Wang, Tai-Xiang Wu, Jian-Ping Liu, Ernest H.Y. Ng and Heping Zhang.