Multifaceted Benefits of Auricular Point Sticking for IVF Patients: Psychological Well-being, Sleep, and Treatment Outcomes

1.Diagnostic Criteria for Infertility

The diagnosis is established in accordance with *Obstetrics and Gynecology (10th Edition)* and the *Guidelines for Diagnosis and Treatment of Infertility (2019)*. To be eligible, patients must meet the following criteria:

• Be a woman of reproductive age, between 20 and 45 years old;
• Have failed to achieve a clinical pregnancy after ≥12 months of regular, unprotected intercourse (or ≥6 months for women aged ≥35).

Furthermore, the indication for IVF-ET must be met by satisfying at least one of the following conditions:

• Ovulatory factor infertility (e.g., hypothalamic amenorrhea or menstrual disorders, pituitary amenorrhea or menstrual disorders, ovarian amenorrhea or menstrual disorders, other endocrine disorders);
• Pelvic factor infertility (e.g., congenital anomalies of the reproductive system, cervical factors, uterine disorders, tubal and/or peritoneal factors, endometriosis);
• Male factor infertility (e.g., azoospermia, oligospermia, asthenospermia, teratospermia, isolated abnormal seminal plasma);
• Unexplained infertility.

• Diagnostic Criteria for Anxiety State

Diagnosis is based on the diagnostic criteria for anxiety disorders as outlined in the *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)* and the *International Classification of Diseases, Eleventh Revision (ICD-11)*. Eligible patients must meet the following criteria:

• Score ≥5 on the self-administered Generalized Anxiety Disorder 7-item (GAD-7) scale;
• Exhibit significant anxiety symptoms: excessive worry not confined to specific circumstances, or disproportionate worry about various aspects of life;
• Experience associated symptoms, such as: muscle tension or restlessness; symptoms of autonomic hyperactivity (e.g., frequent gastrointestinal symptoms like nausea or abdominal discomfort, palpitations, sweating, trembling, dry mouth); subjective feelings of tension, restlessness, difficulty concentrating, or irritability;
• Symptoms persist for at least one month and are present most of the time;
• The symptoms are not better explained by another mental disorder, are not attributable to the physiological effects of a substance or medication (or its withdrawal), and are not a manifestation of another medical condition;
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

3 Diagnostic Criteria for Insomnia Disorder Diagnosis is based on the diagnostic criteria for insomnia disorder as outlined in the *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Eleventh Revision (ICD-11) 3. Eligible patients must meet the following criteria:

• Score ≥8 on the self-administered Pittsburgh Sleep Quality Index (PSQI);
• Report dissatisfaction with sleep quantity or quality, accompanied by one or more of the following symptoms: ① Difficulty initiating sleep (sleep latency >30 minutes); ② Difficulty maintaining sleep, characterized by frequent awakenings or difficulty returning to sleep after awakenings (wake after sleep onset >30 minutes); ③ Early morning awakening (waking >30 minutes earlier than desired) with inability to return to sleep;
• The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning;
• The sleep difficulty occurs at least three nights per week and has been present for at least one month;
• The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder, mental disorder, or medical condition, and is not attributable to the physiological effects of a substance.

Inclusion criteria

• (1) Patients who meet the above diagnostic criteria and have undergone IVF-ET; (2) Female patients aged 20-45 years, with a BMI of 18-28 kg/m²; (3)The embryo to be transferred is a high-quality frozen-thawed embryo (either a Day-3 embryo with ≥8 cells, uniform blastomere size, and fragmentation rate <10%, or a blastocyst with a grade of ≥3BB); (4) Willing to provide written informed consent and comply with luteal support therapy and follow-up.

Exclusion criteria

• (1) Unauthorized use of sedatives or anxiolytics during the treatment period; (2) Adherence to auricular point sticking therapy less than 80% (based on patient diary records); (3) Cancellation of the frozen embryo transfer cycle (e.g., due to endometrial transformation failure or sudden onset of ovarian hyperstimulation syndrome); (4) The participant voluntarily requests to withdraw from the study.