Wellness services are the latest craze at fertility clinics. They're side businesses that offer such things as massages, mindfulness meditation and advice on herbs to sprinkle on food that go beyond the medical treatments people are seeking from their physicians.

One of the most popular services is acupuncture. The traditional Chinese treatment involves placing sterile needles at various points on the body to manipulate the "chi," or energy flow. Acupuncture is used by a growing number of patients seeking relief from lower back pain, headaches and arthritis. The National Institutes of Health's Center for Complementary and Integrative Health (NCCIH) says some studies suggest it may help ease some types of pain, although any improvement is indistinguishable from a placebo effect.

For women undergoing in vitro fertilization (IVF), acupuncture practitioners say the procedure may increase blood flow, which may increase the chances of an embryo implanting. It's an alluring pitch, but the scientific literature on this subject has been mixed, with some early studies suggesting a potential benefit but some later reviews finding no effect. There have been questions and limitations about the quality of the evidence.

Last month in the American Medical Association's journal, JAMA, researchers report the results of a study that drilled down on that question using a respected research method: A randomized clinical trial. It involved looking at women who received either acupuncture or what the researchers called "sham acupuncture," in which noninvasive needles were placed away from acupuncture points. There were 848 women, from Australia and New Zealand, in the study, and all were undergoing a fresh IVF cycle. Their mean age was 35.4 years.

Three treatments were given. The first was administered some time between days six to eight to the women taking drugs to stimulate the ovaries to make more eggs, the second before embryo transfer, and the third after embryo transfer.

The results, as measured by live births, between the two groups were no different. In the acupuncture group, 74 out of 405 women, or 18 percent, had live births. In the sham acupuncture group, 72 out of 404, or 18 percent, had live births.

Caroline Smith, the lead investigator, and her co-authors wrote: "The findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF."

The findings support the most recent guidelines, released in 2017, from the American Society for Reproductive Medicine, that there is "fair" evidence that acupuncture performed around the time of embryo transfer does not improve live-birth rates.

In Britain, reproductive health experts expressed worry that people seeking fertility services are being "bullied" into add-on treatments. Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, said that some clinics were taking advantage of vulnerable patients, according to the Independent.

"I see women and men come in who have been given shoe boxes full of add-on therapies, and have spent thousands and thousands of pounds on non-evidence-based treatments," she said.