Benefits of IVF add-ons 'not based on evidence'

There is a lack of quality evidence on the benefits of almost all fertility clinic add-on treatments, a study published in the BMJ has suggested.

Many fertility clinics across the UK offer a range of treatments in addition to standard IVF, which are implied or stated to improve fertility outcomes for patients, with prices ranging from £100–3500. BBC Panorama commissioned the Centre for Evidence-Based Medicine (CEBM) at the University of Oxford to conduct an independent review of these treatments, and it found that 26 out of 27 add-on treatments had no beneficial effect, and some may even be harmful.

Professor Carl Heneghan, the CEBM director who led the project, told Panorama that 'it was one of the worst examples [of evidence based practice] I've seen in healthcare' and that while 'some of these treatments [have] no benefit … some of them are harmful'.

The researchers examined 74 fertility centre websites and identified 38 treatments offered to improve fertility outcomes, other than standard IVF. Out of these, 27 were classified as add-ons, comprising treatments such as PGS (preimplantation genetic screening), additional drugs, and blood tests.

The researchers found 60 centres made claims of benefit relating to fertility interventions, including add-ons. In total, this comprised 276 claims while only 13 websites cited any scientific references.

The National Institute for Health and Care Excellence (NICE), which provides guidance on medical treatments, has published advice for just 13 of the 38 fertility interventions, and systematic reviews are available for only 27 interventions.

The CEBM report states that its 'findings demonstrate that whilst many claims were made on the benefits of fertility treatments, there was a lack of supporting evidence cited'. The report found that only one add-on, endometrial scratch, had research supporting its benefits, which was categorised as being of moderate quality. While there is currently a randomised trial underway in the UK, the results have yet to be published.

Professor Robert Winston, speaking to Panorama, said that most add-ons 'are not justified' since they focus on 'giving the patients hope' rather than 'a treatment which is reliable'.

Professor Adam Balen, chair of the British Fertility Society, said: 'New treatments and approaches are always being evaluated and it is important that patients receive full information about everything that is being offered.' He added that 'it is essential that [it is] made clear exactly what they are being charged for'.

A spokesman for the Human Fertilisation and Embryology Authority (HFEA), which regulates fertility clinics in the UK, said that it has 'limited powers to stop clinics offering them, or to control pricing' and that their focus will be on educating patients before they go to clinics for treatment. 

The programme was broadcast on 28 November.