Most IVF add-ons ineffective or lack evidence

Most common IVF add-ons lack strong evidence of proven benefits for patients, an extensive meta-analysis of trusted studies has shown.

IVF add-ons are procedures offered alongside standard fertility treatments in the hope of boosting the chances of a live birth. Over 70 percent of IVF patients in Australia, New Zealand and the UK report having accessed at least one of these treatments, which usually incur extra costs above the price of an IVF cycle. Yet whether these approaches indeed increase the likelihood of having a baby has remained unclear.

'Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients,' said Dr Sarah Lensen, senior research fellow in the Department of Obstetrics, Gynaecology and Newborn Health at the University of Melbourne, Australia, and lead author of the study published in The Lancet Obstetrics, Gynaecology and Women's Health. 'Unproven add-ons can lead to false hope, greater financial strain and unnecessary medical procedures at what already can be a very difficult time for patients.'

The team initially considered 157 randomised trials of various IVF add-ons, ultimately excluding 72 of them due to potential concerns about their trustworthiness. The remaining 85 studies covered ten of the most commonly offered IVF add-ons. Of these, only endometrial scratching – a light scraping of the uterus lining before embryo transfer – was linked to potential improvements in live birth chances.

EmbryoGlue, a product purported to help the embryo implant, might increase the probability of pregnancy, but whether it has an impact on live births is unclear, with only some analyses showing a positive effect. Physiological intracytoplasmic sperm injection, whereby sperm is selected based on its ability to bind to hyaluronic acid, may be linked to lower miscarriage rates, but not to improved birth rates.

The remaining seven add-ons either showed no benefits (corticosteroid drugs, PGT-A and endometrial receptivity testing), or the data was too poor or lacking to establish conclusions (acupuncture, intralipid infusion and injections of platelet-rich plasma into the ovaries or the uterus).

Despite the lack of clear scientific consensus, add-ons remained commonly advertised by fertility clinics. In response, Dr Sarah Lensen and her team created a website detailing the current state of scientific evidence for each add on. They evaluated the impact of this resource in a study led by Dr Afsana Afroz, also published in The Lancet Obstetrics, Gynaecology, and Women's Health. Over 1200 Australian women who had undergone IVF were enrolled and assigned to either a control group who was provided commercial IVF website content, or to a group who was directed to the custom website. Results showed that patients who had accessed the resource designed by the researchers had a better understanding of IVF adds-ons, as well as their scientifically proven benefits and risks.

'IVF is heading in the wrong direction and requires more robust protection for patients and stronger oversight from regulatory bodies,' said Baroness Geeta Nargund, honorary professor of women's health at City St George's, University of London and first author of a commentary published alongside the two studies. 'Many of the add-ons in IVF are unproven and ineffective, with some posing serious health risks to patients. Urgent action is needed to address these add-ons.'