Most IVF “add-on” treatments sold to people hoping to boost their chances of having children are not backed by reliable evidence, fail to boost fertility and may be a complete waste of money, the largest study of its kind has concluded.
There has been a surge in extra procedures, medicines or techniques offered to patients in addition to standard IVF with bold claims they will increase the probability of success. Take-up is widespread, with more than 70% of IVF patients in the UK, Australia and New Zealand paying for one or more add-on during IVF treatment.
But the world’s most comprehensive review into their effectiveness – and the evidence behind them – found the majority show no effect on fertility or remain inconclusive due to limited or low-quality data.
Unproven add-ons also lead to false hope, greater financial strain and needless medical procedures at what is already a difficult time for patients, experts behind the research said. The findings were published in The Lancet Obstetrics, Gynaecology & Women’s Health journal.
“In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add-ons are extremely expensive,” said Dr Sarah Lensen of the University of Melbourne.
“Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients. 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.”
In recent years, there has been mounting concern about the prevalence of suspect or untrustworthy randomised controlled trials within reproductive medicine, including those looking at IVF add-ons.
The aim of the researchers leading the meta-analysis was to offer a comprehensive overview of the effectiveness and safety of 10 common IVF add-ons, limited to high-quality studies.
Of 157 potentially eligible trials, 72 were excluded on trustworthiness grounds. Researchers pooled data from the remaining 85 trials.
They found either no effect on fertility or inconclusive results due to limited or low-quality data for the following seven IVF add-ons:
Acupuncture – inserting thin needles into points on the body.
Corticosteroids – medication to reduce inflammation and suppress immune system activity.
Endometrial receptivity testing – a biopsy of the uterine lining to assess gene expression patterns.
Intralipid infusion – a liquid containing fats that is administered into the blood.
Intraovarian injection of platelet-rich plasma – injecting platelet-rich plasma into the ovaries.
Intrauterine infusion of platelet-rich plasma – insertion of platelet-rich plasma into the uterus.
Pre-implantation genetic testing for aneuploidy – a screening test to check whether embryos have the expected number of chromosomes.
The review also found only weak evidence of some possible benefit from three IVF add-ons:
EmbryoGlue – an embryo transfer medium containing hyaluronic acid. The evidence review found it may increase the probability of pregnancy and live birth; however, the effect on live birthrates was not robust.
Endometrial scratching – a minor procedure undertaken to scratch or disturb the lining of the uterus. The review found this may increase the probability of pregnancy and live birth.
Physiological intracytoplasmic sperm injection (PICSI) – a technique used to select sperm based on their ability to bind to hyaluronic acid. There was weak evidence this may lower the risk of miscarriage.
“There is widespread misinformation about IVF add-ons with private clinic websites and patient forums on social media – major information sources for patients – often overstating the benefits and omitting the costs and risks of add-ons,” Lensen said.
“IVF clinics and clinicians should carefully consider whether it is appropriate to offer unproven add-ons, as their availability is often perceived by patients as implicit endorsement of benefit.”
