Most IVF ‘add-on’ treatments have no effect on fertility or remain unproven, study says | IVF

The largest study of its kind has concluded that most IVF “add-on” treatments sold to people hoping to improve their chances of having children are not supported by reliable evidence, fail to improve fertility and may be a complete waste of money.

There has been an increase in extra procedures, medications or techniques being offered to patients in addition to standard in vitro fertilization treatment, with the claim that this will increase the likelihood of success. Participation is common, with over 70% of IVF patients in the UK, Australia and New Zealand paying for one or more add-ons during IVF treatment.

But the world’s most comprehensive review of their effectiveness and the evidence behind them found that the majority showed no effect on fertility or were inconclusive due to limited or low-quality data.

Experts behind the study said unproven add-ons also lead to false hopes, more financial hardship and unnecessary medical procedures during an already difficult time for patients. Findings published In the journal Lancet Obstetrics, Gynecology and Women’s Health.

“In many countries, infertility care is largely provided by private clinics where in vitro fertilization is highly commercialised, and some of the add-ons are extremely expensive,” said Dr Sarah Lensen from the University of Melbourne.

“Our review finds a lack of evidence that most of the IVF add-ons we evaluated provide any benefit to patients. Unproven add-ons can lead to false hopes, further financial hardship and unnecessary medical procedures during what can already be a very difficult time for patients.”

There has been growing concern in the field of reproductive medicine in recent years about the prevalence of questionable or unreliable randomized controlled trials, including those looking at in vitro fertilization add-ons.

The aim of the researchers who led the meta-analysis was to provide a comprehensive overview of the effectiveness and safety of 10 common IVF adjuncts, limited to high-quality studies.

Of 157 potentially eligible trials, 72 were excluded for reliability reasons. The researchers pooled data from the remaining 85 trials.

they found The following seven IVF add-ons have no effect or inconclusive results on fertility due to limited or low-quality data:

• Acupuncture – insertion of thin needles into points on the body.

• Corticosteroids – drugs that reduce inflammation and suppress immune system activity.

• Endometrial receptivity testing – biopsy of the uterine lining to evaluate gene expression patterns.

• Intralipid infusion – a fat-containing liquid 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 benefits from three IVF add-ons:

• EmbryoGlue – an embryo transfer medium containing hyaluronic acid. The evidence review found that it may increase the likelihood of pregnancy and live birth; however, the effect on live birth rates was not strong.

• Endometrial scratching – a minor procedure performed to scratch or disturb the lining of the uterus. The review found that it may increase the likelihood 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 that this could reduce the risk of miscarriage.

“There is widespread misinformation about IVF add-ons on private clinic websites and patient forums on social media (important sources of information for patients), which often exaggerates the benefits of add-ons and ignores their costs and risks,” 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 an implicit endorsement of benefit.”