One in seven couples worldwide struggle to conceive. For many, in-vitro fertilisation (IVF) becomes the last resort. And where there is desperation, there is an industry ready to supply hope, at a price. But a study has found that most of the extra treatments routinely sold to IVF patients lack proven scientific benefit.
The review, led by Dr Sarah Lensen of the University of Melbourne and published in The Lancet Obstetrics, Gynaecology, and Women's Health, is the most comprehensive assessment of IVF add-ons to date. It examined 85 randomised clinical trials covering ten of the most commonly used IVF add-ons while excluding studies with serious trustworthiness concerns.
The researchers found that "most add-ons are not proven to benefit patients going through IVF."
Add-ons are extra procedures, medications or techniques used alongside standard IVF "with the aim of increasing the chance of success". Examples include EmbryoGlue, endometrial scratching, acupuncture and preimplantation genetic testing.
Their use has become widespread. According to the study, IVF add-ons "are available at 80% of IVF clinics and used by more than 75% of patients undergoing IVF in Australia and the UK." They also "increase out-of-pocket costs for patients, with some costing thousands of dollars."
For the primary outcome of live birth, the review found that endometrial scratching "might be associated with a small increase in the chance of live birth."
Four commonly used add-ons, however, "appeared to have no effect": EmbryoGlue, preimplantation genetic testing for aneuploidy (PGT-A), endometrial receptivity testing and corticosteroids.
For five others, including PICSI (physiological intracytoplasmic sperm injection), acupuncture, intralipid infusion and two forms of platelet-rich plasma therapy, "the evidence was unclear because of the poor quality or scarcity of the data."
The researchers cautioned that uncertainty should not be mistaken for effectiveness. "In many cases, the quality of evidence was poor, contributing to uncertainty regarding effectiveness."
Part of the difficulty lay in the quality of the available research itself. Of 12,398 search results, the researchers ultimately included only 85 trials. Another 72 potentially eligible studies were excluded because of "possible trustworthiness concerns, such as the absence of prospective trial registration."
The review comes against the backdrop of growing concerns over research integrity in reproductive medicine. The authors note that "up to 20–30% of published trials might be fabricated or otherwise unreliable," while analyses suggest that "up to 50% of RCTs in reproductive medicine are either unregistered or raise trustworthiness concerns."
The review was specifically designed to exclude studies with major trustworthiness concerns in order to provide a more reliable assessment of IVF add-ons.
The financial implications make the findings particularly significant. In India, where an estimated 27–30 million couples experience infertility, a single IVF cycle costs families an average of around Rs 2.3 lakh at private hospitals. A government-commissioned report by the Indian Council of Medical Research found that nearly 89% of patients undergoing IVF experienced catastrophic health expenditure, defined as treatment costs exceeding 10% of a household's annual income. Unproven add-ons can push those costs even higher.
How patients make treatment decisions adds another layer to the issue. Studies have shown that IVF patients frequently rely on clinic websites and online forums for information. Private clinic websites and patient communities often present add-ons in highly favourable terms while giving limited information about uncertain benefits, costs or risks. Patients who rely on such information are responding to what the system places before them.
The authors conclude that "well designed, large-scale RCTs are needed to generate reliable evidence on the effect of these interventions."
Until such evidence exists, the review suggests that couples facing one of the most emotionally and financially demanding experiences of their lives deserve clear information about what is proven to work, what remains uncertain, and what those uncertainties may ultimately cost them.
Dr Abha Majumdar, advisor and emeritus consultant at the Centre of IVF and Human Reproduction at Sir Ganga Ram Hospital, said, “No IVF add-on had proven value unless it was backed by well-designed randomised controlled trials with adequate patient numbers and a clear improvement in outcomes.”
Her view aligns with the Lancet review's central finding, while adding a clinical perspective specific to the Indian context. She said patients often began IVF treatment already carrying the emotional and financial burden of repeated failed cycles, and that a lack of honest communication from clinicians only compounded their distress.
Dr Majumdar said IVF add-ons frequently increased patients' financial burden while creating false hope, despite insufficient scientific evidence to justify either their cost or the expectations attached to them.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
