Older women face lower chance of fertility treatment working, even with donor eggs, study finds
Most IVF add-ons lack reliable evidence, with benefits either absent or inconclusive, the largest review of its kind has found.
More than 70 per cent of IVF patients in the UK, Australia and New Zealand reportedly pay for one or more additional treatments.
However, researchers found that most of the procedures, medicines and techniques had no effect on fertility or were backed by limited or low-quality evidence.
Unproven add-ons can also lead to false hope, greater financial strain and unnecessary medical procedures at an already difficult time for patients.
Dr Sarah Lensen, of the University of Melbourne, said: “In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add-ons are extremely expensive.
“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.”
Researchers said concerns have grown in recent years about potentially untrustworthy randomised controlled trials in reproductive medicine, including studies of IVF add-ons.
The team set out to review the effectiveness and safety of 10 commonly offered add-ons using trustworthy studies.
Researchers initially identified 157 potentially eligible randomised controlled trials but excluded 72 because of concerns about their reliability.
Randomised controlled trials compare treatments by assigning participants to different groups, helping researchers assess whether an intervention causes a particular outcome.
The team combined data from the remaining 85 trials in a meta-analysis, which brings together findings from several studies.
The review found no effect on fertility or inconclusive evidence for seven of the 10 add-ons examined.
These included acupuncture, which involves inserting thin needles into points on the body, and corticosteroids, medicines that reduce inflammation and suppress immune activity.
Endometrial receptivity testing was also not backed by reliable evidence. The procedure involves taking a sample from the lining of the womb to examine patterns of gene activity.
Another add-on was intralipid infusion, which delivers a fat-containing liquid into the bloodstream.
Researchers separately examined injections of platelet-rich plasma into the ovaries and infusions of platelet-rich plasma into the womb.
Platelet-rich plasma is made from a patient’s blood and contains a high concentration of platelets, which play a role in healing.
The seventh treatment was pre-implantation genetic testing for aneuploidy, which examines embryos to check whether they have the expected number of chromosomes.
The review found only weak evidence of a possible benefit from three other add-ons.
EmbryoGlue, an embryo transfer medium containing hyaluronic acid, may increase the probability of pregnancy and live birth. However, the evidence on live birth rates was not considered robust.
Endometrial scratching, a minor procedure that deliberately disturbs the lining of the womb, may also increase the probability of pregnancy and live birth.
Physiological intracytoplasmic sperm injection, known as PICSI, selects sperm based on their ability to bind to hyaluronic acid. Weak evidence suggested it may reduce the risk of miscarriage.
Lensen said: “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.
“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.”
