News | Most IVF Add-ons Lack Evidence of Fertility Benefit; Lancet Study Calls for Cautious Use
In assisted reproductive treatment, an increasing number of patients encounter so-called IVF "add-ons." These are additional procedures, medications, or laboratory techniques typically promoted as improving embryo implantation rates, pregnancy rates, or live birth rates. However, a recent systematic review and meta-analysis published in The Lancet Obstetrics, Gynaecology, & Women's Health shows that most common IVF add-ons lack sufficient evidence to demonstrate improved fertility outcomes for patients.
The study, conducted by researchers from the University of Melbourne in Australia and other institutions, aimed to comprehensively evaluate the effectiveness and safety of common IVF add-ons. The research team noted that IVF treatment itself already imposes significant financial, physical, and emotional burdens on patients, and the widespread use of add-ons further increases treatment complexity. Particularly in many countries, infertility care is primarily provided by private clinics with a high degree of commercialization; some add-ons are expensive, yet their actual benefits have not been adequately confirmed.
IVF, or in vitro fertilization, is an important treatment for many infertility patients. However, even with IVF, the chance of successfully having a baby per cycle is typically around 30% to 40%, and it declines significantly with increasing female age. It is against this backdrop of high expectations, high stress, and limited success rates that many patients hope to "increase their chances" through additional procedures. Over the past decade, IVF add-ons have proliferated rapidly, including pharmacological interventions, embryo testing, endometrial treatments, sperm selection techniques, and immune-related therapies.
The researchers pointed out that IVF add-ons are very commonly used in real-world clinical practice. More than 70% of IVF patients in Australia, New Zealand, and the United Kingdom report having used at least one add-on during their treatment. However, the problem is that when patients choose these procedures, they often face information asymmetry: clinic websites, social media, and patient forums may emphasize potential benefits while downplaying the quality of evidence, costs, and risks.
The study initially identified 157 potentially eligible randomized controlled trials. Because some trials in the field of reproductive medicine have credibility issues, the research team screened study quality using a trustworthiness assessment tool, ultimately excluding 72 trials due to credibility concerns. The researchers then pooled and analyzed the remaining 85 randomized controlled trials deemed credible, focusing on evaluating 10 IVF add-ons with high patient demand and widespread clinical use.
The analysis results showed that among the 10 categories of common add-ons, 7 showed no clear fertility benefit, or results were uncertain due to limited data or insufficient quality. These add-ons include acupuncture, corticosteroids, endometrial receptivity testing, intralipid infusion, intraovarian platelet-rich plasma injection, intrauterine platelet-rich plasma infusion, and preimplantation genetic testing for aneuploidy.
Among these, endometrial receptivity testing typically involves taking endometrial tissue samples to assess gene expression patterns, aiming to determine the so-called "optimal window" for embryo transfer; preimplantation genetic testing for aneuploidy is used to screen whether embryos have a normal number of chromosomes. Although these procedures are often portrayed with high expectations in marketing, this review concluded that current credible evidence is insufficient to support their use as routine add-ons to improve IVF fertility outcomes.
The study also found that 3 categories of add-ons had weaker evidence of potential benefit: EmbryoGlue, endometrial scratching, and physiological intracytoplasmic sperm injection. EmbryoGlue is an embryo transfer culture medium containing hyaluronic acid, a substance naturally present in the reproductive tract and thought to be potentially related to embryo implantation. The study showed it may increase the probability of pregnancy and live birth, but its effect on live birth rates was not robust.
Endometrial scratching is a minor procedure involving slight disruption or stimulation of the endometrium; the study found it may increase the probability of pregnancy and live birth. However, this evidence was still described as weak, meaning it is not yet sufficient to support routine recommendation for all patients. PICSI is a sperm selection technique that selects sperm potentially more mature and capable of fertilization based on their ability to bind to hyaluronic acid. This review showed that PICSI may reduce the risk of miscarriage, but this also constitutes weak evidence.
Study author Dr. Sarah Lensen from the University of Melbourne stated that infertility care is highly commercialized in many countries, and some add-ons are very expensive. She noted that this review found that most IVF add-ons evaluated lack evidence of actual benefit for patients. Unproven procedures may give patients false hope, additional financial strain, and unnecessary medical interventions, at a time when patients, already in a difficult phase of treatment, especially need clear, honest, and evidence-based information.
This study also highlights the importance of research quality in reproductive medicine. The research team emphasized that IVF add-ons should be based on credible, rigorous, and reproducible clinical trials, rather than relying on results from small samples, poorly designed studies, or studies with questionable credibility. The fact that nearly half of the potentially eligible trials were excluded indicates that the field urgently needs larger-scale, higher-quality, and more transparent randomized controlled studies in the future.
Meanwhile, the researchers also published another related randomized controlled trial evaluating whether a non-commercial, evidence-based IVF information website could help patients understand add-ons. The results showed that, compared with general online information, the website improved patients' understanding of the benefits, risks, and quality of evidence of IVF add-ons, and also increased information satisfaction.
This finding has practical significance. Research shows that 92% of IVF patients in Australia rely heavily on clinic websites for information, and more than 60% of patients use social media platforms such as Facebook and Reddit to assist treatment decisions. The researchers believe that when clinic websites and patient forums overemphasize the benefits of add-ons while ignoring costs and risks, it is difficult for patients to make truly informed choices.
Dr. David Barad from the Center for Human Reproduction in New York noted in an accompanying commentary that these studies demonstrate what evidence-based reproductive medicine should look like: treatment claims should be tested against credible clinical trial evidence, uncertainty should be clearly communicated rather than hidden behind optimistic language, and patient information should be treated as part of clinical intervention rather than as a marketing tool.
For patients considering IVF treatment, this study does not mean that all add-ons are absolutely useless, nor does it mean that no patient should use any add-on. Its more important reminder is that add-ons should not be automatically regarded as "helpful" simply because they are "available." Before accepting any add-on, patients should understand whether the procedure is supported by high-quality evidence, whether it truly improves live birth rates, which populations it is suitable for, what the potential risks are, what the costs are, and whether not using the procedure would affect the quality of standard treatment.
Clinicians and fertility centers also need to offer add-ons more cautiously. For procedures with insufficient evidence or unclear benefits, uncertainty should be fully explained, and vague language that reinforces patient expectations should be avoided. Especially when patients are under emotional and financial stress, healthcare institutions should ensure that recommendations are based on evidence rather than commercial gain or market competition.
Overall, this study has pressed the "evidence review button" on the use of IVF add-ons. In the field of assisted reproduction, what truly matters is not that more procedures are better, but that every additional intervention should withstand scrutiny by high-quality research. For patients, scientific, transparent, and individualized counseling may help them make appropriate treatment choices more than blindly stacking add-ons.
Story source:
Collected from the internet
Author LinkedIVF TeamPublished 2026-07-01
This article used AI assistance; LinkedIVF has not recorded an editorial review for this item. It is not medical advice.
This content is for informational purposes only and does not constitute medical advice. Please consult a licensed physician. Content guidelines & editorial policy
News | Most IVF add-ons lack evidence of fertility benefit, Lancet study urges cautious use
News | Most IVF Add-ons Lack Evidence of Fertility Benefit; Lancet Study Calls for Cautious Use
In assisted reproductive treatment, an increasing number of patients encounter so-called IVF "add-ons." These are additional procedures, medications, or laboratory techniques typically promoted as improving embryo implantation rates, pregnancy rates, or live birth rates. However, a recent systematic review and meta-analysis published in The Lancet Obstetrics, Gynaecology, & Women's Health shows that most common IVF add-ons lack sufficient evidence to demonstrate improved fertility outcomes for patients.
The study, conducted by researchers from the University of Melbourne in Australia and other institutions, aimed to comprehensively evaluate the effectiveness and safety of common IVF add-ons. The research team noted that IVF treatment itself already imposes significant financial, physical, and emotional burdens on patients, and the widespread use of add-ons further increases treatment complexity. Particularly in many countries, infertility care is primarily provided by private clinics with a high degree of commercialization; some add-ons are expensive, yet their actual benefits have not been adequately confirmed.
IVF, or in vitro fertilization, is an important treatment for many infertility patients. However, even with IVF, the chance of successfully having a baby per cycle is typically around 30% to 40%, and it declines significantly with increasing female age. It is against this backdrop of high expectations, high stress, and limited success rates that many patients hope to "increase their chances" through additional procedures. Over the past decade, IVF add-ons have proliferated rapidly, including pharmacological interventions, embryo testing, endometrial treatments, sperm selection techniques, and immune-related therapies.
The researchers pointed out that IVF add-ons are very commonly used in real-world clinical practice. More than 70% of IVF patients in Australia, New Zealand, and the United Kingdom report having used at least one add-on during their treatment. However, the problem is that when patients choose these procedures, they often face information asymmetry: clinic websites, social media, and patient forums may emphasize potential benefits while downplaying the quality of evidence, costs, and risks.
The study initially identified 157 potentially eligible randomized controlled trials. Because some trials in the field of reproductive medicine have credibility issues, the research team screened study quality using a trustworthiness assessment tool, ultimately excluding 72 trials due to credibility concerns. The researchers then pooled and analyzed the remaining 85 randomized controlled trials deemed credible, focusing on evaluating 10 IVF add-ons with high patient demand and widespread clinical use.
The analysis results showed that among the 10 categories of common add-ons, 7 showed no clear fertility benefit, or results were uncertain due to limited data or insufficient quality. These add-ons include acupuncture, corticosteroids, endometrial receptivity testing, intralipid infusion, intraovarian platelet-rich plasma injection, intrauterine platelet-rich plasma infusion, and preimplantation genetic testing for aneuploidy.
Among these, endometrial receptivity testing typically involves taking endometrial tissue samples to assess gene expression patterns, aiming to determine the so-called "optimal window" for embryo transfer; preimplantation genetic testing for aneuploidy is used to screen whether embryos have a normal number of chromosomes. Although these procedures are often portrayed with high expectations in marketing, this review concluded that current credible evidence is insufficient to support their use as routine add-ons to improve IVF fertility outcomes.
The study also found that 3 categories of add-ons had weaker evidence of potential benefit: EmbryoGlue, endometrial scratching, and physiological intracytoplasmic sperm injection. EmbryoGlue is an embryo transfer culture medium containing hyaluronic acid, a substance naturally present in the reproductive tract and thought to be potentially related to embryo implantation. The study showed it may increase the probability of pregnancy and live birth, but its effect on live birth rates was not robust.
Endometrial scratching is a minor procedure involving slight disruption or stimulation of the endometrium; the study found it may increase the probability of pregnancy and live birth. However, this evidence was still described as weak, meaning it is not yet sufficient to support routine recommendation for all patients. PICSI is a sperm selection technique that selects sperm potentially more mature and capable of fertilization based on their ability to bind to hyaluronic acid. This review showed that PICSI may reduce the risk of miscarriage, but this also constitutes weak evidence.
Study author Dr. Sarah Lensen from the University of Melbourne stated that infertility care is highly commercialized in many countries, and some add-ons are very expensive. She noted that this review found that most IVF add-ons evaluated lack evidence of actual benefit for patients. Unproven procedures may give patients false hope, additional financial strain, and unnecessary medical interventions, at a time when patients, already in a difficult phase of treatment, especially need clear, honest, and evidence-based information.
This study also highlights the importance of research quality in reproductive medicine. The research team emphasized that IVF add-ons should be based on credible, rigorous, and reproducible clinical trials, rather than relying on results from small samples, poorly designed studies, or studies with questionable credibility. The fact that nearly half of the potentially eligible trials were excluded indicates that the field urgently needs larger-scale, higher-quality, and more transparent randomized controlled studies in the future.
Meanwhile, the researchers also published another related randomized controlled trial evaluating whether a non-commercial, evidence-based IVF information website could help patients understand add-ons. The results showed that, compared with general online information, the website improved patients' understanding of the benefits, risks, and quality of evidence of IVF add-ons, and also increased information satisfaction.
This finding has practical significance. Research shows that 92% of IVF patients in Australia rely heavily on clinic websites for information, and more than 60% of patients use social media platforms such as Facebook and Reddit to assist treatment decisions. The researchers believe that when clinic websites and patient forums overemphasize the benefits of add-ons while ignoring costs and risks, it is difficult for patients to make truly informed choices.
Dr. David Barad from the Center for Human Reproduction in New York noted in an accompanying commentary that these studies demonstrate what evidence-based reproductive medicine should look like: treatment claims should be tested against credible clinical trial evidence, uncertainty should be clearly communicated rather than hidden behind optimistic language, and patient information should be treated as part of clinical intervention rather than as a marketing tool.
For patients considering IVF treatment, this study does not mean that all add-ons are absolutely useless, nor does it mean that no patient should use any add-on. Its more important reminder is that add-ons should not be automatically regarded as "helpful" simply because they are "available." Before accepting any add-on, patients should understand whether the procedure is supported by high-quality evidence, whether it truly improves live birth rates, which populations it is suitable for, what the potential risks are, what the costs are, and whether not using the procedure would affect the quality of standard treatment.
Clinicians and fertility centers also need to offer add-ons more cautiously. For procedures with insufficient evidence or unclear benefits, uncertainty should be fully explained, and vague language that reinforces patient expectations should be avoided. Especially when patients are under emotional and financial stress, healthcare institutions should ensure that recommendations are based on evidence rather than commercial gain or market competition.
Overall, this study has pressed the "evidence review button" on the use of IVF add-ons. In the field of assisted reproduction, what truly matters is not that more procedures are better, but that every additional intervention should withstand scrutiny by high-quality research. For patients, scientific, transparent, and individualized counseling may help them make appropriate treatment choices more than blindly stacking add-ons.
Story source:
Collected from the internet