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 typically promoted as additional procedures, medications, or laboratory techniques that can improve embryo implantation rates, pregnancy rates, or live birth rates. However, a latest 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 prove they improve patient fertility outcomes.
Conducted by researchers from the University of Melbourne in Australia and other institutions, the study aimed to comprehensively evaluate the effectiveness and safety of common IVF add-ons. The research team noted that IVF treatment itself already imposes high 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 fully substantiated.
IVF, or in vitro fertilization, is an important treatment for many infertility patients. However, even with IVF, the probability 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 pressure, and limited success rates that many patients hope to "increase their chances" through additional procedures. Over the past decade, IVF add-ons have rapidly proliferated, including drug interventions, embryo testing, endometrial treatments, sperm selection techniques, and immune-related therapies.
Researchers pointed out that IVF add-ons are very commonly used in real-world clinical practice. Over 70% of IVF patients in Australia, New Zealand, and the UK reported using at least one add-on during their treatment. However, the problem is that when patients choose these add-ons, 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.
This study initially identified 157 potentially eligible randomized controlled trials. Due to credibility issues with some trials in the field of reproductive medicine, the research team used a trustworthiness assessment tool to screen study quality, 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 that are in high demand among patients and widely used clinically.
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 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 embryos for normal chromosome numbers. Although these add-ons are often marketed with high expectations, 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 three 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 found in the reproductive tract and thought to be related to embryo implantation. The study showed it might 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 might 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 based on their ability to bind to hyaluronic acid, potentially identifying more mature sperm capable of fertilization. This review indicated that PICSI might 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 in many countries is highly commercialized, and some add-ons are very expensive. She noted that this review found that most of the evaluated IVF add-ons lack evidence of providing actual benefit to patients. Unproven add-ons may give patients false hope, additional financial pressure, and unnecessary medical procedures, especially during an already difficult stage of treatment when patients particularly 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, not on results from small samples, poorly designed studies, or those with questionable credibility. The exclusion of nearly half of the potentially eligible trials indicates an urgent need for larger, higher-quality, and more transparent randomized controlled studies in this field in the future.
Concurrently, 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 to general online information, the website improved patients' understanding of the benefits, risks, and quality of evidence for IVF add-ons, as well as their satisfaction with the information.
This finding has practical significance. The study showed that 92% of IVF patients in Australia heavily rely on clinic websites for information, and over 60% use social media platforms like Facebook and Reddit to aid treatment decisions. Researchers believe that when clinic websites and patient forums overemphasize the benefits of add-ons while ignoring costs and risks, it becomes very difficult for patients to make truly informed choices.
Dr. David Barad from the Center for Reproductive Medicine in New York commented in the same issue that these studies demonstrate what evidence-based reproductive medicine should look like: treatment claims should be tested against credible clinical trial evidence, uncertainties should be clearly communicated rather than hidden under optimistic language, and patient information should be considered part of clinical intervention, not a marketing tool.
For patients considering IVF treatment, this study does not mean that all add-ons are absolutely useless or that no patient should use them. Its more important reminder is that add-ons should not be automatically considered "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 cost is, and whether not using the add-on would affect the quality of standard treatment.
Clinicians and fertility centers also need to be more cautious in offering add-ons. For procedures with insufficient evidence or unclear benefits, uncertainties should be fully explained, avoiding vague language that reinforces patient expectations. Especially when patients are under emotional and financial stress, healthcare institutions should ensure recommendations are based on evidence, not on 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 from high-quality research. For patients, scientific, transparent, and personalized counseling may help them make more appropriate treatment choices than blindly stacking add-ons.
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Published 2026-07-01
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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 typically promoted as additional procedures, medications, or laboratory techniques that can improve embryo implantation rates, pregnancy rates, or live birth rates. However, a latest 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 prove they improve patient fertility outcomes.
Conducted by researchers from the University of Melbourne in Australia and other institutions, the study aimed to comprehensively evaluate the effectiveness and safety of common IVF add-ons. The research team noted that IVF treatment itself already imposes high 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 fully substantiated.
IVF, or in vitro fertilization, is an important treatment for many infertility patients. However, even with IVF, the probability 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 pressure, and limited success rates that many patients hope to "increase their chances" through additional procedures. Over the past decade, IVF add-ons have rapidly proliferated, including drug interventions, embryo testing, endometrial treatments, sperm selection techniques, and immune-related therapies.
Researchers pointed out that IVF add-ons are very commonly used in real-world clinical practice. Over 70% of IVF patients in Australia, New Zealand, and the UK reported using at least one add-on during their treatment. However, the problem is that when patients choose these add-ons, 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.
This study initially identified 157 potentially eligible randomized controlled trials. Due to credibility issues with some trials in the field of reproductive medicine, the research team used a trustworthiness assessment tool to screen study quality, 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 that are in high demand among patients and widely used clinically.
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 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 embryos for normal chromosome numbers. Although these add-ons are often marketed with high expectations, 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 three 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 found in the reproductive tract and thought to be related to embryo implantation. The study showed it might 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 might 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 based on their ability to bind to hyaluronic acid, potentially identifying more mature sperm capable of fertilization. This review indicated that PICSI might 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 in many countries is highly commercialized, and some add-ons are very expensive. She noted that this review found that most of the evaluated IVF add-ons lack evidence of providing actual benefit to patients. Unproven add-ons may give patients false hope, additional financial pressure, and unnecessary medical procedures, especially during an already difficult stage of treatment when patients particularly 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, not on results from small samples, poorly designed studies, or those with questionable credibility. The exclusion of nearly half of the potentially eligible trials indicates an urgent need for larger, higher-quality, and more transparent randomized controlled studies in this field in the future.
Concurrently, 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 to general online information, the website improved patients' understanding of the benefits, risks, and quality of evidence for IVF add-ons, as well as their satisfaction with the information.
This finding has practical significance. The study showed that 92% of IVF patients in Australia heavily rely on clinic websites for information, and over 60% use social media platforms like Facebook and Reddit to aid treatment decisions. Researchers believe that when clinic websites and patient forums overemphasize the benefits of add-ons while ignoring costs and risks, it becomes very difficult for patients to make truly informed choices.
Dr. David Barad from the Center for Reproductive Medicine in New York commented in the same issue that these studies demonstrate what evidence-based reproductive medicine should look like: treatment claims should be tested against credible clinical trial evidence, uncertainties should be clearly communicated rather than hidden under optimistic language, and patient information should be considered part of clinical intervention, not a marketing tool.
For patients considering IVF treatment, this study does not mean that all add-ons are absolutely useless or that no patient should use them. Its more important reminder is that add-ons should not be automatically considered "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 cost is, and whether not using the add-on would affect the quality of standard treatment.
Clinicians and fertility centers also need to be more cautious in offering add-ons. For procedures with insufficient evidence or unclear benefits, uncertainties should be fully explained, avoiding vague language that reinforces patient expectations. Especially when patients are under emotional and financial stress, healthcare institutions should ensure recommendations are based on evidence, not on 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 from high-quality research. For patients, scientific, transparent, and personalized counseling may help them make more appropriate treatment choices than blindly stacking add-ons.
Story Source:
Online Collection