A systematic review and meta-analysis of 85 clinical trials has evaluated the effectiveness of ten common additional procedures offered alongside in vitro fertilization (IVF). The study, published in The Lancet Obstetrics, Gynaecology & Women's Health, found that seven of the ten add-ons showed no measurable effect on fertility outcomes or were supported only by limited evidence. Weak evidence of possible benefit was identified for three add-ons.
Study Methodology
The research was led by Dr. Sarah Lensen and Dr. Sarah Henson of the University of Melbourne. The team reviewed data from 157 eligible trials, of which 72 were excluded due to trustworthiness concerns, resulting in a final analysis of 85 trials. The study evaluated ten commonly used IVF add-ons—additional procedures, tests, or medications offered alongside standard fertility treatment.
Add-Ons with No or Limited Evidence
The following seven add-ons showed no evidence of improving live birth rates or had inconclusive results:
- Acupuncture
- Corticosteroids (anti-inflammatory medication)
- Endometrial receptivity testing (biopsy of the uterine lining to assess gene expression)
- Intralipid infusion (soybean oil and egg yolk administered into the blood)
- Intraovarian injection of platelet-rich plasma
- Intrauterine infusion of platelet-rich plasma
- Pre-implantation genetic testing for aneuploidy (PGT-A)
Add-Ons with Potential Benefit
Three add-ons showed weak evidence of possible benefit:
- EmbryoGlue (hyaluronic acid transfer medium): May increase pregnancy and live birth rates, though findings on live birth were not robust.
- Endometrial scratching: Deliberate disruption of the womb lining before embryo transfer may increase pregnancy and live birth rates.
- Physiological intracytoplasmic sperm injection (PICSI): Showed weak evidence of reducing miscarriage risk.
Prevalence and Information Sources
According to the researchers' 2021 survey of 1,590 women, 82% had used an additional treatment alongside IVF. More than 70% of IVF patients in Australia, New Zealand, and the UK report using at least one add-on. Costs for these procedures range between $150 and $5,000.
The study found that patients rely heavily on fertility clinic websites and social media platforms for information. The researchers stated that these sources often overstate benefits and omit costs and risks. Dr. Lensen noted that many IVF clinics operate in a highly commercialized environment, and unproven add-ons can lead to false hope, financial strain, and unnecessary medical procedures.
Recommendations
The study authors recommend that clinics carefully consider whether it is appropriate to offer unproven add-ons, as their availability may be perceived as an endorsement of benefit. Fertility experts noted the findings align with existing knowledge and emphasized the need for informed consent. The researchers launched the Evidence-Based IVF website to provide independent, evidence-based information on add-ons.