IVF add-on treatments: a new analysis finds most have no effect on success

The majority of add-on treatments marketed to improve IVF success rates have no proven clinical effect, while imposing several thousand pounds of additional cost per cycle on patients, according to a comprehensive new review described by the Guardian on Tuesday. The work revives the tension between evidence-based medicine and the economics of private fertility clinics.

The review focused on roughly 30 add-on treatments that the United Kingdom's Human Fertilisation and Embryology Authority (HFEA) has evaluated over the years. Under HFEA's traffic-light system of green, amber and red ratings, only a portion of treatments showed strong positive evidence. The new analysis confirmed that, with the latest update, most add-on treatments remain in the red or amber categories.

One example is "endometrial scratching," a procedure marketed as helping the embryo attach more securely to the uterus. A meta-analysis combining multiple randomized controlled trials found the procedure did not produce a meaningful increase in live-birth rates. HFEA now lists the practice in the red category.

Another example is "embryo glue," promoted as helping the embryo adhere. According to the Guardian summary of the work, the existing evidence base is too limited by small studies and heterogeneous populations to support a reliable conclusion.

The cost of add-ons in private clinics outside the NHS can range from 200 to 1,500 pounds per treatment. An IVF cycle already averages 5,000 to 7,000 pounds. While patients in emotional distress may understandably reach for any option said to improve their chances, the review shows most of these additions are not scientifically supported.

Fertility Network UK chief executive Gwenda Burns told the Guardian: "We observe that, because people are going through an emotionally difficult process, they accept additional options readily when offered; but the scientific basis for those suggestions is not always strong." Burns added that clinics should communicate the evidence status clearly before recommending add-ons.

HFEA chair Julia Chain said in a statement that "evidence-based practice in fertility treatment is critical for reducing both the financial and emotional burden on patients." Under the updated HFEA guidance, the obligation for clinics to state the evidence rating for each add-on in patient information leaflets has been broadened.

The review also noted that some add-ons show benefits in contested subgroups. Endometrial receptivity assays (ERA), for instance, have shown a small benefit in certain populations, particularly patients who have had repeated failed cycles. The work emphasized, however, that even such targeted uses have not yet attained an evidence-based recommendation in general clinical practice.

The research also said the use of intracytoplasmic sperm injection (ICSI) outside cases involving male factor infertility should be reconsidered. Although ICSI has become a routine part of IVF in the United Kingdom over the years, the evidence level is not the same across all indications. HFEA recommends ICSI only for evidence-based indications.

While the NHS provides some funding for fertility treatment in the United Kingdom, the majority of cycles take place in private clinics. The study's authors called for greater transparency and regulatory oversight to help patients balance cost against evidence. The Guardian reported that complaints to HFEA have risen 18 percent in the last six months.