Lancet review questions IVF add-ons as most show little proven benefit

A Lancet review found that most treatments added to IVF offer no clear fertility benefit. The findings sharpen concerns over high costs, weak evidence and patient misinformation.

In Short

• Researchers analysed 85 reliable trials after excluding 72 over credibility concerns
• Acupuncture, steroids, PRP and PGT-A showed no clear fertility benefit
• EmbryoGlue, endometrial scratching and PICSI showed only weak positive signals

A major international review has raised fresh questions about the effectiveness of many additional treatments commonly offered alongside in vitro fertilisation (IVF), finding that most of these “add-ons” either do not improve fertility outcomes or lack sufficient high-quality evidence to prove they work.

The findings, published in The Lancet Obstetrics, Gynaecology, & Women’s Health, are particularly significant for India, where infertility affects an estimated 2.8 crore people and around 3 to 3.5 lakh IVF cycles are carried out every year.

With IVF treatment already placing a substantial financial burden on families, the study is likely to spark discussions about the value and necessity of costly add-on procedures.

While the procedure has become a widely used treatment for infertility, success rates remain limited and, globally, the chance of having a baby after a single IVF cycle is estimated at around 30-40 percent, with success rates declining as women age, the latest study noted.

Over the past decade, fertility clinics have increasingly offered add-ons – extra procedures, medications or laboratory techniques intended to improve the chances of pregnancy.

These interventions often come at an additional cost and are widely used. More than 70 percent of IVF patients in countries such as Australia, New Zealand and the UK report using at least one add-on during treatment.

FEW POSITIVE SIGNALS

To evaluate whether these interventions actually help, researchers conducted a large systematic review and meta-analysis of randomised controlled trials. They examined ten commonly used IVF add-ons and assessed only studies considered trustworthy and of acceptable quality.

Out of 157 potentially eligible trials, researchers excluded 72 because of concerns over their reliability. The final analysis included 85 trials.

The review found either no fertility benefit or inconclusive evidence for seven commonly used add-ons. These include acupuncture, corticosteroids, endometrial receptivity testing, intralipid infusion, platelet-rich plasma (PRP) injections into the ovaries or uterus, and pre-implantation genetic testing for aneuploidy (PGT-A).

Researchers said the available evidence for these interventions was either too weak or too limited to support routine use.

The study identified only weak evidence suggesting possible benefits from three add-ons.

One of them is EmbryoGlue, a special embryo transfer medium containing hyaluronic acid, a naturally occurring substance in the reproductive tract. Researchers found it may improve the chances of pregnancy and live birth, although the evidence was not considered robust.

Another procedure, endometrial scratching, which involves gently disturbing the lining of the uterus before embryo transfer, showed some indication of improving pregnancy and live birth rates.

The third add-on, Physiological Intracytoplasmic Sperm Injection (PICSI), a sperm-selection technique, showed weak evidence of reducing miscarriage risk.

Study co-author Dr Sarah Lensen of the University of Melbourne said many fertility patients are paying for treatments that have not been adequately proven.

“In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add-ons are extremely expensive,” she said. According to her, the review found little evidence that most of the assessed add-ons provide meaningful benefits to patients.

She warned that unproven interventions can create false hope, increase financial pressure and expose patients to unnecessary medical procedures during an already emotionally challenging period.

INDIA'S COST BURDEN

The findings have special relevance for India, where IVF treatment is often paid for out of pocket.

A first-of-its-kind cost analysis published last year found that a single IVF cycle costs patients an average of around Rs 2.3 lakh in private hospitals and approximately Rs 1.1 lakh in public hospitals. Since many couples require multiple cycles before achieving a successful pregnancy, treatment expenses can quickly escalate.

Additional procedures and tests can further increase costs, making it crucial for patients to understand whether these interventions are supported by strong scientific evidence.

Dr Monika Gupta, Center Head at Kailash IVF, Noida, in response to query by India Today said that the treatment today is increasingly personalised, and several add-ons are used to address “specific clinical situations.

According to her, commonly used add-ons in India include PGT-A, EmbryoGlue, PICSI, Endometrial Receptivity Testing and, in selected cases, PRP-based therapies.

She explained that PGT-A is often recommended for women with recurrent pregnancy loss, repeated IVF failures or advanced maternal age, while PICSI may be considered in certain cases of male-factor infertility.

“The role and effectiveness of IVF add-ons can vary depending on the clinical indication and the patient’s specific circumstances,” Dr Gupta said. She emphasised that fertility specialists generally adopt a tailored approach and that treatment decisions should be individualised after consultation with experts.

Meanwhile, alongside the main review, researchers also published a second study examining whether patients can make better decisions when provided with clear, evidence-based information about IVF add-ons.

The team developed an independent website offering unbiased information on the benefits, risks and quality of evidence behind various IVF add-ons.

In a randomised controlled trial, patients who used the website demonstrated a better understanding of IVF add-ons than those who relied on standard online information. They also reported greater satisfaction with the information they received.

Dr Lensen said misinformation about IVF add-ons is widespread, with private clinic websites and social media forums often overstating benefits while downplaying risks and costs.

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