Clinical pregnancy rates after IVF treatment seem to have been stabilising around the unimpressive rate of 36%, according to the European IVF-Monitoring Consortium for the European Society of Human Reproduction and Embryology ⁽¹⁾.

Despite technological advances in laboratory techniques and quality assurance implementation, efficacy of IVF still remains low, highlighting the need to introduce new interventions if we are to overcome current success rates. IVF add-ons are optional extras commonly used to provide a boost in IVF success rates, including extra procedures, medicines, or lab techniques.

It is interesting that still there isn’t a universally accepted list of add-ons, with numbers ranging from a few to dozens. Examples include use of corticosteroids, aspirin, heparin, endometrial scratch, time lapse technology in the IVF lab and pre-implantation genetic testing of embryos. While patients are actively seeking information on several add-ons and IVF clinics frequently provide a range of these, it is important to highlight that robust research studies looking at safety and efficacy are often missing ⁽²⁾.

In this context, it is highly encouraging that different professional bodies are taking an active interest in the use of IVF add-ons, aiming to communicate currently available information for involved parties in an impartial and independent manner. This is not an easy task and it is likely to take some time before we see add-ons rating systems that are patient-friendly.

A recent development in the field of IVF add-ons is a different approach in evaluating success of such interventions, incorporating other, previously underestimated, parameters, such as miscarriage rate, time to pregnancy and others ⁽³⁾.

While in anticipation of more data on safety and effectiveness for all kind of different add-ons, it is important for ART professionals to approach requests for add-ons with responsibility, allowing patients voices to be heard, but at the same time, highlighting current limitations in the use of IVF add-ons. Shared-decision making by health professionals and patients should be the way forward in all similar situations.

1. ART in Europe, 2017: results generated from European registries by ESHRE, Human Reproduction Open, Vol.00, No.0, pp. 1–17, 2021 doi:10.1093/hropen/hoab026
2. Evidently Cochrane. IVF add-ons: the latest Cochrane evidence, October 2020.
3. “Adding Up What We Know: A Global Perspective on Fertility Treatment Add-Ons” The Progress Educational Trust, 2022.

©2021, Nicholas Christoforidis, Fertility Matters
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