Many 'add-on' treatments offered by fertility clinics to boost the chances of conception lack reliable scientific evidence and may even be detrimental to a woman's ability to conceive, according to a major review of existing research. These unproven procedures can lead to false hope, increased financial strain, and unnecessary medical interventions for women undergoing in vitro fertilization (IVF).
Natasha Whiting, 39, a patient who has undergone three failed IVF attempts, spent approximately £10,000 on various add-on treatments in addition to the £60,000 spent on IVF over four years. She opted for tests examining her uterus's microbiome and blood tests, which her private London fertility clinic recommended, costing over £2,000 for the microbiome analysis alone. However, these tests revealed no underlying issues impacting her fertility.
Last month, a review published in The Lancet Obstetrics, Gynaecology & Women’s Health found that over 70 percent of IVF patients now pay for such add-ons, the number of which has significantly increased in the past decade. Researchers concluded that most of these treatments do not improve conception rates and may even pose risks. "Unproven add-ons can lead to false hope, greater financial strain and unnecessary medical procedures at what already can be a very difficult time," said Dr. Sarah Lensen, a senior research fellow at the University of Melbourne and study author.
Unlike medications, most add-ons are not classified as drugs and therefore do not undergo the same rigorous clinical trials to prove their efficacy and safety. "They’re just products, out on the market with a small amount of data," stated Dr. Ippokratis Sarris, a consultant in reproductive medicine at King's College Hospital in London. Some procedures, such as platelet-rich plasma ovarian injections, which aim to improve egg quality and quantity, have not only lacked proven effectiveness but also carry risks like bleeding, infection, and ovarian scarring.
The global IVF market is estimated to be worth £18 billion annually, with a substantial portion derived from these add-on treatments, which critics have termed "a tax on hope." Vulnerable and desperate patients are often more susceptible to purchasing these unproven services. Dr. Sarris acknowledged that while the majority of doctors may genuinely believe they are helping patients, "Belief is not the same as fact. There is some bad practice that needs to be stamped out."
Regulating these treatments is challenging. The Human Fertilisation and Embryology Authority (HFEA) in the UK has limited authority to prevent clinics from offering add-ons and has requested further governmental oversight. Professor Tim Child, a reproductive medicine expert at the University of Oxford and on the HFEA board, noted that reforms are pending and described the situation as "a minefield."
Social media also plays a role, with unverified success stories on platforms like TikTok potentially influencing patient demand. Dr. Sarris spends considerable time advising patients against unnecessary treatments, yet many still request them. Doctors may also feel pressured to offer add-ons when patients are insistent, even if they have doubts about their effectiveness. "When the clinician maybe thinks there is no harm or no risk, and the patient really wants it, it’s easier to give in rather than spend 20 minutes explaining why they don’t want to," Dr. Lensen explained, adding that patients often feel guilt if they don't pursue every possible option.
Natasha, who runs a vitamin supplement business, initially pursued treatments like EMMA (Endometrial Microbiome Metagenomic Analysis) and ALICE (Analysis of Infectious Chronic Endometritis), which assess uterine bacteria. EMMA is graded 'grey' by the HFEA due to insufficient evidence. Another procedure, Endometrial Receptivity Array (ERA), has been graded 'red' as it may potentially reduce IVF success rates. She also underwent Preimplantation Genetic Testing for Aneuploidy (PGT-A) on nine embryos, costing £350 each, which is graded 'green' for reducing miscarriage but not for increasing live birth rates. Five embryos were deemed non-viable, leaving uncertainty about whether they could have resulted in a live birth.
Her first embryo transfer in January involved an additional £250 add-on called EmbryoGlue, which mimics natural womb fluids. While EmbryoGlue has weak evidence supporting it and is graded 'amber' by the HFEA, Professor Child highlighted a broader issue: "Because add-ons aren’t drugs, they can be sold with literally no evidence behind them at all."
Concerns about research integrity have also surfaced, with Dr. Lensen's review finding that some studies were excluded due to methodological flaws or untrustworthiness, including instances of fabricated data. "The patients don’t exist, the study was never done, but they want to get the credit and the promotion at their institution," she said.
Following her latest failed attempt in May, which left her experiencing pregnancy-like symptoms that ultimately proved unfounded, Natasha is now considering a drug to switch off her ovaries to minimize inflammation from her endometriosis. She and her partner have two remaining embryos but face continued uncertainty and expense in their pursuit of a family. "I can’t see an end," she stated, reflecting the ongoing struggle for closure faced by many undergoing fertility treatments.