A major systematic review published in The Lancet Obstetrics, Gynecology, & Women's Health found that most commonly used IVF add-on treatments have not demonstrated convincing benefits for improving live birth rates, despite being widely marketed by fertility clinics. The findings challenge the routine use of procedures that patients often pay extra for, highlighting a significant gap between marketing claims and scientific evidence.

What Are IVF Add-On Treatments and Why Do Clinics Offer Them?

IVF add-ons are optional procedures offered alongside standard in vitro fertilization to theoretically improve success rates. An international team of researchers and clinicians conducted a systematic review and meta-analysis of 10 of these adjunctive interventions, excluding nearly half of available studies due to methodological limitations. The review examined treatments that fertility clinics commonly recommend to patients seeking to boost their chances of conception.

The most frequently offered add-ons include:

• Preimplantation Genetic Testing for Aneuploidy (PGT-A): Assesses the chromosomal makeup of embryos to avoid transferring those unlikely to result in a live birth
• Endometrial Receptivity Testing: Uses endometrial biopsy to determine the optimal timing for embryo transfer
• Endometrial Scratching: A superficial injury to the endometrium intended to trigger an inflammatory response believed to promote implantation
• Corticosteroids: Administered to modulate the endometrial immune response and reduce implantation failure risk
• EmbryoGlue: A hyaluronic acid-rich embryo transfer medium used during the transfer procedure

Which Add-Ons Actually Work?

The review's findings were disappointing compared to the marketing claims made by many fertility clinics. Neither PGT-A nor endometrial receptivity testing provided convincing evidence of improved live birth rates. Endometrial scratching showed only a modest increase in live births, and corticosteroids demonstrated no clinical benefit. EmbryoGlue also failed to show benefit in the analysis.

For other treatments, the evidence remains insufficient or of inadequate quality to draw reliable conclusions. These include acupuncture, intravenous lipid emulsion therapy intended to modulate the immune response during embryo implantation, and autologous platelet-rich plasma infusion into the ovaries or uterus. Physiological intracytoplasmic sperm injection, a sperm selection technique, may reduce the risk for miscarriage but has not been shown to increase live birth rates.

The researchers concluded that robust evidence supporting most add-ons currently offered to patients is lacking and that the field continues to rely largely on small, methodologically weak studies.

How Should Fertility Clinics Communicate With Patients About Add-Ons?

Experts emphasize that transparency is essential when discussing these treatments.

"Before a new treatment is introduced into clinical practice, it must undergo randomized clinical trials, and its efficacy and safety must be shown repeatedly. That is how evidence-based medicine works. Most of the add-on treatments currently offered to couples seeking pregnancy through assisted reproductive technology have not passed this scrutiny," said Andrea Borini, MD, specialist in reproductive medicine and former president of the Italian Society of Fertility, Infertility, and Reproductive Medicine.

Andrea Borini, MD, Specialist in Reproductive Medicine, IVI Center in Cattolica, Italy

Borini noted that it is acceptable to offer a procedure to patients while clearly explaining that some encouraging results have emerged but that data collection is still ongoing to evaluate effectiveness in a larger patient population.

"Transparency is essential, as emphasized in the informed consent document on this topic published by SIFES-MR in September 2025," Borini stated.

Andrea Borini, MD, Specialist in Reproductive Medicine, IVI Center in Cattolica, Italy

Borini also acknowledged a practical reality: couples often seek care at another center if turned down for a procedure they have heard about. As a result, accommodating these requests, provided they do not pose additional risks, has become common practice in Italy. Physicians therefore have a responsibility to provide honest advice, even when patients may find it disappointing, and to direct couples to reliable sources of information such as the UK Human Fertilisation and Embryology Authority website, which classifies common add-ons using a traffic-light system that summarizes the strength of evidence supporting their efficacy and safety.

What Resources Are Available to Help Patients Make Informed Decisions?

The authors of the review developed a dedicated website that independently summarizes the available scientific evidence on add-ons to help couples make informed decisions. A randomized clinical trial published in the same issue of The Lancet Obstetrics, Gynecology, & Women's Health showed that using the website improved patients' understanding of the potential benefits, possible risks, and the strength of the scientific evidence supporting each treatment compared with the information available on general websites.

This development reflects a broader shift in how IVF is being discussed and positioned. While IVF success rates have improved dramatically since the world's first IVF birth in 1978, with rates now approaching 50% for women under 35 due to better stimulation protocols and precision lab techniques, the field must balance innovation with evidence-based practice. The ability to freeze eggs and embryos at ultra-low temperatures without losing quality has also expanded reproductive options, allowing women to make intentional decisions about family planning that align with their career and life goals.

However, it is important to note that IVF is not a guaranteed insurance policy against age-related fertility decline. Reproductive medicine deals in probabilities, not certainties. Success still depends on age, health, embryo quality, and other factors. Women considering fertility preservation or IVF deserve honest information and realistic expectations about what these treatments can and cannot achieve.