IVF add-ons: Research finds expensive invasive fertility clinic extras don’t always help with pregnancy

Infertility now affects one in six Australian couples, leading more people to turn to IVF to have a baby. Australia has one of the highest rates of IVF uptake per capita in the world, with more than 100,000 cycles performed a year. That’s almost doubled since 2010 and now one in 16 babies born in Australia is conceived through IVF. But IVF success rates are relatively modest at an average 30 to 40 per cent per cycle, and out-of-pocket costs can run into thousands of dollars. There are various optional treatments, or add-ons, offered by fertility clinics or available in the community, that are aimed to boost the chance of success of IVF. But new Australian research has found there is little or no evidence that many of these add-ons – some of which are invasive and expensive – help women get pregnant or have a baby. Lead author Sarah Lensen, from the University of Melbourne’s Department of Obstetrics, Gynaecology and Newborn Health, said add-ons were often introduced after one or more failed IVF cycles. “When we’ve interviewed them (IVF patients) in our research before, they often speak about the desperation that they feel and how to some extent that can make them vulnerable to trying out experimental things,” she said. Dr Lensen said IVF add-ons were medicines, techniques and procedures that are used during an IVF cycle on top of the standard IVF process with the claim of increasing the chance of success. Around 90 per cent of IVF patients use one or more add-ons, the team’s research has found. SEE BELOW FOR 10 OPTIONAL IVF TREATMENTS REVIEWED In their systematic review and meta-analysis which was published in The Lancet last month, the researchers analysed the evidence for 10 common IVF add-ons from 85 trials and combined the results to give one answer for each one. The live birth of a baby was the primary outcome in the review. An important part of the research was to exclude trials that were deemed to be biased, low quality or untrustworthy, which equated to 46 per cent of studies initially identified. Co-author Rui Wang, a reproductive epidemiologist and senior research fellow at the University of Sydney, said there was growing concern about the trustworthiness of research, particularly in obstetrics and gynaecology. “There is an increasing trend of retraction of scientific research, especially assessing interventions in women’s health, and there has been estimation that one in four papers has integrity concerns,” he said. Dr Lensen said they found evidence of possible benefit for three common add-ons, but there was little or no evidence that the remaining seven increased the chance of a successful pregnancy. A procedure called endometrial scratching, which is intended to make the womb lining more receptive to an embryo implanting, was found to increase the chance of having a baby from IVF. Physiological intracytoplasmic sperm injection (PICSI) was found to reduce the chance of miscarriage but did not increase the chance of having a baby. PICSI involves the selection of sperm by its ability to bind to hyaluronic acid, which is a possible sign that it is mature enough to fertilise an egg. The selected sperm is then injected into the egg by an embryologist. In standard IVF, sperm and eggs are put together and left to fertilise by themselves. The third add-on that was found to have possible benefit was embryo glue. “This is a solution that the embryo can be dipped into for 30 minutes before the embryo transfer, with the hope it might help the embryo stick when it arrives in the uterus,” Dr Lensen said. The review found there was evidence of no benefit for three add-ons: endometrial receptivity testing, corticosteroids and preimplantation genetic testing for aneuploidy (PGT-A), They found the evidence was unclear for intralipids infusions, acupuncture, platelet-rich plasma (PRP) infusions in the uterus and PRP injections in the ovary. “Unclear is more like unknown. We don’t know,” Dr Lensen said. “There could be a benefit. There might not be a benefit. There could be harm. It’s basically a big question mark.” Roger Hart, a Professor of Reproductive Medicine at UWA, said the comprehensive review made fertility doctors and patients question why add-ons were offered. “Some of these interventions cost a good amount of money, so there must be a good rationale for doing it,” he said. Professor Hart, who is also medical director of Fertility Specialists of WA and national medical director of City Fertility, said the evidence base for IVF add-ons was low because relatively few studies had been done and they had been done with a small sample sizes. “For some things that we do quite a lot of, it would suggest that the evidence behind them is perhaps not as strong as we thought,” he said. But Professor Hart said some of the studies did not appropriately target those who could benefit from a particular add-on treatment for a specific problem, rather the studies covered the general IVF population. “There are some things that we do that do have a good place, despite the fact that it said the evidence behind them is not great,” he said. Professor Hart said a woman suffering serial miscarriages could get information as to why by genetically testing her embryos. And an older woman who produces more abnormal embryos could use genetic testing to select only the chromosomally normal ones to transfer. “Her time to pregnancy would be shorter. So effectively, we’re improving the efficiency of her IVF treatment. But that’s not showing up in the evidence at the moment,” he said. The endometrial receptivity test involves a biopsy of the womb lining to assess its responsiveness to an embryo. Doctors can use the results to find the best timing for an embryo transfer. Professor Hart said the test could help the small proportion of women who have a very narrow implantation window. “The doctor must have excluded all other reasons why the embryo would not implant before you drill down and therefore do that study,” he added. Professor Hart said his clinics did not offer PRP of the ovary or intralipids because he did not believe they were of any benefit. He encouraged women to consider acupuncture, which the research found to be of unknown benefit and the most commonly used IVF add-on treatment. “It doesn’t help fertility, but I strongly encourage patients who may feel they would get some benefit from it because there’s very good evidence for relaxation,” he said. When considering IVF treatment and any add-ons, Professor Hart advised people to avoid social media and see a fertility expert. Dr Lensen said there was not good evidence that IVF add-ons helped people to have a baby. “We need better evidence. We need to run these big trials to find out whether these add-ons actually work or not,” she said. “Ideally, we would get funding from independent government or charitable sources that are free from any commercial interests.” Dr Lensen said IVF patients were typically getting information that was unreliable or of variable quality from social media and fertility clinic websites. “Our solution was to create a resource for patients, somewhere they can go to get the facts about these different IVF add-ons and where they can use the information to make their own decisions,” she said. The Evidence IVF website has been available since April 2025 and had more than 250,000 visits from 130 countries. Sally Kinninmont and her husband Corey, from South Guilford, had been trying to conceive for three years when they turned to IVF. Mrs Kinninmont had been diagnosed with endometriosis and adenomyosis and her fertility doctor prescribed low dose steroids to reduce inflammation. After two failed embryo transfers, they began trying more add-ons in a bid to achieve a successful pregnancy, including aspirin, medication to improve her womb lining and an endometrial scratch and biopsy. A further two embryo transfers resulted in very early miscarriages. For the fifth transfer, Mrs Kinninmont took endometriosis medication Zoladex for three months beforehand and they used embryo glue for the transfer. It was successful and their daughter Mia, who is 21 months old, was born. Mrs Kinninmont advised others to research the different add-on treatments available to see what could help them. “If there’s any advice I could give, it is to just throw everything at it and to trial absolutely everything with each cycle that doesn’t work,” she said. 10 OPTIONAL IVF TREATMENTS REVIEWED Acupuncture Insertion of thin needles into specific points on the body. It has been proposed to increase blood flow, regulate hormones and reduce stress, aiding conception. The research found the evidence was unclear whether it increased the chances of a live birth with IVF. Corticosteroids Medications, such as prednisolone and dexamethasone, are used to suppress activity of a high number of, or overactive immune cells in the womb lining that are thought to prevent embryos implanting or causing them to miscarry. The research found there was evidence of no benefit of them increasing the chances of a live birth with IVF. Embryo Glue Embryos are transferred to a woman in a solution containing hyaluronic acid, which is found in the reproductive tract and considered important for embryo implantation. The research found there was evidence that it could increase the chances of a live birth with IVF. Endometrial receptivity testing A biopsy of the womb lining is taken to find the best time to do a frozen embryo transfer which could be earlier or later than the standard timing. The research found there was evidence of no benefit of it increasing the chances of a live birth with IVF. Endometrial scratching The womb lining is scratched because the resulting inflammation and immune response is thought to improve endometrial receptivity to an embryo. The research found there was evidence that the procedure increased the chances of a live birth through IVF. Intralipid infusion A liquid containing fats (soybean oil and egg yolk) is given intravenously and has been proposed to reduce the activity of immune cells in the endometrium that could be causing implantation failure and miscarriage. The research found the evidence was unclear whether the procedure increased the chances of a live birth through IVF. Physiological Intracytoplasmic Sperm Injection A technique used to select sperm on their ability to bind to hyaluronic acid, which might be a sign that the sperm is mature enough to fertilise an egg. The research found there was evidence that physiological intracytoplasmic sperm injection reduced the chance of miscarriage, but not the chance of getting pregnant. Platelet-rich plasma (PRP) injection into the ovary Made from the blood of the patient with more platelets than normal blood, it has been proposed to improve blood flow to the ovary and support egg quality. The research found the evidence was unclear whether it increased the chances of a live birth through IVF. PRP infusion into the uterus PRP gives extra proteins and growth factors, which are proposed to improve the womb lining before an embryo transfer. The research found the evidence was unclear whether it increased the chances of a live birth through IVF. Preimplantation genetic testing for aneuploidy (PGT-A) A screening test to check whether embryos are chromosomally normal so that only those ones are selected for transfer. The research found there was evidence of no benefit that it increased the chances of a live birth through IVF.