Most IVF “add‑on” treatments sold to patients hoping to improve their chances of having a baby are not backed by reliable evidence, fail to boost fertility and may be a complete waste of money, according to the largest study of its kind. The comprehensive meta‑analysis, published in The Lancet Obstetrics, Gynaecology & Women’s Health, examined ten common optional extras offered alongside standard IVF and found that seven show either no effect on fertility or inconclusive results due to limited or low‑quality data. Only three add‑ons showed weak evidence of possible benefit, and even those findings were not robust.
The review, led by researchers at the University of Melbourne, analysed 85 high‑quality randomised controlled trials after excluding 72 of 157 potentially eligible trials on trustworthiness grounds – a reflection of mounting concern about suspect or untrustworthy research in reproductive medicine. Take‑up of add‑ons is widespread: more than 70% of IVF patients in the UK, Australia and New Zealand pay for at least one extra procedure, medicine or technique during their treatment.
Dr Sarah Lensen of the University of Melbourne, the study’s lead author, said: “In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add‑ons are extremely expensive. Our review finds a lack of evidence that most of the IVF add‑ons we assessed provide any benefit to patients. Unproven add‑ons can lead to false hope, greater financial strain and unnecessary medical procedures at what already can be a very difficult time for patients.”
The seven add‑ons for which the researchers found no reliable evidence of benefit are:
Acupuncture – inserting thin needles into points on the body.
Corticosteroids – medication to reduce inflammation and suppress immune system activity.
Endometrial receptivity testing – a biopsy of the uterine lining to assess gene expression patterns.
Intralipid infusion – a liquid containing fats administered into the blood.
Intraovarian injection of platelet‑rich plasma – injecting platelet‑rich plasma into the ovaries.
Intrauterine infusion of platelet‑rich plasma – insertion of platelet‑rich plasma into the uterus.
Pre‑implantation genetic testing for aneuploidy (PGT‑A) – a screening test to check whether embryos have the expected number of chromosomes.
The review also found only weak evidence of some possible benefit for three further add‑ons. EmbryoGlue, an embryo transfer medium containing hyaluronic acid, may increase the probability of pregnancy and live birth, but the effect on live birth rates was not robust. Endometrial scratching, a minor procedure that disturbs the lining of the uterus, may increase the probability of pregnancy and live birth. Physiological intracytoplasmic sperm injection (PICSI), a technique used to select sperm based on their ability to bind to hyaluronic acid, showed weak evidence that it may lower the risk of miscarriage.
Patients are increasingly exposed to misleading claims about these treatments, Dr Lensen warned. “There is widespread misinformation about IVF add‑ons with private clinic websites and patient forums on social media – major information sources for patients – often overstating the benefits and omitting the costs and risks of add‑ons. IVF clinics and clinicians should carefully consider whether it is appropriate to offer unproven add‑ons, as their availability is often perceived by patients as implicit endorsement of benefit.”
In the UK, the Human Fertilisation and Embryology Authority (HFEA) regulates IVF treatment and has introduced a “traffic light” rating system to help patients understand the evidence behind add‑ons. Currently, no add‑on has received a green light – meaning proven safe and effective for most patients. All add‑ons assessed by the HFEA have been rated as either amber (conflicting or limited evidence) or red (no evidence of effectiveness or potential safety concerns). In October 2023, the HFEA, together with patient and professional bodies, re‑affirmed that add‑ons without strong evidence of safety and effectiveness should only be offered in a research setting. Clinics are required to provide clear information about the clinical evidence, costs and risks of add‑ons. Separately, the Competition and Markets Authority (CMA) has developed guidance on consumer law for UK IVF clinics, specifically addressing the advertising of add‑ons.
The financial burden of these unproven treatments is substantial. Advertised IVF packages in the UK average around £3,850, but the true cost, including medication and standard add‑ons, can reach £6,939 or more. Specific add‑on costs vary widely: ICSI can cost £800 to £1,200 (average £1,375 per cycle in 2025‑26); blastocyst culture £500 to £700; EmbryoGlue £130 to £360; endometrial scratching around £200; PGT‑A between £2,000 and £3,000; endometrial receptivity testing £950 to £1,250; and intravenous immunoglobulin (IVIg) £2,200. Patients have reported remortgaging homes or borrowing money to fund these extras, leading to significant debt. Some professionals have expressed discomfort about charging patients for add‑ons, particularly when the cost of the technology is already covered by the clinic, raising ethical concerns that certain clinics may use add‑ons for financial gain.
Patients undergoing fertility treatment are often in a vulnerable state, driven by desperation to try everything that might increase their chances. The research notes that a significant proportion of add‑on use is driven by clinician offers rather than patient requests, and that patients often interpret a clinic’s willingness to offer a treatment as an endorsement of its benefit. Those who have already experienced unsuccessful IVF cycles are more likely to invest in add‑ons, hoping for a better outcome. For many, however, experts suggest that spending money on multiple standard IVF cycles may be more effective and affordable than using unproven add‑ons in a single cycle. Alternatives such as intrauterine insemination (IUI), ovulation induction with fertility medications, or surgery for conditions like endometriosis or fibroids may also be considered before or instead of IVF.