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In vitro fertilization add-ons for the endometrium: it doesn't add-up
Sarah Lensen1, Norman Shreeve2, Kurt T Barnhart3
1Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.
Fertility and Sterility
|December 18, 2019
Summary
Evidence for common in vitro fertilization (IVF) add-ons to improve endometrial receptivity is lacking. These costly treatments may not be effective or safe, warranting caution before routine use.
Area of Science:
- Reproductive Medicine
- In Vitro Fertilization (IVF) Research
- Embryology and Implantation Science
Background:
- Live birth rates from IVF cycles remain modest.
- Numerous "add-on" treatments are marketed to enhance IVF success.
- Focus on add-ons targeting endometrial receptivity.
Purpose of the Study:
- To review the evidence for common IVF add-ons.
- To assess their impact on endometrial receptivity.
- To evaluate safety and efficacy.
Main Methods:
- Systematic reviews of randomized controlled trials (RCTs).
- Inclusion of individual RCTs.
- Analysis of five specific add-ons: immune therapies, endometrial scratching, endometrial receptivity array, uterine artery vasodilation, and human chorionic gonadotropin (hCG) instillation.
Main Results:
- No robust evidence supports the effectiveness or safety of the reviewed IVF add-ons.
- Current data suggests these interventions do not reliably improve outcomes.
- Potential for significant financial cost without proven benefit.
Conclusions:
- The efficacy and safety of common IVF add-ons are not well-established.
- Costly add-ons may divert resources from proven treatments.
- Mandatory large RCTs and safety assessments are needed before routine implementation.
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