Good practice recommendations on add-ons in reproductive medicine†

Area of Science:

• Reproductive Medicine and Endocrinology
• Assisted Reproductive Technology (ART)

Background:

• Fertility treatments increasingly incorporate 'add-ons'—supplementary options beyond standard procedures.
• These add-ons, including tests, drugs, and therapies, aim to improve pregnancy rates, reduce miscarriage, or expedite conception, often at an additional cost.
• The widespread use of add-ons necessitates clear guidance on their safety and efficacy.

Purpose of the Study:

• To develop clinically relevant, evidence-based recommendations on the safety and efficacy of ART add-ons.
• To enhance the quality of care for patients undergoing infertility treatment.
• To guide healthcare professionals and inform patient decision-making regarding ART add-ons.

Main Methods:

• A European multidisciplinary working group, including clinicians, embryologists, researchers, and patient representatives, was convened by ESHRE.
• A systematic literature search was conducted, followed by critical appraisal of identified studies.
• In the absence of robust evidence, recommendations were based on professional experience and expert consensus, reviewed by 46 international experts.

Main Results:

• Forty-two recommendations were formulated across three categories: diagnosis, laboratory interventions, and clinical management.
• None of the recommendations were based on high-quality evidence; only four were supported by moderate-quality evidence.
• The vast majority (95%) of recommendations rely on low-quality evidence, observational data, or expert consensus.

Conclusions:

• The current evidence base for most ART add-ons is limited, with recommendations largely based on expert opinion.
• Guidelines aim to promote safe and effective ART, ensuring patients make informed decisions with realistic expectations.
• Healthcare professionals should utilize these guidelines to navigate the use of add-ons in infertility treatment.