IVF add-ons: effectiveness, efficiency, safety, and additional costs - A position statement by the SIFES-MR

To critically appraise IVF add-ons, based on current evidence, international recommendations, and expert consensus from SIFES-MR.

Consensus developed by a multidisciplinary panel of Italian reproductive medicine experts over two years, based on clinical expertise, revision of guidelines from ESHRE, HFEA, ISAR, and ASRM, and additional more recent references retrieved from the literature. A list of statements was produced and agreed upon the panel using a Delphi consensus workflow. The manuscript was circulated to SIFES-MR executive committee and society members for final approval. Add-ons were categorized by their putative impact on IVF efficacy, efficiency, or safety. Cost justification and patient communication were also considered.

While some add-ons, such as preimplantation genetic testing for aneuploidies (PGT-A) in select patient populations, demonstrate potential clinical benefits, others lack sufficient evidence or pose safety concerns. Several interventions, including endometrial receptivity testing and mitochondrial DNA load measurement, are not currently recommended. Cost considerations and patient counseling are crucial.

The SIFES-MR panel underscores the importance of evidence-based practice in ART. Clear patient communication, fundamental research, and regulatory oversight are essential to ensure IVF add-ons provide real clinical benefits rather than unnecessary financial burdens.