New Delhi: Most of the extra treatments commonly offered alongside in-vitro fertilisation (IVF) do not improve a couple’s chances of having a baby, according to review of evidence on the subject from Australia and Europe, published Tuesday in The Lancet Obstetrics, Gynaecology & Women’s Health.
IVF is a fertility treatment in which an egg is fertilised with sperm in a laboratory before the embryo is placed in the woman’s uterus.
The researchers looked at 10 of the most commonly used IVF “add-ons”. These are extra procedures, medicines or laboratory techniques that fertility clinics offer in addition to standard IVF, usually at an extra cost, in the hope of increasing the chances of pregnancy or a live birth.
IVF itself does not always work. On average, only about 30 to 40 percent of treatment cycles result in pregnancy, and the chances fall as a woman gets older. Because of these modest success rates, many couples choose to pay for add-ons that promise to improve their odds.
The review, which researchers have termed as the largest ever, found that seven of the ten add-ons either did not improve pregnancy or birth rates, or there was not enough reliable evidence to show that they worked.
The use of these treatments has grown rapidly around the world. More than 70 percent of IVF patients in Australia, New Zealand and the UK reported using at least one add-on during treatment.
“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,” said Dr Sarah Lensen of the University of Melbourne, who authored the study, funded by the Australian National Health and Medical Research Council and the University of Melbourne.
India’s fertility industry is also expanding quickly. The IVF market was valued at about $961 million in 2024 and is expected to reach nearly $1.5 billion by 2030, according to market research firm TechSci Research. The United Nations’ 2025 State of World Population Report estimates that around 27.5 million couples in India experience infertility.
Most add-ons failed to show benefit
The review found no convincing evidence that seven commonly used IVF add-ons improve a couple’s chances of getting pregnant or having a baby.
These included acupuncture, in which thin needles are inserted into the body; corticosteroids, medicines that reduce inflammation and suppress the immune system; endometrial receptivity testing, where a small sample from the lining of the uterus is tested to identify the best time to transfer an embryo; intralipid infusions, a fat-based liquid given through a drip in the hope of helping the embryo implant; and platelet-rich plasma (PRP), in which a patient’s own blood is processed and injected into the ovaries; or into the uterus in the hope of improving fertility.
The review also found no clear benefit from preimplantation genetic testing for aneuploidy (PGT-A), a test that checks embryos for an abnormal number of chromosomes before they are transferred to the uterus. Chromosomes carry a person’s genetic material, and embryos with too many or too few chromosomes are less likely to develop into a healthy pregnancy.
Dr Manisha Mehta, a Delhi NCR-based IVF specialist, obstetrician and gynaecologist with over two decades of experience in reproductive medicine, told ThePrint that PGT-A still has an important role in selected cases because it can help doctors avoid transferring an embryo with an abnormal number of chromosomes and may reduce the risk of miscarriage in older women. However, she cautioned that it does not improve live birth rates for all patients.
In the study, only three add-ons showed some evidence of helping patients.
One was EmbryoGlue, a special liquid used during embryo transfer that contains high levels of hyaluronic acid, a substance naturally found in the body that may help the embryo stick to the lining of the uterus.
Another was endometrial scratching, a procedure in which doctors make tiny scratches in the lining of the uterus before IVF in the hope of making it more receptive to an embryo.
The third was physiological intracytoplasmic sperm injection (PICSI), a technique that uses hyaluronic acid to select sperm that are believed to be more mature before one sperm is injected into an egg.
Even for these three treatments, researchers said the evidence was weak. EmbryoGlue showed the strongest results, but the benefit was still not strong enough to say with confidence that it improves the chances of having a baby.
Dr Mehta said the findings reflect what many fertility specialists have observed in clinical practice.
“EmbryoGlue and endometrial scratching show a modest signal, and they happen to be among the cheapest things we can offer. That tells you something important,” she said.
“The evidence is strongest for the interventions nobody is aggressively marketing. Meanwhile, the add-ons that inflate a patient’s bill the most, such as PGT-A and platelet-rich plasma (PRP), are the ones where the live-birth benefit either disappears or was never really there for the general patient.”
‘Add-ons driving costs’
According to Dr Mehta, private IVF sector add-ons can increase treatment costs by 30 to 60 percent without improving outcomes for most patients.
Dr Hitesha Ramnani Rohira, an IVF consultant at Kokilaben Dhirubhai Ambani Hospital in Mumbai, said the procedures are usually considered only after repeated IVF failures.
“We don’t offer all these add-ons as a first-line treatment to every patient,” she said. “If a patient has had two or three embryo transfers without conceiving, then we start looking at where the problem may be and whether any of these add-ons can improve her chances.”
She said EmbryoGlue may help embryos attach to the uterus, while endometrial scratching is thought to trigger changes in the uterine lining that may improve implantation in some women. PGT-A, she added, has also benefited some patients with repeated pregnancy losses.
India has no national registry tracking the use or outcomes of IVF add-ons, unlike the UK, where fertility treatments are monitored through a central database maintained by the Human Fertilisation and Embryology Authority (HFEA).
As a result, Dr Mehta said there is little reliable information on how widely these treatments are used or how well they work in Indian patients.
Dr Rohira agreed, saying data collection is largely left to individual clinics rather than any national body.
In a linked comment published alongside the review, Dr David Barad of the Center for Human Reproduction in New York, who was not involved in the study, said the paper shows how fertility care should be guided by evidence rather than marketing claims.
(Edited by Nida Fatima Siddiqui)
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