IVF add-ons are commonplace but have little evidence of increasing live birth rates

For over a decade I have becoming increasingly upset by the growing number of new treatments being marketed towards patients going through IVF, that have little or no evidence of increasing the chances of IVF success. The use of these IVF add-ons has now become a booming business but it is one of the most controversial aspects of fertility treatment. I am asked to debate this topic regularly – most recently last week at the CoGEN conference in Paris and next week at the COGI conference, also in Paris. The title of the debate next week is: Standard IVF vs Add-on IVF – What if the patient is willing to pay for add-ons? I will be debating against Simon Fishel.

I spent over 5 years going through IVF. I know the pain and torture of this journey. I sought out any treatment that might increase my chances of getting pregnant. Even I tried acupuncture and reflexology. 20 years ago very few studies had been done to show the effect of these treatments one way or another. I was desperate  – I thought I might as well give it a go.

I am now much more informed about the use of these add-ons and I am part of the Human Fertilisation and Embryology Authority (HFEA) committee that has produced a patient web site on IVF add-ons which summarises the studies that have been done. The HFEA web site uses a traffic light system, where green means there is more than one good quality randomised controlled trial which shows that the procedure is effective and safe, amber means there is a small or conflicting body of evidence, which means further research is still required and the technique cannot be recommended for routine use and red means there is no evidence to show that it is effective and safe. At our last HFEA meeting we have made many recommendations to update the web site, including providing more information for patients so that they can follow the studies that have been done and make a more informed choice.

I was one of the authors of a consensus statement which gives recommendations about the use of IVF add-ons: The responsible use of treatment add-ons in fertility services: a consensus statement. We concluded: “Combination of patient expectation, market forces and a recasting of the professional-patient relationship in an online information age appears to be driving the supply of, and demand for, treatment add-ons. Practitioners have a duty of care to patients, which should separate pressure from patients and commercial interests from their best practice advice. We believe that culture change is required, if the potential benefits of new treatments are to be offered responsibly. It’s time to have an open and honest conversation about treatment add-ons. This consensus statement sets out the principles of responsible innovation which
we believe should guide professionals in the UK.”

I have published three scientific papers on this topic and our most recent paper was published last week. Do à la carte menus serve infertility patients? The ethics and regulation of IVF add-ons concludes that “Because the effects of a treatment can’t be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients.”

Last week I took part in a panel discussion on solo motherhood at the UK’s Fertility Show. It was the first time I had attended as I had been told that there were a lot off add-on treatments being marketed to patients. I took 20 of my Masters students. What did we find? Stands selling Diana Royal Jelly, that will apparently give you a 95% chance of getting pregnant, horoscopes, reflexology, Chinese medicine, vitamins, essential oils that will restore your cellular health and one company saying they have a method that will rejuvenate your ovaries or testicles!

Some argue that the patients should decide if they want to pay for these unproven treatments. But my argument is that many people going through IVF will try anything that has the slightest chance of increasing their success rates and so we have to ensure they have the correct information. If your doctors tells you that there is a slim chance this or that treatment will improve your chances – you may well do it, if you can afford it. But IVF add-ons can hugely increase the cost of fertility treatment. I have heard that many couples only tried once as they spent all their money on add-ons. My argument when I am debating is – what does the doctor tell their patient?  Do they say there is evidence that the add-on will increase their chance of having a baby, or that there is no conclusive evidence?

What do you think? Should patients be able to pay for any treatment if they wish? How much should doctors tell their patients about the evidence?

The image is from the HFEA add-on web site showing assisted hatching. It has been given a red traffic light but almost 30% of UK IVF clinics advertise this on their web site and charge up to £600.