Most IVF Add-Ons Lack Proof They Boost Fertility, Study Finds

Seven of the ten most common IVF add-ons have no reliable evidence of improving fertility, according to a new systematic review and meta-analysis in The Lancet Obstetrics, Gynaecology & Women’s Health. The paper, published on 23 June 2026, pooled 85 high-quality randomised controlled trials and excluded 72 others on trustworthiness grounds, out of 12,398 search results screened. More than 70% of IVF patients in the UK, Australia and New Zealand pay for at least one add-on during treatment.

The lead author, Dr Sarah Lensen of the University of Melbourne, said infertility care in many countries is “highly commercialised” and that some add-ons are “extremely expensive” while failing to deliver proven benefit. Her team’s review is the first to filter IVF add-on studies through a formal trustworthiness screen, and it comes paired with a randomised trial showing that patients who used a new evidence-based website came away better informed than those reading typical search results.

What the Review Examined and What It Found

Researchers led by Dr Lensen, a senior research fellow at the University of Melbourne, reviewed the ten add-ons most widely requested by IVF patients in Australia, New Zealand and the UK. Of 157 potentially eligible trials, they excluded 72 on trustworthiness grounds, including studies published only as conference abstracts or lacking prospective trial registration, leaving 85 trials in the final pooled analysis. The headline finding: seven of the ten add-ons either showed no measurable effect on live birth or returned inconclusive results limited by poor-quality data. Only three add-ons showed weak evidence of possible benefit, each with significant caveats. The Lancet paper, titled “Safety and effectiveness of ten common in-vitro fertilisation add-ons,” was funded by the University of Melbourne and the Australian National Health and Medical Research Council.

The team’s use of the Trustworthiness in Randomised Controlled Trials (TRACT) checklist marked a departure from earlier reviews of IVF add-ons. Reproductive medicine has faced growing concern about suspect randomised trials, with separate estimates suggesting up to half of reproductive-medicine RCTs are unregistered or raise trustworthiness concerns. The authors used the checklist to filter out such studies before pooling data, and they acknowledge the TRACT itself has not been validated, leaving open the possibility that some excluded trials could still be reliable. The review focused on three outcomes patients care about most: pregnancy, live birth and miscarriage.

• More than 70% of IVF patients in Australia, New Zealand and the UK use at least one add-on
• 30-40% average IVF success rate per cycle
• 85 high-quality trials pooled out of 157 potentially eligible
• $810 million annual value of Australia’s assisted reproductive technology industry
• 100,000+ assisted reproductive technology cycles performed in Australia each year

The Seven Add-Ons That Showed No Fertility Benefit

Seven of the add-ons the researchers could assess failed to show any proven benefit for patients trying to conceive or carry a baby to term. They are sold to patients as ways to lift the odds of a live birth, often at substantial extra cost, and they are among the most popular requests at fertility clinics in the three countries surveyed. Across dozens of high-quality trials, the data either showed no measurable effect or was too thin to support a conclusion.

The researchers organised their findings by three patient-relevant outcomes: pregnancy, live birth and miscarriage. For each of the seven add-ons listed below, the pooled evidence was either empty or inconclusive on those measures. Several are well known to IVF patients by name, including acupuncture and corticosteroids. Others, such as intraovarian platelet-rich plasma injection, are newer and less familiar but increasingly marketed.

• Acupuncture: thin needles inserted at body points
• Corticosteroids: anti-inflammatory and immune-suppressing medication
• Endometrial receptivity testing: a biopsy of the uterine lining to read gene expression patterns
• Intralipid infusion: a soybean oil and egg yolk fat mixture given into the blood
• Intraovarian platelet-rich plasma injection: PRP made from a patient’s own blood, injected into the ovaries
• Intrauterine platelet-rich plasma infusion: PRP inserted into the uterus
• Pre-implantation genetic testing for aneuploidy (PGT-A): a screen for embryos with an abnormal chromosome count

Pre-implantation genetic testing for aneuploidy (PGT-A) has been one of the most heavily marketed add-ons in commercial IVF, particularly in markets where patients pay out of pocket. The Lancet review found the evidence for PGT-A improving live birth outcomes was inconclusive, and earlier non-trustworthy trials had inflated the apparent benefit. The intralipid infusion and the two platelet-rich plasma approaches have grown popular as regenerative add-ons, but the review found no reliable evidence that any of them improve outcomes. The authors note they cannot rule out small effects the trials were not powered to detect.

Dr Lensen summed up the patient implications directly. “Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients,” she said. She added that “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.” The team’s position is that offering these add-ons in the absence of evidence amounts to treating patients with unproven interventions at one of the most emotionally loaded moments of their lives.

Three Add-Ons Carrying Cautious Signals of Benefit

Three add-ons emerged from the review with some sign of possible benefit, though none with the kind of robust evidence that would change standard practice. The authors describe the support for all three as “weak,” meaning the underlying trials are limited, the results are not robust enough to confirm a real effect, or both. Two of the three, EmbryoGlue and endometrial scratching, showed some signal of raising pregnancy or live birth rates. The third, physiological intracytoplasmic sperm injection (PICSI), offered a possible reduction in miscarriage risk and no clear sign of a pregnancy gain.

The authors are careful to flag each caveat. For EmbryoGlue, the live birth effect did not survive robust analysis. For endometrial scratching, the trial pool was small and methodologically uneven, even though a single measure reached statistical significance. For PICSI, the miscarriage reduction signal rests on a narrow base of evidence and may apply most clearly to couples with male fertility issues, with little sign of benefit for the general IVF population.

Dr Devini Ameratunga, a Brisbane-based reproductive endocrinologist not involved in the study, said PICSI “could offer some benefit for patients with male fertility issues, but was unlikely to help clients with basic infertility problems.” Her clinic, like roughly three out of four Australian IVF clinics, offers some add-ons and absorbs the cost of EmbryoGlue itself. “I don’t think that this means add-ons can’t be offered, it just allows patients to have open eyes and informed consent,” she said. “The bottom line is that the majority of add-ons don’t have good evidence, so you need to be careful if using them.”

Why Clinics Keep Offering Add-Ons With Little Evidence Behind Them

Why does the gap between evidence and practice persist? Dr Lensen points to two forces acting at once: a commercialised fertility sector in which most clinics are privately run, and an information environment that tilts heavily toward optimism. The Australian assisted reproductive technology industry alone is worth about $810 million a year, and add-ons routinely inflate the headline cost of a cycle. About one in seven couples struggle to conceive in their lifetime, and many arrive at clinics after months or years of trying, primed to do whatever a clinician recommends.

IVF clinics and clinicians should carefully consider whether it is appropriate to offer unproven add-ons, as their availability is often perceived by patients as implicit endorsement of benefit.

Lensen, a senior research fellow at the University of Melbourne who led the new review, said misinformation about IVF add-ons is widespread, with private clinic websites and patient forums on social media often overstating the benefits and omitting the costs and risks. Patients, not clinicians, often drive the demand. Dr Ameratunga said the pressure typically flows the other way in her practice: patients arrive having read about add-ons on clinic websites or in social media forums and ask for them by name. A companion study published alongside the main review, accessible as the companion randomised trial of the new patient website, found 92% of IVF patients surveyed in Australia relied heavily on clinic websites for information, and more than 60% reported using social media platforms such as Facebook and Reddit to guide their decisions. The Lancet authors say the responsibility to close the information gap lies with clinics and clinicians, who decide which add-ons to put on the menu.

An IVF Patient’s $60,000 Bill, and the Evidence Behind It

Deanna Carr was 22 when she started IVF, the same age as many of her friends were travelling abroad. Over the next four years she had four egg collections, seven embryo transfers and saw multiple specialists, all while working through what she described as an isolating stretch of her life. One couple’s multi-year route to parenthood through fertility treatment offers a parallel picture of the years of attempts that can precede a baby. “While everyone was travelling Europe and doing all those great things, I was hanging out in IVF clinics,” she told the ABC. “It felt very isolating. None of my friends were going through the same thing.”

She and her husband were willing to try anything to lift their chances, even procedures that carried risks. That included add-ons such as acupuncture and an intralipid infusion, the latter giving her an allergic reaction. She later helped test and build the Evidence-based IVF website at the University of Melbourne and is listed as a co-author on the companion paper describing how patients responded to it. Looking back, Carr said it was “deflating” to know she had paid large sums for therapies not backed by strong evidence.

Carr estimates the total bill for her IVF treatments and add-ons came to about $60,000. In Australia, about 20,000 babies a year are born from IVF treatment, roughly one in 18 children, and the country’s assisted reproductive technology sector runs more than 100,000 cycles a year. Dr Lensen said the patient she remembers most clearly was one who told her “she was so desperate she would have chopped her arm off if it increased her chance of pregnancy,” a desperation she argued is part of why add-ons with little evidence behind them remain so widely available. Clinicians see it in clinic: Dr Genia Rozen, a gynaecologist and fertility specialist at Royal Women’s Hospital and Genea Fertility, said the choices IVF patients face are “emotional, expensive and time-sensitive.”

“If an add-on does not clearly improve the chance of having a baby, patients deserve to know that,” Dr Rozen said. “Good fertility care should support hope, but it should also be honest.” Carr and her husband welcomed a daughter, Amélie, ten months ago, after the long road, and the birth came at a price the data now suggest was inflated by unproven extras.

How the Field Is Responding to the New Evidence

The most direct response so far is the Evidence-based IVF website, hosted by the University of Melbourne and developed by Dr Lensen’s team. The site presents the evidence on each add-on for pregnancy, miscarriage and live birth, in language designed for patients and free from commercial ties. A randomised controlled trial published in the same Lancet issue reported that users of the site had a better understanding of the benefits, risks and evidence quality of add-ons than a control group who read high-ranking Google search results, with users saying they “felt worse” about add-ons afterwards.

These […] papers are a case study in what evidence-based fertility care ought to look like. Claims should be judged against trustworthy trials; uncertainty should be communicated clearly, not concealed beneath optimistic language; and patient information should be treated as part of the clinical intervention, not as a marketing accessory.

Dr David Barad of the Center for Human Reproduction in New York wrote the comment that accompanied the two studies. The authors are funded by the University of Melbourne and the Australian National Health and Medical Research Council, and Dr Lensen disclosed in the paper’s conflicts of interest section that she is Chair of the International IVF Add-ons Group and lead researcher behind the Evidence-based IVF website. Dr Lensen said the evidence is applicable to IVF patients globally, and that she hopes to see the resource endorsed and used by fertility specialists, clinics and patients around the world. In Australia, more than 100,000 IVF cycles begin each year, and the new review puts the evidence about what helps and what does not directly in front of patients planning their next cycle.

Frequently Asked Questions

What are IVF add-ons?

Extra procedures, medicines or techniques offered to patients on top of standard IVF, sold with the stated aim of raising the chance of pregnancy or live birth. Examples include acupuncture, corticosteroids, platelet-rich plasma injections and pre-implantation genetic testing for aneuploidy (PGT-A).

Which IVF add-ons were found to lack reliable evidence?

Seven of the ten reviewed: acupuncture, corticosteroids, endometrial receptivity testing, intralipid infusion, intraovarian platelet-rich plasma injection, intrauterine platelet-rich plasma infusion, and pre-implantation genetic testing for aneuploidy (PGT-A). Of 157 potentially eligible trials identified by the authors, 72 were excluded on trustworthiness grounds before any analysis of these seven began.

Which IVF add-ons showed some weak evidence of benefit?

Three: EmbryoGlue, endometrial scratching and physiological intracytoplasmic sperm injection (PICSI). The authors flag caveats for each, including that EmbryoGlue’s live birth effect did not survive robust analysis and that PICSI’s miscarriage reduction signal rests on a narrow base of evidence.

How many IVF patients use add-ons?

More than 70% in the UK, Australia and New Zealand, and at least 75% in Australia specifically, report using at least one add-on during IVF treatment, according to the University of Melbourne research team.

What did the Lancet authors recommend?

Dr Sarah Lensen and her co-authors said clinics and clinicians should carefully consider whether it is appropriate to offer unproven add-ons. They also pointed patients to the Evidence-based IVF website at the University of Melbourne for evidence on each add-on.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. IVF and fertility treatments carry medical, financial and emotional risks, and individual outcomes vary. Always consult a qualified fertility specialist before making decisions about treatment or add-ons. Figures and findings are accurate as of publication on 24 June 2026.