IVF Clinics Keep Selling Add-Ons Without Live Birth Proof

Most IVF add-ons lack proof they raise live birth rates, according to a Lancet review of 85 trials published on June 23, 2026.

The extras still sit on private clinic menus. In the UK, 73% of fertility patients used at least one additional test, treatment or emerging technology in their latest round of care.

Most Add-Ons Fail a Live-Birth Test

The systematic review of 85 trials in The Lancet Obstetrics, Gynaecology, & Women’s Health tested ten common extras against live birth, pregnancy and miscarriage. Lead author Dr Sarah Lensen, a senior research fellow at the University of Melbourne, and colleagues pooled only randomised trials that passed a trust screen.

Chance of a baby after IVF is about 30% to 40% per cycle and falls with age. That gap is the market. Add-ons are extra procedures, drugs or lab steps sold on top of a standard cycle in the hope of closing it.

Authors said three extras showed weak signs of possible benefit: hyaluronan transfer medium sold as EmbryoGlue, endometrial scratching, and physiological ICSI (PICSI). The other seven showed no effect, or the data were too thin or too poor to say.

TEN ADD-ONS AGAINST THE EVIDENCE

HFEA colours describe the chance of a baby for most patients. Yellow means the evidence conflicts. Black means no effect. Red flags safety worry or a possible drop in success. Grey means there is not enough good evidence to rate. Acupuncture sits off the regulator’s list because complementary therapy is not licensed as clinic treatment.

The Clinic Pitch Behind Most Extra Charges

The review said more than 70% of IVF patients in Australia, New Zealand and the UK report using one or more add-ons. That three-country figure is the authors’ own. A separate UK snapshot is sharper, and it names who does the selling.

The Human Fertilisation and Embryology Authority’s National Patient Survey of 1,500 people, fielded in September to October 2024 and issued in March 2025, found 73% had used an additional test, treatment or emerging technology. Private patients were far more likely to have done so than NHS-funded patients, 76% against 57%.

WHAT THE 1,500-PATIENT SURVEY SHOWED

• Clinic advice: 59% chose an extra because their clinic recommended it.
• Risk talk: Only 37% said the clinic explained the risks.
• After the pitch: 52% used an extra after the clinic had explained how well it works.
• Repeat cycles: Use rose from 62% after one cycle to 86% after five or more.

The most common extras in that survey were additional medicines or supplements (39%), acupuncture (27%) and time-lapse imaging (26%). Endometrial scratching fell from 24% in 2018 to 10% in 2024. PGT-A nearly doubled, from 7% in 2021 to 13% in 2024, mostly in people over 38.

Lensen has been tracking the sales channel for years. In 2021 her group found that 77% of 40 Australian clinic websites made unsubstantiated claims of benefit for add-ons. About 100,000 people go through IVF in Australia each year, and more than 20 different extras are on offer there.

Immune tests, ERA-style receptivity assays and PGT-A still generate clinic fees on thin live-birth data. Fear of regret does the rest. Once a first cycle fails, the next invoice is more likely to carry extras, which is exactly what the 62% to 86% split shows.

Why 72 Trials Never Reached the Pool

Of 157 trials that looked eligible, the authors threw out 72 on trustworthiness grounds and kept 85. They used the 19-item TRACT trustworthiness checklist, published in 2023 by Ben W. Mol and colleagues. Typical deal-breakers were conference abstracts with no full paper, and trials that were never registered in advance.

TRACT’S SEVEN DOMAINS

• Governance: Prospective registration, sample size and ethics sign-off.
• Author group: Track record, including retracted papers or an implausible flood of trials.
• Intervention: Whether the method is described well enough to repeat.
• Timeframe: Whether recruitment and publication dates are even possible.
• Drop-out rates: Losses that look too neat, including zero drop-outs.
• Baseline characteristics: Starting groups that do not look like real randomisation.
• Outcomes: Results that fail basic checks.

The authors said TRACT itself has not been validated, so some excluded trials might still hold up. The screen is still the point. A separate look at Cochrane infertility reviews found 132 of 324 trials, 40.7%, failed a TRACT-style check, and dropping them flipped the conclusion in about one in five comparisons.

Fertility research has a junk-trial problem. Clinics have been selling procedures off a literature that does not always survive a basic integrity pass.

Yellow Lights Have Not Cleared the Price List

None of this arrived in a vacuum. The UK regulator has been trying to cut add-on use since 2017. Its traffic-light tool was rebuilt in 2023. On the current UK regulator’s treatment add-on ratings page, last reviewed on September 28, 2026, still none of these common extras is green for raising the chance of a baby.

HOW THE RULES CAUGHT UP WITH THE MENU

1. 2017: The HFEA begins a public push to reduce add-on use, because almost all remain unproven for a live birth in most patients.
2. October 19, 2023: A consensus statement with professional and patient groups says treatments without strong evidence of safety or effect should be offered only in research, and patients should not be charged extra to take part.
3. March 2025: The national survey still finds 73% using an extra, and 59% doing so on clinic advice.
4. April 2025: Lensen’s team launches Evidence-based IVF, an independent patient site.
5. June 23, 2026: The Lancet review and a companion website trial are published.

The 2023 consensus already told clinics not to bill for unproven extras outside research. The 2026 paper is the evidence bill coming due. The ratings page, reviewed more than three months after publication, still shows yellow for scratching and EmbryoGlue, black for PICSI, and red for PGT-A, receptivity testing, steroids and PRP.

HFEA advice to self-pay patients is blunt. For most people, proven IVF or IUI without extras is the treatment that works. If you are paying, it may be better to fund another full cycle than to load one cycle with extras that have not been shown to help.

Independent Evidence Lowered Demand for Weak Extras

Lensen’s group did not stop at the review. They built an independent Evidence-based IVF website, funded by the University of Melbourne and the Australian National Health and Medical Research Council, with no clinic or drug-company ties. A second Lancet paper tested that site against typical Google-style clinic copy.

Between March 19 and April 6, 2025, 1,217 eligible Australian patients were randomised, 606 to the new site and 611 to control pages. 899 gave outcome data. People who saw the independent site understood benefits, risks, evidence quality and costs better than people who saw ordinary online copy. For extras with no proven benefit, including receptivity testing and intralipid, they were less willing to raise the add-on with a specialist.

In that Australian sample, 92% leaned heavily on clinic websites. More than 60% also used Facebook or Reddit. Lensen said clinic sites and forums often overstate benefits and skip costs and harms.

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.

Dr Sarah Lensen, University of Melbourne, Lancet news release

Deanna De Cicco, a previous IVF patient and a co-author on the website trial, said conflicting information plus intense emotion can make a clear choice almost impossible, and that the site gives the facts in a form people can actually use. Dr David Barad of the Center for Human Reproduction in New York, writing a linked comment, went further.

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, Center for Human Reproduction, New York, linked Lancet comment

Does Endometrial Scratching Raise Live Birth Odds?

Endometrial scratching was linked to a small rise in live birth, odds ratio 1.20 (95% CI 1.02 to 1.41, p=0.02), across 19 trials, with moderate-certainty evidence and I² of 39%. Authors said the procedure may also raise the chance of pregnancy. It is a brief lining injury, usually in the cycle before transfer, and it can cramp and spot.

That is the strongest live-birth signal in the set, and it is still small. HFEA keeps it yellow because other high-quality work has not agreed. Use has already fallen in the UK, from 24% to 10%.

EmbryoGlue is a hyaluronan-rich medium used at transfer. Authors said it may raise pregnancy and live birth odds, but the live-birth effect was not solid. The pooled live-birth odds ratio was 1.12 (0.91 to 1.37, p=0.29) from seven trials, low-certainty evidence. The confidence interval crosses 1.00, which is why the HFEA rating stays yellow rather than green.

PICSI selects sperm that bind hyaluronic acid. The review found weak evidence it may lower miscarriage. For live birth the single included trial gave an odds ratio of 1.12 (0.98 to 1.29, p=0.16), low certainty. The UK regulator rates PICSI black, meaning no effect, for people having ICSI for male-factor infertility. Those are different endpoints, and they should be read that way.

PGT-A, receptivity testing and corticosteroids had no live-birth benefit in the trustworthy trials (odds ratios 1.16, no pooled live-birth figure for receptivity testing, and 0.95). Acupuncture, intralipid and both PRP routes were inconclusive because the surviving data were scarce or very low certainty.

A Decade of Extras and Little Movement in Odds

Base IVF is already expensive. University Hospitals Coventry and Warwickshire, in a fee schedule from November 1, 2025, lists a self-pay IVF cycle at £3,510 plus a £100 HFEA fee, before drugs. The same sheet prices PICSI at £420, endometrial scratch at £240 without sedation and £450 with it, and time-lapse Embryoscope culture at £490.

ADD-ON FEES ON ONE NHS HOSPITAL LIST

• PICSI: £420 on top of ICSI.
• Endometrial scratch: £240 without sedation, £450 with sedation.
• Time-lapse culture: £490 for Embryoscope.

Manchester Fertility lists an endometrial scratch at £336. In Australia, IVF Australia’s schedule prices PGT-A at AU$770 per embryo, capped at AU$5,390, plus a AU$635 biopsy fee, with no Medicare rebate on that line. EmbryoGlue is bundled at no extra charge there, which is a reminder that the same extra can be a line item in one clinic and standard kit in another.

Lensen said some add-ons are extremely expensive, and that unproven extras bring false hope, extra cost and extra procedures at an already hard time. A specialist reading of Japanese registry data after the paper made a related point: add-on menus grew over a decade while headline success barely moved, and using extras is not proof a clinic is advanced.

The HFEA page reviewed on September 28, 2026 still rates none of these common extras green for a live birth. The science is now in a major journal. The invoices have not caught up.

Frequently Asked Questions

What Do the HFEA Green, Yellow, Grey, Black and Red Ratings Mean?

Green means high-quality evidence shows the add-on improves that outcome. Yellow means moderate or high-quality studies disagree. Grey means there is not enough moderate or high-quality evidence to rate it. Black means the better evidence shows no effect. Red means safety concerns, or the better evidence shows the add-on may reduce success. Ratings are set by the Scientific and Clinical Advances Advisory Committee and are reviewed when new evidence appears, or at least every five years. Some extras carry extra colours for miscarriage or for people over 40, on their individual pages.

What Is the TRACT Checklist Used in the Lancet Review?

TRACT is a 19-item screen with seven domains, built to flag randomised trials that may not be trustworthy. Each item is scored as no concern, some concern or major concern. Mol’s group published it in Research Integrity and Peer Review in June 2023. The IVF add-on authors used it to drop conference-only reports and trials that were not registered in advance, and they said the tool is not formally validated, so a dropped trial might still be sound.

How Is the Evidence-Based IVF Website Funded?

The site is hosted by the University of Melbourne and funded by the university and Australia’s National Health and Medical Research Council, with collaboration from Cochrane. Expert researchers are university academics who state they have no financial ties to Australian IVF clinics or companies. Lensen chairs the International IVF Add-ons Group and is the lead expert on the site, which was co-designed with patients and clinic staff and launched in April 2025.

Can Clinics Charge Patients Extra to Join Add-On Research?

The October 19, 2023 consensus between the HFEA and professional and patient bodies says treatments without strong evidence of safety or effectiveness should be offered only in a research setting, and that patients should not be charged extra to take part in research, including clinical trials. The Competition and Markets Authority has also issued consumer-law guidance for UK clinics that sell fertility treatment.

Disclaimer: This article is news reporting and analysis of published research and regulator data. It is for information only and is not medical advice, a fertility-treatment recommendation, or a substitute for a consultation. It does not tell anyone whether to start, continue or decline IVF or any add-on. Readers should speak with a qualified fertility specialist or reproductive-medicine consultant who knows their history before making treatment or payment decisions. Figures, ratings and trial results reflect the sources named above and may change as new studies appear.