There is a lack of evidence to suggest the majority of in vitro fertilisation (IVF) add-ons improve fertility in patients undergoing IVF, according to a systematic review and meta-analysis published in The Lancet Obstetrics, Gynaecology, & Women’s Health journal. There is weak evidence for some possible benefit from three IVF add-ons: EmbryoGlue, endometrial scratching, and physiological intracytoplasmic sperm injection.
Many people with infertility use IVF; however, the probability of having a baby following IVF is only approximately 30-40% per cycle [1] and decreases significantly with age.
Over the past decade, many ‘add-on’ therapies - extra procedures, medicines or techniques used in addition to standard IVF with the aim of increasing the chance of success - have become available. The use of IVF add-ons is widespread; more than 70% of IVF patients in Australia, New Zealand and the UK report using one or more add-ons during IVF treatment [2,3].
Author Dr Sarah Lensen, University of Melbourne (Australia), says, “In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add-ons are extremely expensive. Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients. 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. 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.”
There has been growing concern about the prevalence of problematic or untrustworthy randomised controlled trials within reproductive medicine, including those looking at IVF add-ons. The aim of this meta-analysis was to provide a comprehensive overview of the effectiveness and safety of ten common IVF add-ons, limited to high quality studies with no trustworthiness concerns [4].
Of 157 potentially eligible trials, 72 were excluded on trustworthiness grounds. Authors pooled data from the remaining 85 trials assessed to be trustworthy and looked at the effectiveness of ten widely used IVF add-ons for which patients have expressed a strong demand for evidence-based information.
The study found either no effect on fertility or inconclusive results due to limited or low-quality data for the following seven IVF add-ons:
The review found weak evidence of some possible benefit from three IVF add-ons:
To address the widespread availability and poor-quality information about IVF add-ons, Dr Lensen and her team developed the Evidence-based IVF website ( www.unimelb.edu.au/ivf ), providing patients with impartial, evidence-based information to help them make decisions about using IVF add-ons [5].
In a second study, also published in The Lancet Obstetrics, Gynaecology, & Women’s Health journal, a randomised controlled trial found the impartial website improved patients’ understanding of the benefits, risks, and evidence quality of IVF add-ons, compared to typical online information about these add-ons.
The study also found 92% of the IVF patients surveyed in Australia relied heavily on IVF clinic websites for information and more than 60% of patients reported using social media platforms such as Facebook and Reddit for information to guide their IVF decision-making.
Dr Lensen says, “There is widespread misinformation about IVF add-ons with private clinic websites and patient forums on social media - major information sources for patients - often overstating the benefits and omitting the costs and risks of add-ons. Our trial shows an evidence-based website, free from commercial interests, increased understanding and information satisfaction among IVF patients, addressing a clear unmet need. Although developed in Australia, the evidence is applicable to IVF patients globally and we hope to see this new resource endorsed and used by fertility specialists, clinics and patients around the world."
Previous IVF patient and author on the website trial, Deanna De Cicco says, "When you are going through IVF you can be so overloaded with conflicting information, add in some intense emotions and it can be almost impossible to make a properly informed decision. This website really helps by giving patients an easy way to access the facts in a digestible way, helping to guide them to make a well-informed personal choice.”
The researchers note some limitations of their studies, including recognising that the TRACT checklist used to measure trustworthiness in the meta-analysis has not been validated and it is possible that some of the excluded trials provide reliable data [4]. For the trial looking at the website, authors note that all participants were living in Australia, meaning there may be differences to other regions in characteristics such as education and health literacy, which may limit generalisability to other settings.
Writing in a linked Comment, Dr David Barad from Center for Human Reproduction, New York who was not involved in the study, says, “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.”
References:
The studies were funded by the University of Melbourne and the Australian National Health and Medical Research Council. The studies were conducted by researchers from the University of Melbourne and other universities and with people with lived experience of IVF (for a full list, see the paper).
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf . If you have any questions or feedback, please contact The Lancet press office at pressoffice@lancet.com.
Quotes from Authors cannot be found in the text of the Article but have been supplied for the press release. The Comment quote is taken directly from the linked Comment.
IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS.
Evidence Article: https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(26)00054-3/fulltext
Website Article: https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(26)00114-7/fulltext
Meta-analysis
People
Safety and effectiveness of ten common in-vitro fertilisation add-ons: a systematic review and meta-analysis
23-Jun-2026
Paper 1: SL declares a strong research interest in IVF add-ons and evidence-based medicine. She is the lead researcher behind the Evidence-Based IVF website, has published several systematic reviews and other publications relating to IVF add-ons, and is Co-ordinating Editor for the Cochrane Gynaecology and Fertility Group, as well as an Editor for Human Reproduction Open, Fertility and Sterility, and Trials. SL was funded by the Fertility Society of Australia and New Zealand to attend the annual conference (2025) to present on some of the work included in this Article. SL is Chair of the International IVF Add-ons Group. RW is supported by an National Health and Medical Research Council Emerging Leadership Investigator grant. RW is a Deputy Editor of Human Reproduction Update and a former Deputy Editor of Human Reproduction. CF and MVW are Co-ordinating Editors for the Cochrane Gynaecology and Fertility Group. All other authors declare no competing interests. Paper 2: