In vitro fertilization add-ons for the endometrium: it doesn’t add-up
There is no robust evidence to support the use of in vitro fertilization add-ons targeting the endometrium, many of which are costly and carry a risk of harm.
Volume 112, Issue 6, Pages 987–993
Sarah Lensen, Ph.D., Norman Shreeve, B.M.B.S., Kurt T. Barnhart, M.D., M.S.C.E., Ahmed Gibreel, M.D., Ernest Hung Yu Ng, M.D., Ashley Moffett, M.D.
The probability of live birth from an in vitro fertilization (IVF) cycle is modest. Many additional treatments (add-ons) are available which promise to improve the success of IVF. This review summarizes the current evidence for common IVF add-ons which are suggested to improve endometrial receptivity. Systematic reviews of randomized controlled trials and individual trials were included. Five add-ons were included: immune therapies, endometrial scratching, endometrial receptivity array, uterine artery vasodilation, and human chorionic gonadotropin instillation. The results suggest there is no robust evidence that these add-ons are effective or safe. Many IVF add-ons are costly, consuming precious resources which may be better spent on evidence-based treatments or further IVF. Large randomized controlled trials and appropriate safety assessment should be mandatory before the introduction of IVF add-ons into routine practice.