You might be offered extra fertility treatments if you’ve had previously failed IVFs or investigations suggest they might help, these are called ‘Add-ons’. The difficulty for patients having IVF is that these treatments are not supported by robust evidence and may not add any benefit to your IVF, could be harmful or might just work. We often do not know; so as a patient you are relying on the expertise of your clinic.
The UK’s regulator of IVF clinics (HFEA) has devised a simple traffic light system to help you decide. But it only looks at the evidence to show that they are effective at improving the chances of having a baby for most fertility patients and not whether it will help in your particular situation. If just one randomised controlled trial says it’s ok and improves the chances of having a baby for most patients, the HFEA gives it a green light. If only acupuncture research was afforded such generous largess. I digress. The point is, who are the patients it doesn’t work for and are you one of them? The green-light treatments aren’t even then listed as an add-on.
At a recent Progress Educational Trust seminar (2022), Peter Thompson, Chief Executive of HFEA said that Intracytoplasmic sperm injection (ICSI) was not listed as an add-on because there was evidence it worked to improve chances where sperm was of poor quality and he was reassured that “the use of ICSI in 50% of IVF procedures by clinics was close to the proportion of infertility due to the man”. Leading aside whether the statistics are even accurate for a moment, in my practice I see ICSI offered in IVF to try and bypass poor sperm (shape, count, motility) but no investigation of the sperm DNA is made. The quality of the DNA is what will lead to a healthy pregnancy and baby. So the question arises, is it really a bypass and shouldn’t clinics be investigating why the sperm is suboptimal in the first place rather than subjecting the woman to huge doses of hormones?
Questions to Ask
If your clinic offers you an add-on, you’ll need to weigh the financial cost versus the perceived benefits of the add-on against having more rounds of IVF (average of 3 for success). It might be better to save your money to have more cycles than have the add-on. Consult the HFEA’s traffic light system, as a start, and then ask your fertility consultant these questions:
- Will it improve my chance of success?
- What are the risks?
- What if I do nothing?
- Are there simpler, safer, less expensive options?
- Why is it offered by a limited number of clinics?
- What does the data show?
- Can this data be related to me?
Add-ons (amber & red) 2022
Adding calcium to the egg, assisted hatching, freeze all cycles, endometrial receptivity array, endometrial scratching, embryo glue, immune testing and treatments, IMSI, intrauterine culture, PICSI, PCT-A, time-lapse imaging.