Fertility Add-Ons: Hope, Hype, and Hard Truths

Disclaimer: This is an opinion podcast for educational purposes only and does not constitute medical advice. Listeners should consult their healthcare providers before making any decisions about diagnosis or treatment.

Fertility Add-Ons: Hope, Hype, and Hard Truths

Quick Look:

Add-ons are optional extras in IVF promising better success. Most lack strong evidence for improving live birth rates and often add only cost, risk, and complexity.

What Are Add-Ons?

Add-ons are drugs, procedures, or lab techniques added to standard IVF hoping to improve outcomes. Examples include additional drugs (DHEA, growth hormone), lab innovations (time-lapse imaging, embryo glue), and procedures (endometrial scratching). Today's routine (like ICSI) was often yesterday's add-on, reminding us that today's fashion may be tomorrow's history.

The Vulnerability of Patients

The emotional burden of infertility makes patients vulnerable and willing to try anything. History shows the dangers of untested interventions (e.g., Thalidomide, DES). Embryos are highly sensitive, and add-ons may carry hidden long-term risks.

Do Add-Ons Really Work?

Most fail to improve live birth rates:

· Androgens/Growth Hormone: May increase eggs retrieved but not proven to improve live births.

· Antioxidants: Can improve sperm quality, but link to live birth is weak.

· Aspirin/Heparin: Evidence does not support routine use.

· Metformin: Useful for PCOS to reduce risk but doesn’t clearly raise live births.

· Endometrial Scratching/Assisted Hatching/ERA: Strong trials show little to no benefit for most.

The Herd Effect & Problem with "Evidence"

Medicine is not immune to fashion. Unproven add-ons become mainstream as patients request them and clinics offer them to stay competitive. Supporters often cite weak evidence like meta-analyses of small studies or statistically significant but clinically meaningless p-values. Fertility treatment demands the strongest evidence.

What This Means for Patients

· Ask: “Is it proven to help someone like me achieve a live birth?”

· Weigh the significant financial costs.

· Understand potential side effects and unknown long-term risks.

The Hard Truth

Most add-ons do not increase your chance of a baby. They reliably add cost, confusion, and complexity. Innovation must continue but with caution, protecting patients.

Final Takeaway

Until solid evidence proves they increase live births without harm, add-ons remain optional extras—not essentials.