Kate Brian
Women’s Voices Lead, Chair of the RCOG Women’s Network, Royal College of Obstetricians & Gynaecologists
Time-lapse imaging, embryo glue, endometrial scratch, reproductive immunology… These are just some of the many extras you may be offered alongside your fertility treatment.
Perhaps the best place to start is by understanding what add-ons are. It ought to be straightforward, but it is not always clear as fertility clinics may include some of them as part of their standard IVF or ICSI treatment. Other clinics may present you with what looks like a shopping list of extras to consider. Although they may be offered in different ways, add-ons are all additions to IVF or ICSI, and most are relatively new so there is little or no clear evidence about how effective they are.
Add-ons are all additions to IVF or ICSI, and most are relatively new.
Some clinics may offer every add-on available giving you a huge range of extras to choose from, while others provide very few, or none at all. Patients sometimes assume that a clinic offering lots of add-ons must be better, but that is not always the case. Clinics that don’t provide them may have looked at the evidence and decided they cannot justify charging patients for a treatment which they do not believe will increase success and may even be risky.
Are patients in favour of fertility add-ons?
Assessing the evidence is not easy, and the Human Fertilisation and Embryology Authority (HFEA) recently carried out a patient survey to find out what people think about add-ons. Some patients were very much in favour and felt that the lack of scientific evidence did not necessarily mean that add-ons did not work. They were concerned that patients might miss out if clinics could only provide treatments that have been proven to work. Others were more sceptical, and felt it was too difficult for patients to be faced with an array of extras without clear evidence. Some felt that people could feel pressured into paying for add-ons because they would do anything that had any possibility of increasing the chances of success.
Deciding what fertility add-on is right for you
So how can you decide whether an add-on is right for you? The first thing to look into is whether there is any evidence that the add-on works. You may come across research which seems promising, but there are many different types of evidence, and the gold standard is the randomised controlled study. This takes a large group of people who are randomly placed into two separate groups. The people in one group have the add-on and those in the other group don’t and the outcomes are then compared. The majority of add-ons have not been through this kind of testing.
Look into whether there is any evidence that the add-on works.
The HFEA decided to help patients by assessing the evidence about add-ons and got together a group of leading scientists and fertility experts to look at all the existing research. They introduced a traffic light system for add-ons to help patients when considering possible risks and benefits. When there is more than one good quality study which shows that the procedure is effective and safe, they have given the add-on a green light. A yellow light indicates that there is some evidence or some potentially promising results but further research is still required, and a red light indicates that there is no evidence to show that an add-on is effective and safe. Once they had made their own assessments, they brought in an expert in the validity of evidence who double checked every traffic light to make sure the ranking was right.
Balancing the risks and cost of fertility treatment
Before going ahead with any add-on, make sure you are happy with the evidence that your clinic has given you about it and that you have read the information on the HFEA website. Check the price, and think carefully about whether you can afford it. Think about whether paying for add-ons would have an impact on your chances of affording another cycle if you need it.
Going ahead with an add-on is fine as long as you are fully aware of the evidence about any risks and benefits, and have made an informed decision. It may be worth bearing in mind that there have been no huge leaps in national success rates since add-ons were introduced, and any differences they make to treatment outcomes may be relatively small.
