This was the subject of a Panorama television programme recently and it featured in several newspaper stories. This is obviously a potential worry for people needing fertility treatment so the question arises: is it a nonsense headline-chasing scare-story or is it evidence-based sensible guidance for patients being hoodwinked?
Here at Concept Fertility, we do believe that there are a small number of clinics who seem to sell certain treatments which have dubious value. It causes us problems because patients sometimes ask us what we do differently, what extras we specialise in, what can they add on to improve their chances? The answer is sometimes difficult to hear – there is no miracle cure, there is just careful choice of the right treatment, be it IVF, IUI or something else, and the rest is down to the apparent randomness of nature. With the right treatment we can improve nature’s probability of success but no clinic or treatment can ever guarantee a birth. Adding on extras will increase the cost but many are likely to produce no, or only marginal, benefit.
Are All The IVF Add-Ons Wrong?
Different doctors try different things and who are we to say that they are wrong? All we can really say is that our own philosophy at Concept Fertility is to stick to the evidence-based, proven basics wherever possible because we believe that sticking to the basics, and repeating the treatment cycle if the first one is unsuccessful, more often than not leads to the best cumulative chance of helping parents create that baby.
How Many IVF Add-Ons Are There And Are They Valid?
The television programme’s research mentioned 27 possible add-ons but the actual programme itself featured three. Any clinic offering any of the add-ons will have an argument that they are beneficial. If they were to be ranked from most-contentious to least, one would assume that the three thought to be most contentious by the programme-makers would be the three featured, and the ones at the other end of the ranking would be the least contentious and more commonly adopted. In fact, the programme’s actual research states that there is good evidence that some of the 27 add-ons improve live birth rates, more are as yet unproven, and a few have been proven not to make any difference. The report suggested that a single add-on (PGS) would actually decrease live birth rates but even for this item it qualified its opinion by stating that its evidence related to an old version of the test. Of course, the main point the programme raised was about money being charged unfairly. All of the add-ons carry a cost but even here you need to look deeper. Some of the add-ons cost thousands of pounds and are only promoted by a few clinics but others, such as the use of aspirin, cost pennies and seem to be more commonly used. We would suggest it more sensible to consider a treatment, where evidence for its benefits may be unclear, if it costs pennies rather than thousands.
What about The Three IVF Add-Ons Featured?
The first of the treatments featured on the television programme was about the level of Natural Killer Cells and related treatment with intralipid infusions. The fertility regulator (HFEA) states “The theory behind reproductive immunology has been widely discredited, and there is no evidence that immunosuppressive therapies improve your chance of getting pregnant.” We have never offered this treatment here at Concept Fertility and we have no intention of introducing it. However, there is a large amount of content on the internet about the suggested benefit of the treatment and several other clinics and doctors promote it. Some patients believe this information regardless of the statements made by regulatory bodies such as the HFEA quoted earlier in this paragraph. A small number of our patients have chosen to pursue this treatment elsewhere, regardless of our advice.
The second treatment featured was about embryology with time-lapse photography and the clear statement was made that this does not improve live birth rates. Again, we do not offer this treatment here at Concept Fertility. However, the case for or against it is a little more unclear. Its proponents suggest that the reason for it is to improve embryo selection where there is a choice of which embryo to return to the womb, rather than make any suggestion that it improves the embryos themselves. We believe that this argument is strongest for a fairly limited number of patients.
The third treatment featured was Pre-Implantation Genetic Screening. We believe there is a genuine benefit from this but only for a very small subset of patients. As the requirement is so specialised, we do not offer the treatment in our clinic but do have an arrangement with another clinic where our patients can have the treatment. (Patients pay the other clinic directly and we have no financial interest.)
In Conclusion, Are Add-Ons Rip-Offs?
It would be definitely be wrong to say that all add-ons are rip-offs. Evidence for them varies. Many have some value to a specific group of patients. Some have proven clinical benefits and are widely, or universally, adopted. Others lack this good quality, evidence-based, proof of their value. A few are only offered by a limited number of clinics.
What does seem to be the case is that the cost of a cycle of treatment varies quite significantly between clinics and much of this is down to the add-ons. It also seems to be the case, according to statements made by the HFEA, that the underlying live-birth success rates of most clinics are similar (once individual clinic policies on patient and/or treatment selection are factored out).
Here at Concept Fertility our belief is that most add-ons are not necessary in most cases. In medicine any genuine breakthroughs are usually widely published, distributed and adopted. A doctor’s first duty is to do no harm, and that includes to the wallet. On the internet there are hundreds, if not thousands, of “miracle” treatments or add-ons, some of them very believable. Our recommendation to patients is to be realistic about the options open to them and if it seems too good to be true, then it probably isn’t true. As in so many things, trust your own judgement.