But some services, such as endometrial ‘scratching,’ have seen significant reductions.
BY RON SHINKMAN
Despite the government of the United Kingdom officially discouraging the use of most IVF “add-ons” due to their lack of effectiveness, almost three-quarters of the nation’s fertility patients said they recently used an additional treatment or test in hopes of improving their chance of conception.
The data was gathered as part of the U.K.’s Human Fertilisation and Embryology Authority annual survey of fertility patients. The HFEA interviewed 1,500 patients and their partners in the U.K. in September and October of last year. The agency has been officially discouraging the use of most add-one treatments since 2017.
Nearly 40% Report Use of Additional Medications, Supplements
According to the survey, 73% said they had used an add-on that was either an additional test, treatment or a supplement. Among that cohort, 39% resorted to additional medications such as DHEA or growth hormones, while 27% said they used acupuncture and 26% said they used time-lapsed imaging. Nearly 19% said they used a hyaluronate-enriched pre-transfer culture medium such as EmbryoGlue, while 13.5% said they used pre-implantation genetic testing for aneuploidy (PGT-A). Another 13.2% said they employed sperm DNA damage testing.
The overall utilization rate was lower among patients who only underwent one IVF cycle (62%), meaning the adds-on are more likely after an initial attempt fails.
The HFEA and an embryologist suggested that the use of add-ons remain so high because they are marketed aggressively by fertility practices, and that patients may be anxious about boosting their chances of success.
“Different studies show that in some cases clinics are offering add-ons and in others, patients themselves are asking for them,” Clare Ettinghausen, the HFEA’s director of strategy and corporate affairs, told Inside Reproductive Health
Almost 60% of Patients Think Unproven Add-Ons Will Improve Outcomes
The survey noted that 58.5% of respondents resorted to add-ons in part because “the clinic recommended it as they said it would increase my/our chance of having a baby,” according to the survey data.
“Patients place significant trust in the recommendations of their care provider,”
Mina Alikani, an embryologist based in New York City, told Inside Reproductive Health
Some add-ons have become less popular compared to past years. Only 10.3% of those surveyed said they resorted to endometrial “scratching” – using a plastic tube to create a superficial injury to the endometrial lining within the uterus that supposedly makes it more receptive to an embryo. By comparison, 24% of patients used the procedure in 2018.
“It’s a case of evidence catching up to practice,” said Alikani, who noted that recent studies have shown it does not improve birth rates. “Clinics are probably recommending it less frequently. Undergoing a procedure that mimics an endometrial biopsy is not trivial and patients understand that.”
PGT-A use doubled in UK in 3 year span
By contrast, the use of PGT-A nearly doubled from 7% in 2021 to 13% in 2024.
“Its growing use, particularly among older patients, likely reflects a fear of failed implantation or miscarriage if an embryo with chromosomal abnormalities is transferred. Reduced time to pregnancy can also be an incentive,” Alikani said.
But she added that the current PGT-A techniques need improvement, refinement and standardization. “The biopsy methods, testing platforms, and even the interpretation of results vary widely and are not optimized,” she said.
What concerned Alikani most about the survey was that 30% of those surveyed said they didn’t understand what the add-one treatment was being used, and just 37% said they had been explained the risks of additional procedures.
“As the field becomes increasingly complex, with emerging technologies, integration
of AI, and automation, we need to prioritize patient education to the level of clinical outcomes,” Alikani said. “We need to do better.”
