IVF Add-ons: Where is the evidence?

 

For many families over the last three decades, IVF (In-Vitro Fertilisation) has given them the opportunity to become parents when all natural avenues have been unsuccessful. However, research published in the BMJ on 22nd November 2016 shows add-on procedures offered by many fertility clinics lack solid evidence.

The research was commissioned by the BBC’s Panorama programme and conducted by the University of Oxford’s Centre for Evidence Based Medicine. According to the BBC around one in four cycles of IVF end in a live birth, with around 70% of couples experiencing problems conceiving, IVF is a viable option. Fertility treatments include a variety of interventions, for women under the age of 40 this includes IVF (in-vitro fertilisation) with or without intracytoplasmic sperm injection (ICSJ).

 

 

Image result for IVF


Human egg cell with zona pellucida during IVF treatment. Image by Zeiss Microscopy.
This file is made available under Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

 

UK fertility clinics across the UK not only offer these standard types of intervention but may also suggest extra treatments and interventions. It is these which have been subject to investigation. In the UK all fertility centres have to be registered with the Human Fertilisation and Embryology Authority regardless of whether they provide NHS, private or both types of care. Yet, it has been suggested that these extra treatments which go beyond the standard IVF may not be of great benefit to patients, are expensive and are often not be stringently tested or backed up by appropriate evidence.

The research itself was carried out over the course of a year. The team searched for every claim which has been made about every treatment offered in the UK and studied more than 70 websites and 1401 web pages which related to the types of interventions they were looking for. This led to 27 add-on treatments being classified by the research team. Twenty six of these were found to not be supported by substantial scientific evidence of success. For those of you wondering which treatment was backed up with some evidence it was a process known as endometrial scratch. Although evidence is still relatively limited it has been noted that a randomised clinical trial is in process to determine the treatment’s effectiveness.

However, the research shows that while many of the fertility centres offering these types of add-on interventions may claim to benefit the patient. In the majority of cases they fail to supplement these claims with reliable evidence. The problem with this is that the centre may make claims but the treatments may not actually be of benefit to the patient or in this case increase the chances of conception. Furthermore, these extra treatments also come at an extra cost ranging anything from £100 to £3500. Experts such as Professor Robert Winston even suggest that these add-on treatments are unnecessary and unjustified.

One specific type of add-on, the preimplantation genetic screening or PGS which is designed to look at embryos and identify any abnormalities has been the subject of research. A study carried out by the University of Amsterdam found that this type of treatment actually significantly reduced rather than increased the odds of live birth in women of advanced maternal age. Despite this, some clinics are still offering this intervention even though the results of any randomised control trial are yet to be published.

So what about the Human Fertilisation and Embryology Authority?

The BBC Panorama programme was told by a representative from the Authority that although they were concerned “they had little powers to stop clinics offering them, or to control pricing.” The regulatory body do provide prospective parents with published information to ensure patients were aware of the facts before undergoing any treatment. However, many patients are still prepared to pay for such add-on interventions in the hope that they may increase or speed up the process of conception through to live birth.

The researchers conclude that fertility centres should refer to evidence when promoting their additional techniques and treatments citing relevant sources including NICE where appropriate. This should not only report the benefits but also any limitations.

 

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