ESHRE 2021

Despite moderate evidence, use of add-ons in IVF remains ‘common’

Sarah Lensen found the use of add-ons to IVF still prevalent in Australia.

Published 01 July 2021

A survey of more than 1500 IVF patients in Australia has found that most had used adjunct treatments alongside their standard treatment – and usually at additional cost.

Add-ons in ART continue to cause concerns among fertility regulators - and ESHRE - and now results from a national survey of IVF patients in Australia have added to the debate by suggesting clinicians are driving use among patients.

Co-author Dr Sarah Lensen, from the University of Melbourne, has recently summarised the results of a study based on the experience of 1590 women.(1) They show that add-ons are a common feature in IVF with a majority (82%) of women having one or more add-on treatments, usually at additional cost (72%).

And more than half (54%) of these patients said they first heard about add-ons (both clinic-based and alternative) from their IVF clinician, with fertility doctors overwhelmingly (71%) raising the possibility of adjunct treatments at the clinic, rather than patients themselves (18%).

A key question, asked Lensen, is whether patients are made aware of the benefits and risks. Those who took part in the survey rated evidence as very important when considering whether or not to use add-ons, especially for safety and improving the chance of a live birth. Yet this exposes a contradiction in that adjunct therapies are not supported by robust data. The implication from this, added Lensen, is that patients probably aren’t being told about the pros and cons.

Australia, where the study took place, has one of the highest rates of IVF in the world and treatment is provided mainly by large private companies. One possible reason for widespread use of fertility treatment, she said, is a generous approach by the government which reimburses half the cost.

The aim of this patient survey was to understand the prevalence and types of add-ons used, their cost, the role of the clinician and patient both in driving adjuvant use and in decision-making. Moreover, the importance of scientific evidence was taken into account.

Participants were aged from early to late 30s, were highly educated, had undergone IVF and add-on use over a 3.5-year period (2017 to 2020), and completed an online questionnaire between June and July 2020. They were recruited via Facebook in adverts which deliberately did not mention add-ons, which, said Lensen, was an attempt to ‘reduce the risk of people having strong views (on the issue)’ and therefore leading to bias.
Results showed that acupuncture (45%), PGT-A (28%), Chinese herbal medicine (26%), heparin and aspirin (both 24%) were the most commonly used ‘optional extras’ which women used in addition to standard IVF.

Not only was there a financial cost associated with add-ons for women but also a psychological one too. The proportion overall (15%) who experienced regret at their decision to use add-ons was not high but this rose to around a third (30%) among patients who did not have a baby compared with just 5% of those who did. The greater the input of the doctor in the decision, the more likely women were to feel regret.

Questions from the virtual floor reflected a need to protect women from costly and unproven add-ons to which so many clearly turn. Measures already taken by regulators include attempts to make clinics more transparent about adjunct treatments, one example cited being an enforcement notice issued last month to UK clinics by the Advertising Standards Authority. More high-quality research and patient follow-up are other potential routes to take. Lensen has previously made the case for this approach - as has ESHRE which has recently convened an expert group on responsible adjunct use.

1. Lensen S, Hammarberg K, Polyakov A, et al. How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients. Hum Reprod 2021; doi:10.1093/humrep/deab0981

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