An international review of 85 randomized trials found insufficient or uncertain evidence of improved live birth for most of 10 IVF add-ons.
Endometrial scratching showed a small potential benefit; evidence for PGT-A, immune treatments and embryo glue remained uncertain.
For many patients undergoing IVF, one successful attempt is the overriding hope. Additional tests, medicines and substantial costs can seem worthwhile if they might improve implantation. Expectations can be particularly high after repeated implantation failures.
But do add-ons promoted as ways to improve IVF success actually increase the probability of having a baby?
An international research team assessed 10 add-ons used in fertility practice. For most, the evidence of improved live-birth rates was insufficient or uncertain.
The systematic review and meta-analysis was published in The Lancet Obstetrics, Gynaecology, & Women’s Health in 2026. It evaluated 85 randomized controlled trials.
Ten add-ons, with birth as the key outcome
IVF add-ons are tests, medicines or procedures offered in addition to standard ovarian stimulation, egg retrieval, fertilization, embryo culture and transfer, with the aim of improving pregnancy chances.
The review covered preimplantation genetic testing for aneuploidy (PGT-A), endometrial receptivity testing, corticosteroids, embryo glue, endometrial scratching, physiological intracytoplasmic sperm injection (PICSI), ovarian platelet-rich plasma (PRP), intrauterine PRP, acupuncture and intralipid infusion.
The researchers excluded 72 studies during their assessment of trial trustworthiness and included 85 in the final analysis. Live birth was a principal outcome, rather than implantation or a positive pregnancy test alone.
A positive blood test or an ultrasound-confirmed gestational sac does not always lead to birth. The review focused on the ultimate outcome of fertility treatment: having a baby.
Endometrial scratching showed a modest potential benefit
Of the 10 add-ons, endometrial scratching showed evidence of a possible increase in live birth.
The procedure deliberately causes a small injury to the endometrium before embryo transfer. Its rationale is that subsequent tissue repair and changes in immune responses might favor implantation.
Across 19 trials, the odds ratio for live birth was 1.20, with a 95% confidence interval of 1.02–1.41. Certainty of evidence was moderate.
An odds ratio of 1.20 does not mean a 20-percentage-point increase in the birth rate. It suggests a possible small benefit, not that every patient needs the procedure.
For embryo glue, the live-birth odds ratio was 1.12, but the 95% confidence interval of 0.91–1.37 did not show a statistically significant increase.
This approach uses a hyaluronan-rich transfer medium to try to create a favorable environment for implantation. The analysis did not establish a clear improvement in live birth.
PGT-A, receptivity testing and steroids
PGT-A did not show a confirmed increase in live birth in this review.
The test assesses embryo chromosome numbers to help select embryos for transfer. Across five randomized trials, the live-birth odds ratio was 1.16, without a statistically significant difference.
That should not be interpreted as proof that PGT-A is unnecessary for every patient. Its purpose and clinical context may vary with age, embryo availability and pregnancy or miscarriage history. It should also be distinguished from PGT-SR, which concerns structural chromosome rearrangements.
Endometrial receptivity testing likewise lacked sufficient evidence of improved birth rates. These tests examine features such as endometrial gene expression to identify transfer timing. Three trials were included, but no pooled meta-analysis was performed for this intervention.
Corticosteroids, used to modify immune responses, had a live-birth odds ratio of 0.95, without a significant improvement.
This does not mean steroids are unnecessary for patients who need them for a specific autoimmune condition. The analysis concerned their use as an additional intervention to improve IVF outcomes.
Intralipids, PRP and acupuncture: limited evidence
The remaining add-ons also lacked convincing evidence of improved live birth.
Intralipid infusion is sometimes used after repeated implantation failure in the hope of modifying immune responses. Only one trial was included, and certainty of evidence was very low.
Ovarian PRP, intended to improve ovarian function, and intrauterine PRP, intended to improve the endometrial environment, were represented by one and two trials respectively, making conclusions difficult.
PICSI selects sperm using their ability to bind to hyaluronan. Its live-birth odds ratio was 1.12, without a significant difference. Ten acupuncture trials were included, but certainty of evidence was very low.
A lack of proven effectiveness is not necessarily proof of no effect. Some interventions have not been tested in enough large, reliable studies to support a firm conclusion.
Assessment of effectiveness also does not establish comprehensive long-term safety. Additional medicines and invasive procedures should be considered in terms of adverse effects and physical burden, as well as possible benefit.
Hope is not a substitute for evidence
The findings raise questions about the evidence used to recommend add-ons in fertility care.
IVF carries substantial physical, emotional and financial burdens. After repeated implantation failure or miscarriage, a new treatment can feel like a last hope.
More treatment does not necessarily mean a higher probability of birth. Repeated use of uncertain interventions may increase costs and physical burden without a demonstrated benefit.
The researchers acknowledged limitations in their trial-trustworthiness assessment. Some excluded studies may have contained reliable data, so the review should not be treated as a final verdict on every add-on.
Nevertheless, a recommendation should explain more than a change in implantation or positive pregnancy-test rates. It should address whether live birth improved, which patients benefited and how certain the evidence is.
Before choosing an add-on, patients can ask whether benefit has been demonstrated in people with similar circumstances, what the expected benefits and risks are, and whether the evidence justifies the extra cost.
The goal of IVF is a healthy birth, rather than more tests and treatments. A patient’s hope should not itself become a reason to choose an unproven intervention.
Related reading: Our guide to recurrent implantation failure.
Source: “Safety and effectiveness of ten common in-vitro fertilisation add-ons: a systematic review and meta-analysis,” published in The Lancet Obstetrics, Gynaecology, & Women’s Health in 2026. The international team searched literature through January 13, 2026 and analyzed 85 randomized controlled trials after a trustworthiness assessment. DOI: 10.1016/S3050-5038(26)00054-3.
The illustration was created using generative AI (ChatGPT, OpenAI). Any people depicted are fictional.
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