What the Lancet review found about costly IVF add-ons

For people already paying for IVF, the offer of one more procedure rarely sounds like an upsell. It comes as a quiet question in a crowded appointment. If the cycle already costs thousands, could another lab technique, adhesive medium or screening step nudge the odds of a baby? In an ABC News report on Australian patients weighing those choices, that uncertainty reads as both emotion and arithmetic.

The new evidence lands with force because IVF is already a high-stakes, high-cost medical process. Add-ons are sold when patients are tired, short on time and primed to hear phrases such as possible benefit or improved implantation. Wanting one more edge is understandable. The harder question is whether the edge is real.

A major 2026 Lancet Obstetrics, Gynaecology & Women’s Health review suggests that, for many of the IVF extras clinics commonly market, the answer is no, or at least not yet. Sarah Lensen and colleagues assessed ten add-ons, excluded 72 potentially eligible trials on trustworthiness grounds, then pooled 85 studies. Most add-ons either showed no improvement in fertility outcomes or remained too weakly supported to inspire much confidence.

In a Guardian interview about the review, Lensen put it plainly:

“Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients.”

Sarah Lensen, The Guardian

That finding is sharper than the usual wellness headline about more research being needed. The authors did not merely shrug at a messy literature. They filtered out studies they did not trust. That matters in fertility medicine, where small trials, shifting endpoints and hopeful marketing can make a marginal signal look sturdier than it is.

Why this review hits harder than earlier warnings

Much of the paper’s force comes from an unglamorous step: sorting the trials before counting them. Plenty of medical literatures look persuasive until someone asks whether the underlying studies are solid enough to pool. Lensen’s group asked, and the answer was uncomfortable. Nearly half of the potentially eligible studies did not survive the filter.

That does not mean every excluded paper was fraudulent. It means the review team judged that too many were unreliable as a basis for medical advice. A separate 2026 methodological paper indexed on PubMed made the same broader point: IVF add-ons are hard to evaluate cleanly because clinics use different patient populations, outcome measures and definitions of success. A pregnancy test is not a live birth. A plausible mechanism is not a clinically meaningful gain.

Those two papers help explain why IVF add-ons have lasted so long in the gap between innovation and evidence. Assisted reproduction moves quickly. Randomised evidence moves slowly. Clinics can sell the future tense long before the literature has settled into the past tense.

Patients are not buying fantasies. They are buying uncertainty.

The uncomfortable part of the review is economic as much as scientific. People do not arrive at fertility clinics as detached consumers comparison shopping for gadgets. They arrive after months or years of trying, after losses, after bad lab values, after birthdays that have started to sound like clocks. In that room, a maybe can become its own product.

Earlier survey work by Lensen and colleagues in Human Reproduction found that 82 percent of women who had undergone IVF in the previous three years had used at least one add-on. The most common were acupuncture, preimplantation genetic testing for aneuploidy and Chinese herbal medicine. That survey did not decide whether the add-ons work. It showed how normal the add-on economy has become.

Lensen has argued that better evidence summaries could reduce some of the fog. In a University of Melbourne release on the project, she warned that unproven extras can generate false hope, more financial strain and unnecessary procedures. The same project found an awkward tradeoff: when patients used a clearer evidence-based website, they felt worse even as they understood the tradeoffs better. More information did not soothe them. It clarified how much of the market rests on ambiguity.

Here the patient and researcher perspectives collide. Patients are not foolish for wanting one more intervention. Researchers are not cruel for saying it may not help. The tension comes from a fertility marketplace that often asks people to convert uncertainty into out-of-pocket spending before the evidence is settled.

Three weak signals can keep a whole category alive

The review did not say every add-on is useless. It found weak evidence for only three: EmbryoGlue, endometrial scratching and PICSI. Weak evidence is not no evidence. It is also not a green light for routine use.

This is where the commercial category keeps breathing. A small positive signal, especially in a field with extreme emotional stakes, can travel farther in clinic brochures and online forums than a paragraph about confidence intervals. One procedure looks somewhat promising in one subgroup, another has a mechanistic story, and soon the sales case sounds firmer than the evidence beneath it.

Weak signals have a business effect, too. Clinics do not need unanimity in the literature to keep an option on the menu. They need just enough plausibility for a patient to ask whether skipping it would feel like regret.

Clinicians who see patients at the sharp end of that mismatch tend to sound more guarded. In the same ABC report, Brisbane reproductive endocrinologist Devini Ameratunga cautioned that patients should be careful with extras because the majority do not have good evidence behind them.

“The bottom line is that the majority of add-ons don’t have good evidence, so you need to be careful if using them.”

Devini Ameratunga, ABC News

That skeptical clinical view answers a question many patients actually face: if there are even a few hopeful signs, is it reasonable to pay for the add-on anyway? Sometimes the honest answer may still be yes, especially when a patient understands the limits and values even a small unproven possibility. That is different from saying the evidence justifies broad routine marketing. It does not.

A better IVF conversation may feel harsher before it feels fairer

Health reporting often assumes that more transparency automatically feels empowering. Fertility care may be a harder case. Clearer evidence can sound like a subtraction. It removes the emotional shelter of the phrase it might help, which makes disclosure delicate.

Timing matters beyond one paper. Fertility clinics in several countries are already under wider scrutiny, including recent ABC reporting on tougher oversight of IVF providers in Victoria. Not every concern in that broader debate is about add-ons. Some involve lab errors, governance and regulation. Together, though, they sharpen a basic question: how much uncertainty should private fertility medicine be allowed to monetize before stronger standards step in?

Read narrowly, the paper-first answer is less a policy manifesto than a patient standard. People deserve to know which extras have been tested, which have only weak signals and which are mostly running on marketing momentum. Clinics deserve room to innovate, but not room to imply certainty the literature has not earned.

The most useful reading of the Lancet review is not that IVF innovation should stop. It is that evidence should stop being treated as a decorative extra. In fertility care, hope is inevitable. Selling hope as if it were data should not be.

References

1. Lensen S, et al. Safety and effectiveness of ten common in-vitro fertilisation add-ons: a systematic review and meta-analysis. Lancet Obstetrics, Gynaecology & Women’s Health. 2026. https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(26)00054-3/fulltext
2. Lensen S, et al. How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients. Human Reproduction 36(7). 2021. https://academic.oup.com/humrep/article-abstract/36/7/1854/6263404
3. Al Wattar BH, et al. Evaluating the efficacy, safety, and clinical effectiveness of IVF add-ons: methodological challenges and future solutions. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2026. https://pubmed.ncbi.nlm.nih.gov/41996906/