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Fertility treatment add-ons – research & recommendations

Research with an article published at Human Reproduction by an ESHRE working group outlines a set of add-on tests and treatments, describes the biological rationale and where available the evidence of their efficacy and safety. The ESHRE appointed working group further makes recommendations for clinical practice including under which conditions and precautions the procedures could be applied in clinical practice, or whether they should be further investigated in a research-context or at least monitored for safety and efficacy.

The working group was composed of experts in reproductive medicine ensuring variation in clinical and laboratory expertise, and geographical balance, supported by two methodological experts. Patient and consumer representation were also included.

Add-on tests and treatments are described in three subgroups:
– diagnosis and diagnostic tests,
– laboratory tests and interventions, and
– for clinical management.

The working group identifies and examines 27 tests and interventions and provides 42 recommendations – mostly with the conclusion of the add-on not being recommended for routine clinical procedures. Of the 42 recommendations, none could be based on high-quality evidence and only four could be based on moderate-quality evidence, implicating that 95% of the recommendations are supported only.

The group discussion states that the field of ART has undergone significant advancements, leading to improved safety and effectiveness of treatments for a greater variety of patients, and that these developments have greatly benefitted individuals struggling with infertility. Innovation plays a crucial role in the field of ART and will continue to do so. The purpose of the survey has not been to discourage ongoing or future research. On the contrary, for add-ons that have a clear rationale, further studies should be encouraged. However, premature implementation of innovations can lead to the widespread use of interventions that have not been proven safe, effective, or relevant for ART. Add-ons often lack evidence on their efficacy and safety and are typically accompanied by additional costs for patients.

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