Most IVF add-ons lack reliable evidence, with benefits either absent or inconclusive, the largest review of its kind has found.

More than 70 per cent of IVF patients in the UK, Australia and New Zealand reportedly pay for one or more additional treatments.

However, researchers found that most of the procedures, medicines and techniques had no effect on fertility or were backed by limited or low-quality evidence.

Unproven add-ons can also lead to false hope, greater financial strain and unnecessary medical procedures at an already difficult time for patients.

Dr Sarah Lensen, of the University of Melbourne, said: “In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add-ons are extremely expensive.

“Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients. Unproven add-ons can lead to false hope, greater financial strain and unnecessary medical procedures at what already can be a very difficult time for patients.”

Researchers said concerns have grown in recent years about potentially untrustworthy randomised controlled trials in reproductive medicine, including studies of IVF add-ons.

The team set out to review the effectiveness and safety of 10 commonly offered add-ons using trustworthy studies.

Researchers initially identified 157 potentially eligible randomised controlled trials but excluded 72 because of concerns about their reliability.

Randomised controlled trials compare treatments by assigning participants to different groups, helping researchers assess whether an intervention causes a particular outcome.

The team combined data from the remaining 85 trials in a meta-analysis, which brings together findings from several studies.

The review found no effect on fertility or inconclusive evidence for seven of the 10 add-ons examined.

These included acupuncture, which involves inserting thin needles into points on the body, and corticosteroids, medicines that reduce inflammation and suppress immune activity.

Endometrial receptivity testing was also not backed by reliable evidence. The procedure involves taking a sample from the lining of the womb to examine patterns of gene activity.

Another add-on was intralipid infusion, which delivers a fat-containing liquid into the bloodstream.

Researchers separately examined injections of platelet-rich plasma into the ovaries and infusions of platelet-rich plasma into the womb.

Platelet-rich plasma is made from a patient’s blood and contains a high concentration of platelets, which play a role in healing.

The seventh treatment was pre-implantation genetic testing for aneuploidy, which examines embryos to check whether they have the expected number of chromosomes.

The review found only weak evidence of a possible benefit from three other add-ons.

EmbryoGlue, an embryo transfer medium containing hyaluronic acid, may increase the probability of pregnancy and live birth. However, the evidence on live birth rates was not considered robust.

Endometrial scratching, a minor procedure that deliberately disturbs the lining of the womb, may also increase the probability of pregnancy and live birth.

Physiological intracytoplasmic sperm injection, known as PICSI, selects sperm based on their ability to bind to hyaluronic acid. Weak evidence suggested it may reduce the risk of miscarriage.

Lensen said: “There is widespread misinformation about IVF add-ons with private clinic websites and patient forums on social media – major information sources for patients – often overstating the benefits and omitting the costs and risks of add-ons.

“IVF clinics and clinicians should carefully consider whether it is appropriate to offer unproven add-ons, as their availability is often perceived by patients as implicit endorsement of benefit.”

LGBTQ+ people across the UK face discrimination, funding inequalities and gaps in fertility care, research has found.

Eligibility for NHS-funded treatment varies across the country, while many services are still structured around heterosexual couples.

People with diverse sexual orientations and gender identities can be left navigating complex systems, paying more for treatment and explaining their needs to healthcare professionals.

Co-author Dr Chloe He, of the UCL Institute of Epidemiology and Health Care, said: “Legal access is not the same as equitable access. LGBTQ+ patients are forced to navigate a Kafkaesque fertility care system alone – researching, self-advocating, and often educating the doctors and nurses treating them.

“In our study, we saw clinicians with no formal LGBTQ+ training, gay men pressured into being relentlessly cheerful to prove parent-worthiness to surrogacy services, and patients travelling hundreds of miles for care after experiencing transphobia at local clinics.”

The University of Stirling-led research involved 54 participants and 36 in-depth interviews with people who had used fertility services and professionals working in or alongside fertility care across the UK.

Researchers from Stirling, SKEMA Business School and University College London examined the extra work undertaken by LGBTIQA+ people seeking to have children.

They called this “reproductive labour”, which includes researching treatment, advocating for themselves, covering additional costs and educating clinicians.

The researchers said this work was used to manage “reproductive bioprecarity”, a term describing the uncertainty and vulnerability people can face while seeking reproductive healthcare.

The study, funded by a Santander Universities Research Grant, primarily reflected the experiences of cisgender lesbian participants.

One participant, Amanda, said she and her partner, Amy, spent a long time trying to find a GP willing to discuss fertility with them.

The couple eventually underwent fertility tests through the NHS, but their private clinic rejected the results because they had not been referred by a GP.

They had to repeat the tests and pay for them privately.

The researchers said lesbian couples are often required to self-fund multiple rounds of intrauterine insemination before becoming eligible for NHS support.

Intrauterine insemination, or IUI, involves placing sperm directly into the womb.

Gay men usually have to pursue surrogacy, which is not funded or supported by the NHS, while transgender people can face long waits to save eggs and sperm to allow them to have children.

Lead author Dr Carolyn Wilson-Nash, senior lecturer at the University of Stirling Business School, began investigating the issue after she and her wife made multiple attempts to conceive and faced challenges throughout the process.

The couple funded almost the entire process themselves and consulted a GP who had no experience of supporting same-sex couples seeking fertility care.

The researchers called for clearer treatment pathways, more inclusive services and better training for healthcare staff.

Dr Wilson-Nash, who is now the mother of a three-year-old boy, said: “The way the current system for fertility services is set up in the UK can lead to unequal pathways for the LGBTIQA+ population.

“For example, heterosexual couples can access NHS-funded in vitro fertilisation (IVF), whereas lesbian couples are often required to self-fund multiple rounds of intrauterine insemination (IUI) before becoming eligible for NHS support.

“Gay men usually have to pursue surrogacy, which is not funded by or supported by the NHS.

“And transgender individuals often face long waiting times to save eggs and sperm to allow them to have children. So legal access does not necessarily translate into equitable or inclusive care.

“Building a family should be neither exclusive nor this difficult. Fertility services should be available to all, regardless of their sexual orientation or gender identity.”

Laura-Rose Thorogood, founder of LGBT Mummies and part of the UK’s Fertility Justice Campaign, said: “Right now, intended LGBTQIA+ parents are being discriminated against because of who they are, and who they love.

“This is ultimately forcing them down alternative pathways which in turn put them at long-term risk physically, psychologically and socially.

“By providing access to treatment, our community can thrive and create the families they dream of by their chosen route.”

Impli has secured a £1.4m grant to begin clinical use of a real-time hormone patch for infertility treatment.

The startup, which is working with innovations from Imperial College London, is developing a continuous hormone monitoring system for use in in vitro fertilisation, known as IVF.

IVF is a fertility treatment in which eggs are fertilised outside the body before an embryo is transferred to the womb.

Timing is critical in IVF, the most common form of infertility treatment, but most patients are still monitored through blood tests taken every other day at best.

Hormone levels can change within hours, meaning important shifts may be missed.

These can include hormone surges linked to egg release, dips that may contribute to implantation failure and early signs of ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome is a potentially serious reaction to fertility medicines, where the ovaries over-respond and become swollen.

In a treatment with low success rates, these uncertainties can affect patient outcomes and wellbeing.

Impli’s system is based on research by Dr Salzitsa Anastasova in the department of mechanical engineering at Imperial.

The technology uses electrochemical biosensors to sample hormones in the fluid between cells.

These can be used in a subcutaneous implant, meaning one placed under the skin, or in Impli’s Bio-Endocrine Analysis Monitor, known as BEAM, which uses microneedles that pierce the skin.

Microneedles are tiny needles designed to enter the upper layers of the skin with minimal discomfort.

The biosensors continuously measure oestradiol, luteinising hormone and progesterone, which are hormones involved in the menstrual cycle and fertility treatment.

Data is transmitted wirelessly to a smartphone, where AI software converts raw signals into real-time hormone trends.

Sotirios Saravelos, consultant gynaecologist and reproductive medicine subspecialist at the Wolfson Fertility Centre, part of Imperial College Healthcare NHS Trust, said:

“Continuous hormone monitoring has the potential to change the landscape of fertility treatment, both in terms of clinical care and patient experience. Rather than snapshots taken at fixed points in time, with Impli we will have access to a live feed of each patient’s hormonal response, allowing us to personalise care in a way that has not been possible before.”

Saravelos is part of the research consortium that has won a £1.4m grant to take Impli’s BEAM device from prototype to its first human clinical validation for IVF.

The project was designed with support from Dr Simon Hanassab as part of a PhD on how AI can support decision making for IVF.

The work was carried out at the UKRI Centre for Doctoral Training in AI for Healthcare at Imperial, a collaboration between the department of computing and the department of metabolism, digestion and reproduction.

Hanassab is now working part-time as Impli’s head of AI.

The grant comes from the National Institute for Health and Care Research Invention for Innovation programme.

It will support a 30-month project bringing together Impli, Imperial College Healthcare NHS Trust, the London Institute for Healthcare Engineering at King’s College London and the patient advocacy network Fertility Europe.

Specialist medical device manufacturer TTP is also involved.

BEAM is the first step in Impli’s plan to develop a broader platform of fully implantable, long-duration monitoring systems.

Anna Luisa Schaffgotsch, founder and chief executive of Impli, said:

“We are not just building a device, we are building the evidence base to show that continuous hormone monitoring is possible, clinically meaningful and ready for the real world. With an exceptional consortium behind us, we now have the funding, the expertise and the clinical pathway to do that properly.”

According to the company, the same core technology could later have applications in hormonally driven cancers, polycystic ovary syndrome, endometriosis and menopause.

Polycystic ovary syndrome is a common hormonal condition that can affect periods, fertility and metabolism.

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus, often causing pain.

BEAM’s development builds on more than 15 years of biosensor research at Imperial, with intellectual property covering the sensing approach, device architecture and data interfaces.

Impli has so far delivered three functional prototypes, completed pre-clinical laboratory trials and begun animal trials, which the company said have shown positive results.

It also has a strategic partnership with Bayer on real-time hormone biosensing and relationships with IVF clinics internationally.