Globally, IVF patients are routinely offered and charged for a selection of adjunct treatments and tests or ‘add-ons’ that they are told may improve their chance of a live birth, despite there being no clinical evidence supporting the efficacy of the add-on. Any new IVF technology claiming to improve live birth rates (LBR) should, in most cases, first be tested in an appropriate animal model, then in clinical trials, to ensure safety, and finally in a randomized controlled trial (RCT) to provide high-quality evidence that the procedure is safe and effective. Only then should the technique be considered as ‘routine’.
Embryo glue and adherence compounds
The use of fibrin sealants to reduce ectopic pregnancy rate and increase LBRs was first proposed by Feichtinger et al. (1990) Despite this early promise, treatment using fibrin sealants never demonstrated reliable significant improvement in clinical outcomes and more recently, the focus has shifted to the use of a specific embryo transfer (ET) medium enriched with the glycoprotein hyaluronan (HA). It is well reported that HA is naturally present in the female reproductive tract and endometrium and forms a viscous solution which could enhance the ET process and prohibit embryo expulsion The published data surrounding the use of adherence compounds are highly varied in quality and robustness of study design and as a result, the use of HA supplemented media for ET is still regarded as controversial.
Sperm DNA fragmentation
Many clinics offer all their patients a sperm DNA fragmentation test. The assays include TUNEL, Comet, SCD assay, SCSA and 8-OHdG test There are clear differences between assays in terms of the type of DNA damage being measured and their relative sensitivity . However, no particular assay has yet emerged as being of greater diagnostic value than any other. Ultimately, the purpose of such an assay is to indicate which treatments may be contraindicated for, or beneficial to, patients. This requires both diagnostic accuracy for the assay and evidence of effectiveness for the treatment(s)
The Practice Committee of the ASRM has concluded that ‘current methods for assessing sperm DNA integrity do not reliably predict treatment outcomes and cannot be recommended routinely for clinical use’ However, a recent Cochrane report observed that low-quality evidence suggests that antioxidant therapy in the male might increase CPR and LBR in patients, where the spermatozoa are suffering from oxidative stress.