Efficacy and safety of additional methods in IVF procedures

The diagnosis and treatment of infertility is the subject of much scientific scrutiny. Thousands of different publications on the causes of infertility, new diagnostic tests, or novel therapies appear annually in the medical literature. Some of them are solidly and well documented, while others are merely premises or speculations of the authors, not supported by reliable scientific evidence.

Research on recurrent in vitro fertilization failures is of particular interest. This issue includes cases in which pregnancy has not been achieved despite several transfers of normal embryos, as well as those in which pregnancy was achieved but miscarried in the early or later stages of its development.

In these situations, the relationship between recurrent in vitro fertilization failures and:

• Incision of the zona pellucida which surrounds the embryo during the first few days of development (Assisted Hatching)

• Culturing embryos in special incubators (EmbryoScope)

• The use of media during embryo transfer to promote implantation in the endometrium (e.g. EmbryoGlue)

• Controlled endometrial trauma in the cycle before embryo transfer (endometrial scratching)

• Use of corticosteroids or low-molecular-weight heparins in the perioperative period

• Treatment with immunosuppressive or immunomodulatory drugs

Based on sound scientific research (evidence-based medicine), it can be concluded that none of the above mentioned clinical and/or laboratory interventions has been unequivocally proven to be effective. In some cases, such as immunomodulatory treatment, it has even been indicated that such treatment has no clinical relevance and should be considered experimental. Immunomodulatory treatment alters the body's susceptibility to bacterial, viral or fungal infections. Therefore, if at all, it should be recommended and conducted only by specialists or under their close supervision. Moreover, the use of this type of therapy should be particularly carefully considered during periods of increased seasonal incidence and greater risk of endemic or epidemic infections, as COVID-19 currently is.

Therefore, it can be concluded that the methods and procedures mentioned above are not recommended for routine use in the diagnosis and treatment of infertility in all couples. On the other hand, they can probably be proposed in individual situations if the doctor decides that their implementation may be beneficial in a given case. There is no doubt that patients in infertility centres should be informed about the possibility of using these methods. However, it is important to remember that the use of some of them may also carry the risk of negative health consequences. To help you identify these methods and signal which ones are scientifically effective, a traffic light rating system has been developed worldwide:

• The green light is given to a procedure for which there is more than one randomized control trial confirming its efficacy, which may indicate that the intervention is effective and safe.

• Amber is used when there is a small amount of conflicting evidence, meaning that further research is still required and the technique cannot be recommended for routine use.

• A treatment is marked in red if there is no evidence that it is effective or safe.

You can find more information on the UK Human Fertilization and Embryology Authority website. A summary of the recommendations can be found on our website here.

Useful information for patients is also available on the British Royal College of Obstetricians and Gynaecologists (RCOG) and the European Society of Human Reproduction and Embryology (ESHRE) websites.

Prof Dr Rafał Kurzawa, MD
Dr Wojciech Głąbowski, MD