After three rounds of IVF treatment and nearly Tk20 lakh spent, a Dhaka-based journalist and his wife are still without the child they desperately hoped for.
One cycle failed. Another ended in miscarriage. A third resulted in an ectopic pregnancy that required surgery.
Now they have been told to wait before considering another attempt.
“Beyond the financial burden, the emotional toll has been immense,” he told Dhaka Tribune.
Their experience reflects a growing reality for many Bangladeshi couples struggling with infertility, often spending several lakh taka on repeated IVF treatments and a range of additional procedures marketed as ways to improve the chances of success.
But a major international review published this week has raised fresh questions about whether many of those costly IVF add-ons actually work.
In-vitro fertilization (IVF), one of the most widely used fertility treatments worldwide, involves fertilizing an egg with sperm in a laboratory and then transferring the embryo into the woman's uterus.
For many couples struggling with infertility, it represents a final hope of parenthood, though the treatment is expensive, physically demanding and often requires multiple attempts before achieving a successful pregnancy.
However, the study, published in The Lancet Obstetrics, Gynaecology and Women's Health and led by researchers from the University of Melbourne, found that most commonly used IVF add-ons offer little or no proven benefit in helping patients achieve pregnancy or have a baby.
Researchers reviewed 157 randomized controlled trials involving 10 widely used IVF add-ons, including extra medications, laboratory procedures and diagnostic tests frequently offered by fertility clinics worldwide.
After excluding 72 studies because of concerns over their reliability, the researchers analyzed 85 trials considered scientifically trustworthy.
The findings were stark.
Seven commonly used interventions -- including acupuncture, corticosteroids, endometrial receptivity testing, intralipid infusions, platelet-rich plasma treatments and pre-implantation genetic testing for aneuploidy (PGT-A) -- either showed no meaningful benefit or lacked sufficient evidence to prove they improve pregnancy or live-birth rates.
The researchers concluded that current scientific evidence does not support the routine use of most IVF add-ons.
Only three interventions, EmbryoGlue, endometrial scratching and physiological intracytoplasmic sperm injection (PICSI), showed signs of potential benefit.
Even then, researchers described the evidence as weak and uncertain, warning that larger and better-designed studies are needed before any firm recommendations can be made.
The findings carry particular significance for Bangladesh, where fertility treatment is almost entirely financed by patients themselves.
A standard IVF cycle typically costs between Tk3 lakh and Tk5 lakh.
Additional procedures, medications and laboratory techniques can substantially increase that figure.
For many families, repeated treatment cycles mean exhausting savings, taking loans or selling assets.
In such circumstances, couples often agree to supplementary procedures in the hope of improving their chances, despite limited scientific evidence supporting their effectiveness.
Lead author Dr Sarah Lensen said the study exposes a growing gap between the way IVF add-ons are marketed and what research actually demonstrates.
“Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients,” she said.
She warned that unproven treatments can create false hope while adding further emotional and financial pressure to an already stressful process.
Researchers noted that the fertility industry has become increasingly commercialized in many countries, with clinics offering a growing menu of optional services that may appear promising to patients desperate for success.
The review suggests that simply offering an add-on may lead patients to assume it works, even when robust evidence is absent.
A separate study published alongside the review found that patients who received independent, evidence-based information about IVF add-ons were better able to understand potential benefits, risks and uncertainties and reported greater satisfaction with their decision-making.
The researchers found that many patients rely heavily on fertility clinic websites, social media platforms and online forums, where claims about treatment effectiveness do not always reflect the best available evidence.
The findings do not mean IVF add-ons should never be used, researchers stressed.
Rather, they argue that clinics should clearly explain the quality of evidence behind each intervention and be transparent when benefits remain uncertain.
For Bangladeshi couples facing difficult and expensive fertility decisions, experts say the key question should be whether an add-on has been proven in high-quality clinical trials to improve live-birth rates, not simply laboratory results or early pregnancy indicators.
For families already navigating the emotional and financial strain of infertility, the study suggests that access to reliable information may be just as important as access to treatment itself.
Reflecting on three unsuccessful IVF attempts and nearly Tk20 lakh spent, the Dhaka journalist said patients deserve clear and honest guidance before making life-changing decisions.
“When people are desperate to have a child, they will try anything that offers hope,” he said.
“But patients deserve to know what actually works and what may not.”