“My wife has undergone IVF three times. We have spent nearly Tk20 lakh in total, but we still have not been able to have a child,” said a journalist based in Dhaka, sharing his experience with Dhaka Tribune.
“The first cycle failed. The second resulted in a miscarriage. During the third attempt, the embryo was implanted in the fallopian tube and had to be surgically removed and now we have been advised to wait for some time before considering the next step,” he said.
“Beyond the financial burden, the emotional toll has been immense,” said the journalist who is working for a leading Bengali daily newspaper.
Their story reflects the experience of many Bangladeshi couples who turn to in-vitro fertilization (IVF) after years of trying to conceive, often spending several lakh takas on treatment while pinning their hopes on additional procedures marketed as ways to improve success rates.
However, a major new review published in The Lancet Obstetrics, Gynaecology and Women's Health on Wednesday, suggests that most of these costly IVF “add-ons” provide little or no proven benefit in helping patients achieve a pregnancy or have a baby.
The study, led by researchers at the University of Melbourne, examined ten commonly used IVF add-ons, including extra medications, laboratory techniques and diagnostic tests frequently offered by fertility clinics around the world.
Researchers reviewed 157 randomized controlled trials, considered the highest standard of medical evidence.
After excluding 72 studies due to reliability concerns, they analyzed findings from 85 trials deemed sufficiently reliable for inclusion.
The review found that seven widely used add-ons, 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 high-quality evidence to demonstrate that they improve pregnancy or live-birth rates.
The authors concluded that the current evidence does not support the routine use of these interventions to increase the likelihood of having a baby through IVF.
Among the ten add-ons assessed, researchers found weak evidence suggesting possible benefits from only three interventions: EmbryoGlue, endometrial scratching and physiological intracytoplasmic sperm injection (PICSI).
EmbryoGlue is an embryo transfer medium containing hyaluronic acid, a natural substance found in the reproductive tract which is considered important for embryo implantation.
The evidence review found it may increase the probability of pregnancy and live birth, the effect on live birth rates was not robust.
Endometrial scratching is a minor procedure undertaken to scratch or disturb the lining of the uterus. The review finds this procedure may increase the probability of pregnancy and live birth.
Physiological intracytoplasmic sperm injection (PICSI) is a technique used to select sperm based on their ability to bind to hyaluronic acid, which may be a sign that the sperm is mature and capable of fertilising an egg. There is weak evidence that this may lower the risk of miscarriage.
But researchers cautioned that the evidence supporting all three interventions remains limited and uncertain.
They said larger and better-designed clinical trials are needed before these procedures can be confidently recommended to patients.
The findings carry particular significance for Bangladesh, where fertility treatment remains largely an out-of-pocket expense.
A standard IVF cycle in Bangladesh typically costs between Tk3 lakh and Tk5 lakh, depending on the clinic and treatment requirements.
Additional procedures, medications and laboratory techniques can significantly increase the total bill.
For many families, multiple treatment cycles can quickly exhaust savings, require loans or force the sale of assets.
Against this backdrop, many patients may feel compelled to pay for supplementary treatments in the hope of improving their chances, even when scientific evidence supporting those interventions remains weak.
Lead author Dr Sarah Lensen said the study highlights a growing disconnect between how IVF add-ons are marketed and what research actually shows.
“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 interventions can create false hope for vulnerable patients while increasing both financial and emotional stress during an already difficult journey.
Researchers noted that in many countries, fertility treatment has become increasingly commercialized, with clinics offering a growing range of optional services that may appear attractive to patients desperate to improve their chances of success.
The authors argue that the availability of an add-on can itself create the impression that it is effective, even when robust scientific evidence is lacking.
In a separate study published alongside the review, researchers examined whether access to independent, evidence-based information could help IVF patients make better decisions about add-ons.
The trial found that patients who used an impartial information platform developed a clearer understanding of the potential benefits, risks and uncertainties associated with IVF add-ons.
They also reported greater satisfaction with the information available to them.
The researchers found that most patients rely heavily on fertility clinic websites for information, while many also seek advice through social media and online forums, where claims about treatment effectiveness may not always reflect the best available evidence.
The researchers say the findings do not mean IVF add-ons should never be used.
Instead, they argue that clinics should be transparent about the quality of evidence supporting each intervention and clearly explain when benefits remain uncertain.
For Bangladeshi couples facing difficult decisions about fertility treatment, experts recommend asking whether a proposed add-on has been shown in high-quality clinical trials to improve live-birth rates, rather than simply increase laboratory or pregnancy indicators.
For families already struggling with the emotional and financial burden of infertility, the study suggests that informed decision-making may be just as important as access to treatment itself.
As the Dhaka journalist reflected on three unsuccessful IVF attempts and nearly Tk20 lakh spent, he said what couples need most is honest information alongside medical care.
"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,"
