Today’s posting covers a wide variety of news topics regarding assisted reproduction, including in vitro fertilization (IVF). From the rising popularity of IVF “add-ons” — many of which have uncertain effectiveness at best — to the reason behind a recent estrogen patch shortage, these stories will keep you in the loop on some interesting current events in the reproductive medicine field that you may have missed. As always, we welcome comments from our readers.
The CHR’s Editorial Staff
Safety and Effectiveness of 10 Common “Add-Ons” to IVF
Since the topic of “add-ons” to IVF has been attracting more attention recently, here is a very relevant paper by mostly colleagues from Australia and New Zealand in Lancet Obstetrics Gynecology and Women’s Health.1 In what they called a metareview, they discussed 10 common “add-ons” to IVF. They included one or more of the following IVF add-ons and compared them with no treatment or placebo: Preimplantation genetic testing for aneuploidy (PGT-A); endometrial receptivity testing; corticosteroids; EmbryoGlue; endometrial scratching; physiological intracytoplasmic sperm injection; platelet-rich-plasma injection into the ovary; platelet-rich plasma infusion into the uterus; acupuncture; and intralipid infusion.
The primary outcome was live birth. Of 12,398 search results, 85 trials were included across the ten systematic reviews and meta-analyses; 72 other potentially eligible studies were excluded for possible trustworthiness concerns, such as the absence of prospective trial registration.
For the primary outcome of live birth, endometrial scratching might be associated with a small increase in the chance of live birth. Four add-ons appeared to have no effect: EmbryoGlue (seven RCTs showed low-certainty evidence); PGT-A (five trials; moderate certainty); endometrial receptivity testing (three trials; moderate certainty); and corticosteroids (moderate certainty). For five add-ons, the evidence was unclear because of the poor quality or scarcity of the data, including physiological intracytoplasmic sperm injection (one trial; low certainty); acupuncture (ten trials; very-low certainty); and intralipid (one trial; very low certainty); platelet-rich plasma injection into the ovary (one trial; very-low certainty); and platelet-rich plasma infusion into the uterus (two trials; very-low certainty).
Most add-ons, therefore, are not proven to benefit patients going through IVF. In many cases, the quality of evidence was poor, contributing to uncertainty regarding effectiveness, and many studies were excluded for trustworthiness concerns.
And as almost every time when this kind of an article is published, the concluding sentence – like here – is: Well designed, large-scale RCTs are needed to generate reliable evidence on the effect of these interventions. What a waste of time and effort!
REFERENCE
Lensen et al., Lancet 2026; https://doi.org/10.1016//S350-5038(26)00054-3
Embryo Mix-Up - an IVF Clinic’s Worst Nightmare?
This was – more or less – the title of a recent Special Contribution article in Fertility and Sterility (F&S) by Steven J. Ory, MD, et al, - one of the few still active first-generation IVF practitioners.1 Transferring the wrong embryo happens in IVF fortunately only very rarely, but – we must admit – also pretty regularly. Just recently, a case like this again made headlines for several reasons: (i) Simply because it happened; (ii) Because a White couple gave birth to a South Asian baby; and (iii) Because the Florida couple who lived through this experience retained custody of the newborn.
The article offers nothing dramatically new, but it is kind of a reminder of how much of a problem such an occurrence can be for an IVF clinic, and we, therefore, recommend it as a kind of quick refresher course. The case also raises the question of what would have happened if the child was the same race as the couple? Would the mix-up have been discovered, - and disclosed? And from those questions arise, of course, the question of how many such cases occur and go undiagnosed?
Nobody, of course, knows!
REFERENCE
Ory et al., F S Rep. 2026; 7(3)173-176
More on Embry Laboratory Automation
And from the same issue of F&S Reports, this time a short editorial by its Editor-in-Chief, which we – for a change – liked (which is not always the case), maybe because it did not directly affect clinical practice (where we on occasion have been known to disagree), but commented on progress made in automating the IVF laboratory.
We, of course, as previously noted in these pages, are not pursuing automation very aggressively at the CHR because – considering the CHR’s unique patient population – the CHR’s practice pattern, characterized by very detailed individualization of treatment, does not lend itself to too much automatization, - at least for the foreseeable future. But for high-volume clinics with a young patient population, they may represent exactly the right medicine, especially considering the current shortage in qualified embryologists.
REFERENCE
Paulson R. F S Rep. 2026;7(3) 171
A Shortage of Estrogen Patches Because of Increasing Demand for Menopause Support
IVF clinics that routinely use estrogen patches may have to reorganize because our general OB/GYN colleagues are prescribing them out of supply as menopausal hormone replacement therapy (HRT) has been exploding in popularity once again after the FDA removed its Blackbox Warning from HRT.1 Prescriptions for these patches have apparently increased by 162% over the last two years. Prescriptions of all estrogens have risen by 78% over the last two years. And patches apparently represent 44% of all estrogen prescriptions.
REFERENCE
Peebles A. CNBC. June 26, 2026. https://www.cnbc.com/2026/06/26/estrogen-patches-are-in-short-supply-as-women-seek-menopause-support.html