Responsible Innovation In IVF—While Protecting a Patient's Hope Without Exploitation
A guest opinion by Dr. Christine Allen.
Christine F. Allen, M.S., PhD, is a globally recognized expert in embryology and IVF laboratory operations and is a board member of several technology companies in the IVF field. She has served as Education Chair of the American Association of Bioanalysts (AAB) for the last eight years and is a current member of the ASRM Technology Committee. She can be reached through the editorial office of the CHRVOICE.
BRIEFING: We, with this guest article, welcome a very well-known embryologist in the embryology community who we, here at the CHR, for the first time met in person at the recent FRMC, where Dr. Allen gave one of the best talks (on A.I. in reproductive medicine) among basically only great talks by some of the best clinicians and basic scientists in reproductive sciences. She, in this article here, expresses strong opinions on how IVF practice must progress (and—especially in more recent years—has not always done so). The CHR agrees with her comments in this article almost completely (probably over 95% of the time) but, considering how contrarian from standard practice in most IVF clinics CHR clinical practice has become over the years in almost all aspects of IVF, this percentage represents huge congruity with Dr. Allen’s viewpoints on IVF practice and we hope to be able in the near future to find some additional mutual benefits from finally having met in person.
There is something profoundly unique about reproductive medicine. Unlike most areas of healthcare—where disease, injury, or survival define the core emotional burden of treatment—assisted reproduction sits at the intersection of science, identity, longing, and deeply personal dreams.
People who come to IVF are not merely “patients”; they are individuals, couples, and families-in-waiting, already emotionally invested in the existence of a person who does not yet exist. They are juggling grief over what has not happened, hope for what may yet happen, and anxiety that time, biology, finances, or fate may run out before they get there.
In that vulnerable emotional environment, every suggestion, every new technology, every “option” carries far more weight than a simple clinical decision. It can feel existential. And that is precisely why the responsibilities of professionals in this field are so enormous—and why, in my opinion, not all of those responsibilities are being met.
Today, IVF is celebrated as a story of extraordinary scientific triumph—and it should be. But alongside those achievements exists another reality: a culture in which innovation is often commercialized faster than it is proven; where the language of “choice” and “empowerment” sometimes masks the quiet exploitation of deeply vulnerable people; and where the psychological fragility of those pursuing fertility treatment is frequently underestimated and, at times, taken advantage of.
As a mother and as a professional, I am the fiercest advocate for innovation—I dedicated my career to it. This commentary is not an attack on innovation. It is not a rejection of progress. It is an argument for responsible progress: for working to discover what truly works, rather than working to prove that a product works at any cost (two very different lines of research). It is a call for honesty, humility, and ethical clarity in a field that works with human life at its most fragile and human hope at its most intense.
The Emotional Reality of IVF: A Perfect Storm for Pressure
Anyone who has worked closely with IVF patients knows this truth: infertility is not simply a medical condition. It is a profound psychological experience. It impacts identity, relationships, self-worth, and the way people envision their future. It carries shame for some, frustration for many, and exhaustion for nearly everyone who endures it.
Already in consultation rooms, patients are burdened by a multitude of questions: Am I running out of time? What if this is my only chance? What if I don’t do everything possible and regret it forever? What if the thing I don’t choose is the thing that would have worked?
Layered on top of this are financial strains—often involving savings, loans, or family support—cultural or familial pressure about parenthood, repeated failures, miscarriages, or traumatic outcomes; social isolation as others conceive easily; and exhaustion from constant medical appointments, hormones, and uncertainty.
In such settings, interventions presented as “something extra that might help” do not register emotionally as optional, but as possibly necessary. Declining something does not feel like a neutral choice; it feels like a risk. It feels like gambling against fate.
Even the language surrounding IVF reinforces this vulnerability. Patients are frequently told to “do everything possible,” “maximize their chances,” and “leave no stone unturned.” These are emotionally powerful statements. They create an atmosphere where restraint feels irresponsible, skepticism feels dangerous, and critical thinking can feel like self-sabotage.
This emotional climate is absolutely real. And pretending otherwise is dishonest.
That is why the burden must never fall on patients alone to navigate the scientific validity of what they are offered. Their vulnerability does not make them weak—it makes them human. It makes them deserving of protection. It makes our ethical obligation stronger, not weaker.
Where Innovation Becomes Marketing—and Marketing Becomes Exploitation
There is nothing inherently wrong with innovation. Every major advancement in IVF began first as an idea, then likely as an experiment, and possibly as a developing technology. Without innovation, we would not have vitrification, ICSI, and countless other truly meaningful improvements.
Problems arise, however, when innovations become profitable products before having been validated—when something is treated as knowledge before evidence has been developed, as is required in evidence-based medicine.
In far too many IVF clinics around the world, technologies are promoted long before robust outcome benefits have been demonstrated. Services are framed as breakthroughs simply because they are new, and emotionally charged, persuasive language replaces factual counselling. Add-ons and their price tags thus become attached primarily to uncertainty.
In addition, we see “choice architecture” designed to steer patients toward add-ons, paired with rhetorical strategies that imply declining an intervention means “doing less” or “giving up.”
Patients are told things like, “this may improve your chances,” “many patients choose this treatment,” or that a proposed intervention is “cutting-edge.” And which patient has not heard the phrase, “I’ll do everything available to increase your chances,” or “if there’s any chance, why not try it?”—likely the most deceiving argument of all.
These statements sound harmless. But in the IVF context, they are incredibly powerful psychological triggers. When you are terrified that your dreams may slip away, the idea of “why not?” can quickly become “how can I possibly say no?”
Too often, the full truth is not clearly stated. Many add-ons—contrary to claims made—do not have convincing evidence of improving live birth rates, and their theoretical benefits remain largely speculative. Risks and costs may outweigh uncertain benefits, even as aggressive promotion benefits clinic business models more than patient outcomes.
At that point, marketing crosses a line. It no longer simply informs; it leverages emotional vulnerability. In reproductive medicine, that should be considered not just questionable ethics, but completely unacceptable.
Because Hope Is Sacred, It Must Not Be Manipulated
Hope is one of the most powerful forces driving humanity. It brings people into IVF clinics after loss, failure, or devastation. It carries them through injections, surgeries, hormonal storms, financial hardship, and emotional exhaustion.
Hope is not a weakness. Hope is strength. But hope must not become a currency.
What troubles me deeply about certain practices in reproductive medicine is not the existence of experimental ideas or innovative approaches. It is the willingness of clinics, at times, to package hope into purchasable units—to sell reassurance, to monetize emotional vulnerability, and to allow scientific uncertainty to be framed as an opportunity simply because someone is desperate enough to believe in it.
We must question ourselves honestly when we offer interventions without strong supporting evidence, when we present possibilities as though they are probabilities. Are we truly serving patients, or are we—perhaps unintentionally—serving financial or reputational interests?
That is the ethical line. In medicine, hope should be supported. It should be honored. It should be protected. But it must never be exploited.
The Shared Responsibility of Reproductive Endocrinologists and Embryologists: Guardians of Trust, Not Vendors of Options
REIs and embryologists working in IVF are not ordinary service providers. This is not a transactional field. Patients do not come to “purchase” a service; they entrust us with something profoundly intimate—their future family. That trust is sacred, and it comes with immense responsibility.
Physicians must do more than present options. They must understand how technology is developed, interpreted, contextualized, and filtered. They must protect patients from unnecessary exposure to interventions that do not meaningfully serve them. They must resist equating “more” with “better,” or “newer” with “effective.”
It requires courage—and significant investment in education—to look at a patient and say: “I know you want to try everything, but not everything that is offered is truly worthwhile. Some of these things simply do not have evidence to support that they will help you take home a baby.”
That is not denying care. It is advocacy. It honors science. It respects ethics.
Unfortunately, financial incentives in some environments reward offering more add-ons—starting with routine ICSI and PGT biopsies, which have been demonstrated to be harmful in certain contexts. Competition between clinics encourages branding and “innovation status” as selling points. The use of AI in IVF laboratories, for example, has begun to feel mandatory, whether substantiated or not.
In this commotion, the line between research and clinical care becomes blurred.
REIs now face pressure from institutions, markets, and patient expectations shaped by social media. But pressure does not absolve responsibility—it increases it.
Medicine has always required the ability to say “no” when something is not justified. Reproductive medicine is no different. Patients do not simply need options; they need advocacy.
To Patients: You Deserve Honesty, Clarity, and Protection
If you are a patient reading this, please hear this clearly: you are not unreasonable for wanting to try everything. You are not irrational for wanting every possible chance. You are not difficult for asking questions. You are not weak because you are vulnerable.
You are strong. You are invested. You are profoundly human.
But you should never feel pressured into a decision because you fear regret, worry about disappointing your doctor, feel guilty saying no, or assume that declining something means decreasing your chance of becoming a parent.
You deserve more than options. You deserve transparent explanations, honest acknowledgment of uncertainty, clarity about cost versus benefit, emotional understanding, and true partnership.
If something is not convincingly shown to improve outcomes, you deserve to hear that plainly—not softened by marketing language. If benefits are uncertain, they should be described as uncertain—not as “promising,” “exciting,” or “innovative” unless those words are grounded in evidence.
Empowerment is not about having more things to buy. It is about having the truth delivered with compassion and respect.
If Our Field Truly Wishes to Honor Patients, We Must Get Better
The future of reproductive medicine depends on innovation. Extraordinary advancements are still to come. We should continue exploring, testing, and dreaming—scientifically, ethically, and responsibly.
But progress does not happen in an ethical vacuum. Innovation must be deliberate, not impulsive. Tested, not merely marketed. Protective of patients, not funded by their uncertainty.
It must protect hope—not commodify it.
The Moral Compass of Reproductive Medicine Must Remain Steady
IVF is one of the greatest scientific and humanitarian achievements of modern medicine. It allows people once excluded from parenthood to hold children in their arms. It gives life—biologically, emotionally, relationally, and spiritually.
Because IVF touches something sacred, it demands unwavering moral discipline. We do not work with cases—we work with human beings. With fragile dreams. With powerful, vulnerable hope.
Responsible innovation honors that truth. Irresponsible innovation exploits it.
We owe our patients more than persuasive optimism. More than options. We owe them protection, honesty, rigor, and compassion. Care guided not only by what is possible, but by what is right.
That is how we protect hope. That is how we honor this field. And that is how innovation in IVF can truly serve those who need it most—people whose deepest wish is not technology itself, but the simple, profound joy of becoming parents.