A research study published in the BMJ and also the subject of a recent BBC Panorama programme claims that some of the add-on treatments offered to Fertility patients are of no benefit, can be harmful and expensive.
We would agree with these assertions to an extent, as well as support the fact that much more research needs to be done to elucidate the benefits of many add-on treatments offered to patients with Fertility problems.
In day-to-day practice however, both patients and healthcare professionals want to do their best to enhance the chances of success and sometimes this involves using treatments that are thought to be of potential benefit. This approach is reasonable, providing the risks and uncertainty of the treatment have been thoroughly discussed.
For any of the treatment to be offered, there would have been a scientific premise for which some research study or experiment would have been undertaken to establish possible benefit.
It would be folly to say that all add on treatments are not of proven benefit. For example, in relation to the “endometrial scratch” there are several studies which have been subjected to scientific peer review that have shown this to be of benefit in patients who have failed at IVF. Conversely some studies have shown no benefit. The use of the“endometrial scratch” remains controversial because it is recognised that many of the studies showing benefit were not of high quality.
We also know that if we were to use certain “add on” treatments, they will work for some groups of patients but not for others. As such, one key element is having an unbiased, expert assess your individual circumstances and determine whether a certain “add on” may or may not be of benefit in your particular situation.
In order to minimize controversy, future approaches to research apart from focusing on high quality randomised controlled trials, perhaps should also explore and take into account the complexities of understanding the variations in patients, thus enabling us all to better individualise (customize) patient care.
Inevitably, more funding for treatment and research is required because the current poor success rates of fertility treatment encourage individuals to take speculative approaches to improve fertility that can lead to the use of costly and ineffective interventions.