Adjuvant Fertility Therapies

Adjuvant fertility therapies (AFT) are supplementary treatments given to women and men undergoing fertility treatments with the aim of increasing pregnancy and live births. However, many of the studies on the therapeutic benefits of AFT in IVF including updated meta-analysis of randomized control trials (RCTs) are conflicting.

DHEA, CO-Q tablets and most AFTs that have been reported beneficial one way or the other. Others include Growth Hormone (GH), dopamine agonists (e.g. bromocriptine and carbergoline), and prednisolone alone or combined with aspirin and/or heparin, luteal phase supplementation with LH and GnRH agonist, hyaluron, recombinant albumin in embryo transfer medium, and preimplantation genetic screening (PGS).

Sildenafil (Viagra) suggestively improves blood flow to the uterus, thereby increase the thickness of the uterine lining. It is used in some centers but the evidence to support wide acceptance of its use is limited and contradictory. Likewise evidence base to support benefits of acupuncture at the time of embryo transfer is contradictory. Hysteroscopy and endometrial scratching before or prior to IVF treatment or embryo transfer has shown consistent improvement in implantation and live births, especially when planned for the excision of submucous fibroids, polyps or adhesiolysis.

Conflicting research reports looking at a myriad of psychological therapies including counselling, stress reduction strategies, detoxification treatments and similar interventions suggested lack of significant benefits and cost-effectiveness of these interventions or strategies alone or in combinations.

For example recently published meta-analysis on the effect of stress on outcomes of IVF suggests no significant negative impact. This, therefore, queries the need and benefits of these expensive stress reducing strategies or treatment panels on the success or live birth rates following IVF treatments.

The beneficial effects and cost-effectiveness of most AFTs to fertility treatments are still largely debatable.  Majority of these therapies are often expensive and mostly unproven. For these reasons, the use of adjuvant fertility therapies for fertility improvements or benefits are not widely practiced.