2024-10-04 10:47:15
At fertility centers, couples can usually choose from a list of options. But you have to pay extra for additional services. However, it is often not entirely clear whether they have any effect and increase the chance of pregnancy.
In almost every German school class there is now a child created through artificial insemination. Parents of these children often face a long journey with many difficult decisions. In fertility centers you not only have different fertilization methods to choose from.
Couples are often asked if they would like to book additional services that seem promising. Sometimes the sperm must be specially prepared, sometimes the embryo must be observed in rapid movement, sometimes hatching from the membrane must be facilitated by scratching. These so-called add-ons usually cost more, and their usefulness is sometimes questionable.
“In principle it can be summed up: supplements have proven to be of little use,” says Ulrich Knuth, president of the Federal Association of Reproductive Medicine Centers in Germany (BRZ), which represents fertility centers. But it is interesting for clinics to offer these services, he says, “because they can earn a lot of money.”
Knuth sees a fundamental problem in the fact that in a still relatively young medical discipline – the first baby was born after in vitro fertilization in 1978 – many things are tried and applied without testing. “Someone invents something clever, it works for one patient, and then it is recommended to everyone, without the procedure having been examined in a clinical trial.” Often the first studies on these procedures only come out years later, also because Carrying out such studies according to recognized guidelines is extremely time-consuming.
The expert believes that embryo glue is one of the least useful procedures: a special means that is applied to the embryo Transfer to facilitate adhesion to the uterine lining. Or scratching, in which a small lesion in the uterus is intended to improve implantation. “This is also on the list: it doesn’t help,” he sums up.
The chance of pregnancy has not improved
Only in July was a large-scale study published in the journal “The Lancet“ came to the conclusion that the so-called time-lapse method of embryo selection does not increase the chances of a successful pregnancy. Thousands of photos are taken to see how the embryos grow in a time-lapse video. This should improve the decision on which of them is best suited for transfer, but apparently this is not the case.
“This shows that the theoretical advantages of advanced technologies do not always translate into better clinical outcomes,” says lead author Priya Bhide of Queen Mary University of London. His co-author David Chan points out that the money would be better spent not on machines that photograph the embryo, but on other laboratory equipment that actually has a measurable impact.
But what are they? The European professional society ESHRE (European Society of Human Reproduction and Embryology) reviewed 42 additional services to make recommendations based on them. The authors complain that none of their recommendations can be based on high-quality evidence, as usually only low-quality studies are available.
37 of 42 additional services not recommended
Overall the company comes to the conclusion: 37 of the 42 additional services cannot be recommended. Some might be considered or recommended, but sometimes only for certain patient groups.
Reproductive medicine specialist Volker Ziller emphasizes that it is worth looking closely at patients and their needs. The head of the department of gynaecology, endocrinology, reproductive medicine and osteology at Marburg University Hospital says: “It’s like being in a car repair shop: you don’t need new rims if the engine sputters.” fertility centers offer everything to all couples.
However, it is possible that some patients who, for example, have low progesterone levels, may benefit from an implant injection. He also sees some benefits with other add-ons, including the time-lapse method.
“This is a very complex and extremely difficult topic,” explains Ziller. The vast majority of their colleagues surely only do things of which they are convinced of the content, even if the evidence may only be weak. “Most doctors are initially interested in the well-being of their patients.”
For many couples, visits to fertility centers are very frustrating. The pregnancy rate for embryo transfer is around 31% and is much lower for older women. It often takes many attempts. “That’s why a lot of people are looking for solutions,” Ziller says. “People hold on to anything. Not only the patients, but also the doctors.” That’s why all these procedures are being developed.
Does the placebo effect help? Does pregnancy rate improve if you pay a lot of money for something and hope it works? “The psychological effect is surprisingly low,” explains Ziller. There is relatively good data for the opposite case, if someone is very stressed during treatment: “If the embryo is fit, then it will make it – no matter how upset the patients are.”
Overall, it says about the website According to the Ministry of Family Affairs, in Germany almost one in ten couples between the ages of 25 and 59 are involuntarily childless. Federal and state funds are available to support some couples. There is also an information portal, although there is no overview of the add-ons. At least one podcast on the topic is expected to be published in October.
dpa/wb
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