THE man鈥檚 crotch, covered only by his underpants, was level with my head and twice as large as life. Luckily it was only a poster at a trade exhibition for fertility doctors I attended in Vienna. It was advertising supplements claimed to boost sperm counts. Odd, given that a recent review concluded that the .
It was the first time I had been to this conference, the . I was both awed and appalled by what I heard. For all the good that reproductive technologies do, for all the joy they bring to those who otherwise may have been unwillingly childless, the whole field is also riddled with pseudoscience.
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Since the birth of the first IVF baby, Louise Brown, 41 years ago, more than 8 million babies have been born after being conceived this way. But many people who have IVF don鈥檛 end up with a baby in their arms. Success varies with age, but overall just one in four IVF cycles leads to pregnancy. In the UK and many other countries, couples often have to pay for IVF, as it is seen as optional rather than a life-saving medical treatment. With some able to afford just one or two attempts, there is inevitably a lot of disappointment.
To try to boost pregnancy rates, many clinics offer other options as well as the basic IVF procedure. Sometimes called 鈥渁dd-ons鈥�, these usually add on to the price too. Many were developed on theory alone, without clinical trials to test they truly work.
Last year, the UK regulator, the Human Fertilisation and Embryology Authority, developed a traffic light system for IVF add-ons, giving a red if there is no evidence of an improved chance of conceiving, amber if there is little or conflicting evidence and green if the evidence suggests they could be used routinely. Of the 11 add-ons it has reviewed, none get a green.
Some of these procedures are now belatedly going through trials. During the conference, researchers announced trial results showing that two widely used add-ons gave no benefit for most couples. One is freezing the embryos for a month or two before putting them in the uterus. The other is a technique called ICSI, which involves a sperm being injected into an egg. ICSI was developed to help couples where the man鈥檚 sperm cannot swim, but is now offered to anyone. Cycles done this way outnumber those of regular IVF by three to one.
When I spoke to attendees at the conference, several agreed that things are bad. Some were insistent their clinic didn鈥檛 carry out such practices unnecessarily. Others justified offering these procedures by saying couples are asking for them.
That isn鈥檛 good enough. Doctors can always refuse any treatment they feel isn鈥檛 in someone鈥檚 best interests. If there is no good evidence that a procedure boosts pregnancy rates, it shouldn鈥檛 be offered commercially. Those clinicians who are genuinely researching new procedures should carry them out only as part of trials where they are provided free of charge, as in most other areas of medicine. Anything else risks exploiting the desperate and the vulnerable.
