JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):14
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263534

P-02. Add-Ons in Reproductive Medicine: An Evidence-Based Approach to Responsible Innovation

Vitória Luiza Batalhoti Brogiato¹, Enzo Nakano¹, Julia Roverso Correa Silveira¹, Gabriel Monteiro Pinheiro¹

¹Universidade Santo Amaro - São Paulo - SP - Brasil

Objective: This study aimed to identify the main add-ons used in reproductive medicine, assess the level of available scientific evidence for each, and present the most recent recommendations from the European Society of Human Reproduction and Embryology (ESHRE).
Methods: A narrative literature review was conducted, analyzing full-text articles published in the last five years on the PubMed platform. The search used the keywords "add-on*" and "reproductive medicine", resulting in 43 articles, of which eight were selected for critical analysis.
Results: Reproductive medicine has seen a rise in the incorporation of complementary procedures, known as "add-ons," aimed at improving the outcomes of assisted reproduction treatments. However, the efficacy and safety of many of these procedures lack robust scientific evidence, highlighting the need for a critical, evidence-based approach to ensure responsible innovation. The analysis revealed that few add-ons have strong evidence of efficacy and safety. Among the most commonly used are: preimplantation genetic testing for aneuploidies (PGT-A), assisted hatching, endometrial scratching, EmbryoGlue, time-lapse imaging (TLI), immunomodulatory supplementation, endometrial receptivity array (ERA), and acupuncture. ESHRE recommendations indicate that only four are based on moderate-quality evidence, and none on high-quality evidence; 95% of the recommendations derive from observational studies, expert consensus, or low-quality evidence. An Australian study involving 1.590 women undergoing IVF found that 82% used some form of add-on, and 66% regretted the choice, particularly in cases of unsuccessful outcomes. The data point to a gap between clinical practice and evidence-based medicine in the use of add-ons. ESHRE guidelines suggest that most of these procedures should be limited to research settings, and their clinical use should be avoided or, at most, conducted with informed consent and a detailed discussion of risks and benefits. Indiscriminate use may lead to clinical frustration and unnecessary financial burden.
Conclusion: The study concludes that most add-ons in reproductive medicine lack robust scientific support, yet their use remains widespread, often driven by non-clinical factors. It is crucial that the use of add-ons be accompanied by informed consent, transparency, and scientific rigor, promoting truly patient-centered care. Innovation must be responsible, distinguishing promising advancements from premature practices.