ObGyn Intelligence
Evidence Matters
Prepare
Evidence LibraryUnderstanding pregnancy, risk, and consentBeing heard
Evidence Library · Being heard

What fertility patients actually report

Most used an add-on. Most paid extra. Two thirds had some regret.

Four independent studies: two surveys of patients, and two audits of what clinics say on their own websites.

1,590 Australian women who had IVF since 2017:

FindingShare
Used one or more add-on82%
Paid an additional cost for it72%
Assumed add-ons were known to be safe49%
Experienced some decision regret66%
Decision regret among those whose IVF was unsuccessful83%
Decision regret where the specialist had contributed more to the decision75%

Regret tracked two things: whether the treatment worked, and whether the patient felt the decision had been made by the clinician rather than with her. Half of them believed safety had been established. It had not.

The authors are careful about their own limits. This was a retrospective survey recruited through social media and reliant on what women remembered, and they note that response bias is most likely to affect exactly these regret and decision-making figures.

1,500 UK fertility patients, surveyed by the regulator in 2024:

73%
Had used an additional test, treatment or emerging technology
National patient survey
50%
Said their clinic explained how effective it was at increasing the chance of a baby
So half were not told
37%
Said their clinic explained the risks
Nearly two thirds were not told

Also from that survey: only 62% of private patients received a personalised cost breakdown, and 40% of those who did paid more than they had originally been shown.

What clinics actually say. An audit of 74 UK fertility centre websites across 1,401 pages found 276 claims of benefit relating to 41 different interventions. Only 29% of those claims were quantified. Sixteen published references were cited in total, across just 13 of the 74 websites. Sixty-one of those websites cited nothing at all.

An equivalent audit of 40 Australian and New Zealand clinic websites found 78% advertised at least one add-on, 77% of the descriptions claimed a benefit, 90% of those claims were unquantified, and 9.8% referenced any scientific publication. Costs ranged from nothing to $3,700 per add-on in Australian and New Zealand dollars. The authors concluded that none of the add-ons were supported by high-quality evidence of benefit for pregnancy or live birth rates.

Why this is a consent issue and not a consumer issueTwo thirds of patients were not told the risks. Half were not told the effectiveness. Half assumed safety was established. That is a description of decisions being made without the first requirement of informed consent being met.

The fertility field publishes its own ethics opinion on informed consent in assisted reproduction. These figures describe what is happening alongside it.
Where this comes from:
92. Lensen S, Hammarberg K, Polyakov A, Wilkinson J, Whyte S, Peate M, et al. How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients. Hum Reprod. 2021;36(7):1854-1861.
93. Human Fertilisation and Embryology Authority. National patient survey 2024. London: HFEA; published March 2025.
94. Spencer EA, Mahtani KR, Goldacre B, Heneghan C. Claims for fertility interventions: a systematic assessment of statements on UK fertility centre websites. BMJ Open. 2016;6(11):e013940.
91. Lensen S, Chen S, Goodman L, Rombauts L, Farquhar C, Hammarberg K. IVF add-ons in Australia and New Zealand: a systematic assessment of IVF clinic websites. Aust N Z J Obstet Gynaecol. 2021;61(3):430-438.
123. Ethics Committee of the American Society for Reproductive Medicine. Informed consent in assisted reproduction: an Ethics Committee opinion. Fertil Steril. 2023;119(6):948-953.

Covered in the essential classes

Continue

More from The add-ons

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.