Is there a place for adjuvant therapy in IVF?

Objectives: To review studies of adjuvant therapies for in vitro fertilization (IVF), and to establish the role of adjuvant therapy for women with repeated failure to conceive with IVF.

Design: Review of the literature. Articles were identified through a PubMed, Medline, EMBASE, Cochrane library, and the national research Register literature search according to preset criteria followed by a cross-reference of published data.

Main Outcome Measure(s): Clinical pregnancies and live births.

Result(s): Most adjuvant therapies for IVF are empirical, and prescribed without a clear diagnosis of whether the failure to conceive is due to a maternal or fetal factor. Although some randomized controlled trials are available, the results are conflicting.

Conclusion(s): No adjuvant therapy has been shown to be definitively advantageous. At present the diagnosis of IVF failure is not specific enough to indicate a certain adjuvant therapy. Hence, some unconfirmed therapies might be highly efficacious for subgroups with particular characteristics. The use of endometrial biopsy with a pipelle is promising, but like other therapies, requires additional testing. Chromosomal aberrations present a confounding factor for maternal adjuvant therapies that are difficult to exclude.

Target Audience: Obstetricians & Gynecologist, Family Physicians.

Learning Objectives: After completion of this educational activity, the reader will be able to interpret the proven scientifically significant studies of the various forms of adjuvant therapy in IVF. Assess shortcomings in many of the different types of adjuvant therapy and interpret potential dangers in some forms of adjuvant therapy.