Reacción a "There is insufficient evidence that most complementary treatments for in vitro fertilization improve fertility"

This study provides a comprehensive and methodologically rigorous assessment of the available evidence on ten of the most commonly used complementary treatments (add-ons) in in vitro fertilisation. For most of these treatments, there is currently no robust evidence that they improve reproductive outcomes, such as the probability of pregnancy or the live birth rate, whilst for some of them the potential benefits remain uncertain and require further, higher-quality studies.

One of the main strengths of this research is the approach adopted by the authors. They did not merely combine the results of the available trials, but carried out a critical assessment of the quality and reliability of the included studies, analysing the risk of bias and the certainty of the evidence using recognised tools. Furthermore, the exclusion of studies with significant reliability issues allows for a more conservative and likely more realistic estimate of the effect of these treatments.

The results are consistent with the evidence accumulated in recent years, which has shown that many complementary IVF treatments have been incorporated into clinical practice before sufficient evidence was available to demonstrate their efficacy and safety. Although some may have a role in specific situations or in certain subgroups of patients, their widespread use is not supported by high-quality evidence.

As the authors themselves point out, the study also has some limitations, including the possibility that certain trials excluded on the basis of reliability criteria may have contained valid information. Furthermore, for some adjuncts, the scarcity of available studies makes it difficult to draw definitive conclusions.

From a clinical and patient-care perspective, this study has important implications. In a field such as assisted reproduction, where patients often face a heavy emotional and financial burden, it is essential that any additional treatment is offered alongside clear and balanced information on its potential benefits, risks and the degree of uncertainty involved. The introduction of new complementary treatments should be guided by sound scientific evidence and, where such evidence is insufficient, should preferably be considered within well-designed research protocols.