Heartbroken after her third failed attempt at IVF this May, Natasha Whiting was desperate to do something – anything – to conceive. At 39, having already subjected her body to a battery of hormones, needles and eye-wateringly expensive procedures in her quest for a baby, she was all too aware time was running out.

Researching potential solutions online, she decided the answer might lie in two treatments to test her uterus’s microbiome.

The tests would examine bacteria in the uterine lining for hidden infection or inflammation which could impact fertility and include blood tests analysing everything from her red blood cell count to her auto-immune system.

Her gynaecologist at a private London fertility clinic agreed the treatments – over £2,000 for the microbiome analysis and ‘hundreds and hundreds of pounds’ for the blood tests – were worth it.

‘Absolutely, they endorsed it,’ says Natasha, who hoped the results would hold the key to conceiving the baby she longed for.

‘Guess what?’ She smiles bleakly. ‘Nothing was wrong.’

Over the past four years, Natasha and her partner, 38, have spent around £60,000 on IVF – plus a further £10,000 on ‘add-on’ treatments now offered by most private clinics. These typically cost £150 to £3,000 each, and may boost the chance of conception.

At least, that’s what the clinics say. Last month, the largest review of its kind, published in The Lancet Obstetrics, Gynaecology \& Women’s Health journal, found most add-ons – the number of which have boomed in the past decade, with over 70 per cent of IVF patients now paying for them – are simply not backed by reliable evidence.

Natasha Whiting and her partner spent around £60,000 on IVF over four years – plus a further £10,000 on ‘add-on’ treatments

Researchers concluded they don’t improve chances of conceiving – and, indeed, may even hinder it, as well as potentially harming a woman’s health.

‘Unproven add-ons can lead to false hope, greater financial strain and unnecessary medical procedures at what already can be a very difficult time,’ said study author Dr Sarah Lensen, senior research fellow at the University of Melbourne’s Department of Obstetrics, Gynaecology and Newborn Health.

Most add-ons are not classified as drugs, so aren’t required to go through the same rigorous clinical trials as medications to prove their efficacy and safety.

‘They’re just products, out on the market with a small amount of data,’ says Dr Ippokratis Sarris, consultant in reproductive medicine at King’s College Hospital in London and chair-elect of the British Fertility Society.

Some, such as platelet-rich plasma ovarian injections, in which platelets from a patient’s blood are injected into their ovaries, purportedly to improve egg quality and quantity, were not only not proven to be effective, but also carry a risk of bleeding, infection and ovarian scarring.

So why on earth are so many fertility clinics offering unproven add-ons? The obvious answer is profit. The global IVF market is worth an estimated £18 billion a year, with a substantial amount coming from add-on treatments, which are now being referred to by critics as ‘a tax on hope’.

That women are often vulnerable and desperate makes them more susceptible to add-ons.

The global IVF market is worth an estimated £18 billion a year

‘I’m sure there are places where you monetise for the sake of monetisation,’ says Dr Sarris. ‘But I would hope the majority of doctors do it because they genuinely think they’re helping their individual patients.’

However, he stresses: ‘That’s not right either. Belief is not the same as fact. There is some bad practice that needs to be stamped out.’

This is easier said than done. Tim Child, professor of reproductive medicine at the University of Oxford, is on the board of the fertility industry regulator, the Human Fertilisation and Embryology Authority (HFEA), and leads the committee reviewing add-ons, which are given a traffic-light grading, from green to red, to rate efficacy.

‘The difficulty is the HFEA has no authority to prevent clinics offering add-ons,’ he says.

While the HFEA has asked the Government for further oversight, reforms await consideration. ‘We need more powers. It’s a minefield,’ adds Professor Child.

Even more so in an age of social media, where so-called miracle treatments are endorsed on TikTok and one woman’s success story can be seized on as cast-iron proof a procedure works.

‘I spend more time at consultations telling people what not to do than how to spend their money. It’s a constant battle,’ says Dr Sarris, who is also director of King’s Fertility Clinic.

He can tell a patient that there is no evidence for a treatment or service, and, regardless, they ask: ‘Can I try it? Will it help?’

Most doctors say no, ‘but a lot say yes. We need to educate patients not to ask for them. We need to educate doctors not to offer them’.

While many women are at risk of exploitation, the experts I spoke to for this investigation also say doctors can feel pressured to authorise add-ons even when they suspect they won’t work.

‘When the clinician maybe thinks there is no harm or no risk, and the patient really wants it, it’s easier to give in rather than spend 20 minutes explaining why they don’t want to,’ says Dr Lensen, who adds that ‘there’s definitely a sense of guilt for patients if they don’t pursue every possible option. They don’t want to leave any stone unturned’.

Natasha, from London – pragmatic and devoid of self-pity as she discusses her ordeal – agrees.

‘I think I am reasonably intelligent. My attitude is, maybe they don’t work, but even though there’s limited proof, I want to look back and say I’ve done everything possible.’

Did her gynaecologist point out the lack of evidence to her?

‘No,’ she says.

Does she think they should? She pauses, out of what sounds like loyalty. ‘Yes, probably.’

Mind you, she adds, she hasn’t ‘looked into the lack of evidence’ either. ‘I follow a lot of IVF doctors on Instagram and, for me, there’s enough evidence there.’

She and her partner of 11 years, a psychotherapist, started trying for a baby five years ago. Natasha had endometriosis, where uterine tissue grows outside the womb, but perhaps naively she ‘didn’t think it would get in the way’.

One of five children, she assumed she’d conceive as easily as her mother had. ‘I grew up in a big family. I knew I’d be a good mum.’

It was ‘eternally disappointing’ to see friends and siblings start families. ‘I felt powerless. It kills your sex life – you’re trying for something you already know isn’t going to work.’

‘Unproven add-ons can lead to false hope, greater financial strain and unnecessary medical procedures,’ said Dr Sarah Lensen

After two years, the couple visited their GP. Tests showed no problem with her partner’s sperm, but at 36 she was considered ‘geriatric’ as a prospective new mother and put on the NHS waiting list for IVF.

Her first cycle took place at Chelsea and Westminster Hospital in February 2024. The embryo successfully implanted – but she miscarried after six weeks. ‘It was very, very sad, but gave us hope maybe it would work,’ she says.

She underwent a laparoscopy –in which a tiny camera is inserted into the pelvis via an incision to investigate damage done by endometriosis – and she was relieved to be told her fallopian tubes were functioning normally.

Only entitled to one NHS cycle, she went to a private central London clinic to continue IVF. She doesn’t want to name the clinic, for fear of it being blamed. ‘It’s not a case of the clinic being bad,’ she says. ‘My doctor’s fantastic.’

Meanwhile, she ‘evolved into an IVF expert’. Some information came from the clinic’s website, others from doctors on social media. ‘I’d scroll before bed and read about “tests you should do for recurrent implantation failure”,’ she says.

Shortly after joining her private clinic, she had a £4,000 hysteroscopy, in which a camera passes through the vagina and cervix and inspects the womb for abnormalities, a procedure jointly decided between Natasha and her new gynaecologist. It came back clear.

She then had a £1,000 add-on called EMMA (Endometrial Microbiome Metagenomic Analysis). It analyses bacteria in the uterine lining ‘to see if there’s something wrong with the microbiome that’s kicking the embryo out’, says Natasha.

A tube was inserted through her cervix into her uterus, where a sample of the lining was collected. Natasha describes this as ‘the most painful’ procedure she’s had. ‘It was horrible.’

EMMA is graded ‘grey’ by the HFEA because there is insufficient evidence to rate it at all, unlike ‘green’ or ‘amber’.

Green indicates there is high-quality evidence to suggest an add-on is effective; amber shows some studies find it has been effective, but others have not.

Professor Child points out that a similar test called Endometrial Receptivity Array (ERA) – which takes a biopsy of the uterus’s endometrial lining – has been graded ‘red’, because it may actually reduce IVF’s success rate by causing infection, bleeding and uterine perforation.

Natasha went through unsuccesful treatment at Chelsea and Westminster Hospital

Natasha, who runs a successful vitamin supplement business, considers herself lucky to have had the funds to do this but says: ‘IVF is a phenomenal, outrageous expense.’

Four rounds of egg retrieval followed, spaced three months apart, to give her egg reserves a chance to replenish. After each £10,000 retrieval, the eggs – which decline in quantity and quality with age – were frozen.

The more Natasha researched, the more she became persuaded that had her embryo been screened for abnormalities before her first IVF cycle – a procedure not available on the NHS – ‘we could have saved ourselves the heartache of miscarriage’.

So she paid £350 each to genetically screen each of their nine embryos. PGT-A (Preimplantation Genetic Testing for Aneuploidy), checks for the correct number of chromosomes in embryos before they’re transferred to the womb.

While it’s graded green because it can reduce the chances of miscarriage in most women by the HFEA, that positive rating isn’t as simple as it looks.

The watchdog also stresses there’s insufficient evidence PGT-A will reduce the chance of miscarriage in older women. It has also graded the procedure red because it does not increase the chance of a live birth.

Professor Child says: ‘We think some patients will be discarding embryos [with] a chance of viability. You can potentially avoid having a miscarriage, but the question is – is the testing really accurate and are you sure you’re not discarding some embryos that actually would go on to a live birth?’

Five of the nine embryos Natasha had tested with PGT-A were deemed not viable: ‘Have we binned five potentially good embryos? Or could they have been miscarriages? We’ll never know. Having miscarried, we were buying ourselves a little less loss.’

Her first embryo was transferred this January – at a cost of £3,800 – using EmbryoGlue, a £250 add-on, coating the embryo in a fluid supposed to mimic those naturally in the womb. ‘It’s meant to help it stick,’ she says. ‘We wanted to try everything.’

EmbryoGlue is one of three treatments last month’s review did find weak evidence for. The HFEA graded it amber, meaning its effectiveness is unclear. ‘We felt there was a lack of studies,’ says Professor Child, which is a problem across the board.

Because add-ons aren’t drugs, they ‘can be sold with literally no evidence behind them at all,’ he explains. ‘We need more, better quality studies.’

Much of the research Dr Lensen unearthed for her Lancet review was deemed inadmissible for reasons ranging from ‘sloppy methods’ to ‘outright fraud’.

Shockingly, she found doctors or academics made up studies subsequently retracted when scrutinised and approximately half of potentially eligible studies were excluded from the review due to trustworthiness concerns.

‘The patients don’t exist, the study was never done, but they want to get the credit and the promotion at their institution.’

She says there needs to be more regulation of add-ons, ‘particularly around the more expensive and potentially harmful options – like PRP ovary injection’, a procedure designed to improve egg production.

After Natasha’s second attempt at IVF failed, an ultrasound revealed her womb lining hadn’t shed, which would normally happen naturally if an embryo had successfully implanted. Her gynaecologist suggested another hysteroscopy to clear the lining and remove a polyp – a small growth in her womb that could potentially interfere with embryo implantation – before her third attempt in May.

This time, she felt ‘nauseous, I had cramping – all the things you should feel if you’re pregnant. I felt sure our life was about to change,’ she says.

But her pregnancy test – taken excitedly at 5am – came back negative. ‘It was heartbreaking.’

Before her follow-up meeting with the clinic, Natasha entered her medical notes into the AI assistant Claude, and asked what more she could do to conceive. ‘I didn’t want to wallow,’ she says.

The top suggestion from her AI research was to try a second EMMA test, as well as ALICE (Analysis of Infectious Chronic Endometritis). Costing around £1,000, it too assesses bacteria in the uterus lining which could affect embryo implantation.

She recalls her gynaecologist did ask: ‘You are aware it’s a lot of money?’

‘I said “yes, but I want to have ticked off everything.” I never felt I was being exploited.’

She believes the tests ‘helped [the clinic with diagnostics]... We’re still in that discovery phase. Try this. Does it work? No. Try something else. We’re working on what’s going to work for my body’.

Her blood tests probed everything from her red blood cell count to her iron levels and autoimmune disorders. When they all came back clear, she felt relief and despair.

‘It left us at a total loss, wondering what the hell we should do next. Life feels stagnant with this constant cycle of testing, trying and hoping.’

The only other explanation, she now realises, is her endometriosis, something she dismissed throughout the add-on treatments due to the laparoscopy showing her fallopian tubes were functioning normally. Both Natasha’s NHS and private gynaecologist warned it might impact her ability to conceive.

Now she is about to try a drug to switch off her ovaries to minimise inflammation, which could have hindered the IVF, for a couple of months, after which she will decide whether to do another round of egg retrieval, or transfer one of their two remaining ‘precious’ embryos.

‘We’re not ready to give up yet.’ Nor is she ready to consider alternative paths to parenthood such as adoption.

Whatever she does will involve more expense. ‘I can’t see an end,’ she says.

For as long as there are companies bringing add-ons to market, fertility clinics willing to offer them and women praying to conceive, closure for those like Natasha will be hard to come by.

Every new add-on available will bring with it new hope, and the nagging sensation, she says, that ‘if I don’t do it, maybe it would have worked’.