In almost every German school classroom there is a child who has been born through artificial insemination. And the parents of such children have usually gone through a long process, during which they were called upon to make many difficult decisions.

Fertility centers not only allow their clients to choose the method that is right for them, but also offer them options related to selected sperm, embryo monitoring and more. These so-called add-ons cost extra of course – and it is debatable whether they change the child that will eventually be born through artificial insemination.

“In summary, one can say that these add-ons have not proven to be very decisive,” says Ulrich Knuth, president of the Association of German Reproductive Medicine Units (BRZ). But through such offers the clinics “can make a lot of money”.

Some new technologies are controversial

According to Knuth, the main problem lies in the fact that in this relatively new field of medicine – the first IVF baby was born only in 1978 – many ideas are applied without the necessary tests.

“Someone thinks of a clever idea that turns out to work in the case of a client, and then automatically this particular idea starts to be generally recommended, but without the necessary clinical studies on the procedure having been done in between”, explains the expert – often enough years until relevant studies are published.

Last July, for example, a large study published in The Lancet found that even time-lapse technology for selecting embryos does not improve the chances of a successful pregnancy. This technology is supposed to improve the decision about which embryo is the most suitable for implantation by providing thousands of photos of the embryo culture – but as it turns out, this is not the case.

“This shows that the theoretical advantages of innovative technologies do not necessarily lead to improved clinical outcomes,” writes lead study author Priya Baid from Queen Mary University of London.

Recently the European Society of Human Reproduction and Embryology (ESHRE) evaluated 42 additional services offered by reproductive medicine units and concluded that 37 of them cannot be recommended. Some of them can be taken into account or even offered, but partly only for certain categories of patients.

Every couple is different

Reproductive medicine specialist Volker Ziller emphasizes that it is important to take into account the specificities and needs of each patient: “It’s like when we take the car to the repair shop: we don’t need to change the rims if the problem is with the engine” – that’s why the practice of clinics offering all couples all additional services is controversial.

However, the issue as a whole “is very complicated and difficult”, adds Chiller. The vast majority of his colleagues are certainly implementing technologies that they are sure will deliver – even if there is not enough evidence to support this belief. “Clearly most doctors are primarily concerned with the well-being of their patients.”

It often takes several tries

For many couples, visits to reproductive medicine units are a difficult process. The rate of successful pregnancy attempts in relation to embryo implantations is about 31% – a rate that appears even lower in older women. Therefore, more efforts are often required. “That’s why a lot of people are looking for other solutions,” says Chiller – and that’s why all these new technologies and processes have been developed.

But is the placebo effect beneficial? Do the chances of pregnancy improve when someone gives more money for something and thus gains the hope that because of it everything will be fine? “The effect of this emotion is remarkably low,” explains Chiller. “If the embryo is suitable, it will make it – regardless of how the patients feel.”

Edited by: Giorgos Passas