Journal of Human Reproductive Science
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Year : 2021  |  Volume : 14  |  Issue : 5  |  Page : 1-2

From the editor's desk

Department of Reproductive Medicine, Shreyas Hospital and Sushrut Assisted Conception Clinic, Kolhapur, Maharashtra, India

Date of Submission17-Oct-2021
Date of Decision17-Oct-2021
Date of Acceptance17-Oct-2021
Date of Web Publication16-Nov-2021

Correspondence Address:
Dr. Padma Rekha Jirge
Department of Reproductive Medicine, Shreyas Hospital and Sushrut Assisted Conception Clinic, 2013E, Rajarampuri, Kolhapur - 416 008, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-1208.330502

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How to cite this article:
Jirge PR. From the editor's desk. J Hum Reprod Sci 2021;14, Suppl S1:1-2

How to cite this URL:
Jirge PR. From the editor's desk. J Hum Reprod Sci [serial online] 2021 [cited 2023 Feb 8];14, Suppl S1:1-2. Available from:

Add-on treatment is any technique that is a variation of normal in vitro fertilisation (IVF) technique using adjuncts. This includes laboratory, clinical and complementary treatments. Examples include taking extra medications such as steroids or aspirin or heparin, using embryo glue as transfer media for embryo transfer or genetic testing of embryos for aneuploidies. These add-on treatments are used to improve the success rate of IVF. Because add-on treatment is additional to standard IVF, it usually comes with an extra cost to patients, and the cost will vary depending on the add-on treatment. The first article in this supplement deals with IVF laboratory add-on treatments. None of the IVF add-ons are supported by high-quality evidence that these are effective and safe. Thus, there is a need for transparent information on interventions, including uncertainties and risks, to be made available by IVF clinics to patients to support well-informed treatment decisions. Apart from lack of evidence, there is also a lack of consensus on the indications for their use. Most add-ons have conflicting evidence from randomised controlled trials (RCTs). There are certain add-ons which have no evidence for its routine use at improving the chances of having a baby for most fertility patients but in certain situations or instances may be helpful.

Pre-implantation genetic testing (PGT) is used to identify euploid embryos for transfer, thus enabling couples to achieve a healthy pregnancy. PGT-A does not carry any additional known risks for the person undergoing fertility treatment. However, PGT-A is known to carry some risks for the embryo which include hampered development of the embryo further and fewer embryos available for transfer and freezing. Using PGT-A many times, a normal embryo may be discarded or an abnormal embryo can be transferred as it may miss an abnormality or detect one that is not there.

The add-ons such as physiological intracytoplasmic sperm injection (PICSI) and PGT-A have no evidence for overall or routine use in fertility patients, could be considered appropriate to use in certain circumstances. For example, PICSI could be used to reduce the chance of miscarriage or PGT-A may improve the chance of pregnancy for women over 35 and also may be beneficial by reducing the risk of miscarriage. The evidence that supports the use of add-ons in specific cases might not be as high quality and some evidence may be there when subgroup analysis of RCTs is done. Therefore, the Indian Society of Assisted Reproduction (ISAR) through this consensus aims to establish certain protocols for the use of add-on treatments.

While assisted reproductive technology (ART) has given hope to millions of couples suffering from infertility, it has also introduced countless ethical, legal and social concerns. Several ethical aspects of IVF lab procedures have emerged since IVF was first introduced. Some of them are upper age limits at which IVF should be refused, 'ownership' of gametes and embryos, IVF in single women and same-sex couples, PGT, emerging laboratory techniques, individual's right to their genetic offspring in the setting of gamete or embryo donation social egg freezing, commercialization, public funding and prioritisation of IVF. One must also look at reporting and practice regulations as well as financial aspect of IVF.

Due to the rapidly evolving nature of the ART, legislation is often unable to keep pace and address all of the ethical and legal issues that are constantly emerging in the field. It is therefore important for the physicians to continually monitor these issues and ensure that ART technologies are offered and delivered in a manner that balances patient care with social and moral responsibility.

The Indian IVF industry is booming; with mushrooming of ART clinics in the country, which makes it necessary that we have regulations for functioning of ART clinics. Today, we have only the guidelines and not a law and therefore ISAR had taken up the initiative to lead the way forward in establishing practice guidelines for the safe and ethical use of ARTs in our country. These guidelines discuss the points to consider before the starting of an IVF unit, to the designing of the laboratory, the staffing pattern and experience recommendations, laboratory safety guidelines, documentation and patient traceability, gamete traceability, handling biological material, the consumables and media and different consents and checklists and also propose key performance indicators for the Indian scenario.

This document should serve as a one-point reference for existing clinics as well and new clinics to establish standardised practices to offer evidence-based treatments and ultimately benefit the country's patients at large.


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