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Beyond the "Live Birth" Illusion

A multidimensional KPI framework evaluating 10 common IVF add-ons strictly on published data, applied to three core pillars: Cumulative Live Birth Rate (CLBR), Miscarriage Rate, and Time to Pregnancy (TTP).

✍️ By Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG — Reproductive Medicine Specialist · Updated August 2026

Multidimensional KPI Framework

Why "live birth rate" alone isn't enough

Most add-on marketing leans on a single headline number. A treatment can look neutral on live birth rate while still meaningfully reducing miscarriage risk — or quietly delaying your timeline by months. We score every add-on against all three pillars.

1

Cumul. Live Birth Rate

The absolute probability of a baby from one egg retrieval, counted on an intention-to-treat (ITT) basis.

2

Miscarriage Rate

The risk of physiological trauma and treatment loss along the way.

3

Time to Pregnancy

The temporal efficiency — months and transfers — required to reach success.

ITT (Intention-to-Treat)
Every patient who started treatment is counted, including drop-outs — the most honest measure of real-world benefit.
OR / RR (Odds / Risk Ratio)
How much more (>1) or less (<1) likely an outcome is versus not using the add-on. "NS" = not statistically significant.
ARR (Absolute Risk Reduction)
The real-world drop in risk, in percentage points — more meaningful than a relative ratio alone.
NNT (Number Needed to Treat)
How many patients must use the add-on for one extra person to benefit. Lower is better.
NNH (Number Needed to Harm)
How many patients must use it for one extra person to be harmed. Lower is worse.
RIF / FET
Recurrent Implantation Failure / Frozen Embryo Transfer — the patient groups most add-on studies were tested in.
✓ Positive / effective – Neutral / no effect ▲ Marginal / fragile evidence ✕ Harmful / negative trend
Category 1

Trauma Reduction & Temporal Efficiency

These interventions profoundly reduce miscarriage risk and accelerate the time to a successful pregnancy.

PGT-A (Genetic Testing)

Study pop: Good-Prognosis & Male Factor
– Cumul. Live Birth
Neutral
OR 0.98
✓ Miscarriage
Highly Effective
ARR 11.6% · NNT = 9
✓ Time to Pregnancy
Highly Effective
Reduces transfers from ~1.8 to 1.2

PICSI (Sperm Selection)

Study pop: 2,772 unselected couples
– Cumul. Live Birth
Neutral
OR 1.12 (NS)
✓ Miscarriage
Effective
Significant reduction (OR 0.58)
✓ Time to Pregnancy
Improved
Prevents loss-related recovery delays
Category 2

Iatrogenic Delay & Lack of Efficacy

These interventions fail to improve live birth or miscarriage rates while artificially delaying the treatment timeline.

ERA (Endometrial Receptivity Analysis)

Study pop: 767 good-prognosis (euploid)
✕ Cumul. Live Birth
Negative Trend
Absolute diff −3.4%
– Miscarriage
Neutral
No reduction in clinical loss
✕ Time to Pregnancy
Harmful / Delayed
Delays transfer by 4–8 weeks

Acupuncture

Study pop: Pooled unselected IVF
– Cumul. Live Birth
Neutral
OR 0.85 with sham controls
– Miscarriage
Neutral
No robust evidence of reduction
– Time to Pregnancy
Neutral
Extensive visits, no timeline change
Category 3

Active Obstetric & Embryonic Harm

These interventions demonstrate active detriment to pregnancy retention or fetal health.

Corticosteroids (Prednisone)

Study pop: 715 RIF patients
– Cumul. Live Birth
Neutral
RR 0.97
✕ Miscarriage
Harmful
Biochemical loss NNH = 14
✕ Time to Pregnancy
Harmful
Doubles preterm delivery (NNH = 16)
Category 4

Marginal / Equivocal Impact

Endometrial Scratching

Study pop: >6,000 pooled patients
▲ Cumul. Live Birth
Marginal
ARR 2.8% · NNT = 36
– Miscarriage
Neutral
No significant reduction
– Time to Pregnancy
Neutral
Requires extra luteal-phase procedure

EmbryoGlue (HA Medium)

Study pop: 248 FET patients
– Cumul. Live Birth
Neutral
OR 1.12 (NS)
– Miscarriage
Neutral
No robust ITT protective effect
– Time to Pregnancy
Neutral
Does not alter transfer cycles
Category 5

Invasive Procedures with Unreliable / Missing Data

Highly invasive experimental therapies lacking robust clinical justification under the KPI framework.

Intraovarian PRP

Study pop: 60 low ovarian reserve
✕ Cumul. Live Birth
Negative Trend
OR 0.40 (0.13–1.21)
– Miscarriage
Neutral
Imprecise (OR 0.17, CI 0.02–1.58)
✕ Time to Pregnancy
Harmful
Invasive ovarian injection delays timeline

Intrauterine PRP

Study pop: 138 RIF / thin endometrium
– Cumul. Live Birth
Neutral
OR 1.46 (NS)
– Miscarriage
Neutral
No protective effect (OR 1.21)
✕ Time to Pregnancy
Harmful
Imposes intrauterine procedure delay

Intralipid Infusion

Study pop: 105 failed-cycle patients
▲ Cumul. Live Birth
Fragile / Unreliable
OR 3.31 (1 small, biased trial)
– Miscarriage
Missing Data
Not reported / evaluable
✕ Time to Pregnancy
Harmful
Requires repeated IV infusions

This page summarizes published randomized trials, meta-analyses, and cohort data as evidence changes over time and individual circumstances vary. It is educational content, not a substitute for individualized medical advice — please discuss any add-on with your treating physician.

Dr. Patsama Vichinsartvichai

About the author

Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG is a board-certified reproductive endocrinology & infertility specialist, former head of the Vajira IVF unit at Navamindradhiraj University, and founder of LIFE by Dr. Pat in Bangkok. His published research focuses on the dysmorphic (T-shaped) uterus and uterine-factor infertility.

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