できる事はなんでもしてください。費用は払います。この様に言われる方がいますが根拠がないことや根拠が少ないことはそう伝えて行うべきではないと思います。
add-onといって付加的な治療法は如何に根拠がないかと延々と説いています。この手の論文が最近多数出ております。背景として医師はあの手この手で患者さんの気を引きたいし患者はなんでもできることはしたいと、この結果として根拠が希薄な技術や薬剤や治療法を多数行っている現状があるとしています。
確かに論文は出ていますし学会でも報告があります。そして偉い先生も発言しています。しかしそれは根拠とは言えません。根拠は大規模なRCTをしてこそでありそれが複数揃って初めて根拠となります。
読んでいて爽快で実に納得ができるものが多く、この様な論文を多くの生殖医療専門医に読んでほしいと思いますし、患者さんにはっきりとこれは根拠がないです、これはお勧めできません、お金と時間をかける価値はないですと断言して欲しいと思います。
自分も論文を読みながら反省もしつつあらためてそう思いました。
Human Reproduction, 2023, 38(11), 2062–2104
Good practice recommendations on add-ons in reproductive medicine
42個の検討のうち３個の赤字のみが「お勧めする」、2個のみ「しても良いのでは」とのこと（青字）。それ以外は全てお勧めできないとしています。
以下結論を記載しますが読んでいて余りにも図星で頭が痛くなりました。
以下英語ですが読み易いのでそのまま掲載します。
もしこれはどんなんでしょうか？と質問がある場合にはコメントをお願いします。解説いたします。
1:Screening hysteroscopy is currently not recommended for routine clinical use.
2:Screening hysteroscopy can be considered in patients with recurrent implantation failure.
3:The presently available endometrial receptivity tests are not recommended.
4:Peripheral blood tests for immune parameters and uNK-cell testing are not recommended.
5:KIR and HLA genotyping is currently not recommended for routine clinical use.
6:Immunomodulating treatments, such as Intralipid, IVIG, rh-LIF, PBMCs, and anti-TNF, are not recommended.
7:Artificial oocyte activation is currently not recommended for routine clinical use.
8Artificial oocyte activation is recommended for complete activation failure (0% 2PN), very low fertilization (<30% fertilization), or globozoospermia.
9:Mitochondrial replacement therapy to affect oocyte quality is not recommended.
10:In vitro activation of dormant follicles is not recommended.
11:Clinical IVM and rescue IVM or natural cycle IVF/M are currently not recommended for routine clinical use.
12: Sperm DNA damage testing is currently not recommended for routine clinical use.
13:Artificial sperm activation is currently not recommended for routine clinical use.
14:Artificial sperm activation is recommended for patients with primary or secondary total asthenozoospermia which are not the result of axonemal structure defects.
15:Sperm hyaluronic binding assay is currently not recommended for routine clinical use.
16:Physiological ICSI is currently not recommended for routine clinical use.
17:Magnetic-activated cell sorting is currently not recommended for routine clinical use.
18:Microfluidics can be considered.
19:Intracytoplasmic morphologic sperm injection is currently not recommended for routine clinical use.
20:Growth factor-supplemented embryo culture medium is not recommended.
21:Assisted hatching is not recommended.
22:Pre-implantation genetic testing for aneuploidy is currently not recommended for routine clinical use.
23:Non-invasive PGT is currently not recommended for routine clinical use.
24:Mitochondrial DNA load measurement is currently not recommended for routine clinical use.
25:Time-lapse imaging is not recommended as a tool to improve live birth rates.
26:Intrauterine administration of platelet-rich plasma is not recommended.
27:Intraovarian administration of platelet-rich plasma is not recommended.
28:Duostim is currently not recommended for routine clinical use.
29:Adjuncts (metformin, growth hormone, testosterone, DHEA, aspirin, indomethacin, and sildenafil) before or during ovarian stimulation are not recommended.
30:Intravaginal or intrauterine culture devices are currently not recommended for routine clinical use.
31:Hyaluronic acid addition to transfer media is recommended. Monitoring of the multiple pregnancy rate is still advisable.
32:Endometrial scratching is currently not recommended for routine clinical use.
33:Intrauterine administration of hCG is not recommended.
34:Intrauterine administration of granulocyte colony-stimulating factor is not recommended.
35:Endometrial administration of embryo culture supernatant is not recommended.
36:Endometrial exposure to seminal plasma is not recommended.
37:Stem cell therapy for premature ovarian insufficiency, diminished/poor ovarian reserve or thin endometrium is not recommended.
38:Glucocorticoids are not recommended in ART.
39:Elective freeze-all is currently not recommended for routine clinical use.
40:ICSI is not recommended for non-male factor infertility.
41:Antioxidant therapy is not recommended in ART.
42:Acupuncture, Chinese and herbal medicine and other complementary therapies are not recommended.