Definition
Couples with a history of repeated unsuccessful treatments expect doctors to come up with treatments that have not been tried before. Unfortunately most of the offered treatments are treatments with no proven effectiveness or in other words what we call empirical methods. In order to prove the effectiveness of a treatment it has to tried on randomly selected couples and should be compared with the results of randomly selected couples that did not benefit from the treatment under investigation. Such trails are almost non-existent. Some of the empirical treatments are briefly explained below:

Blood diluting drugs (Aspirin, Heparin etc.)
To date a total of 5 studies were conducted on low dose aspirin administration during assisted reproduction treatments. In three of these studies no benefits were recorded, and in two of them it was shown that it increased pregnancy rates. In the meta analysis where all the studies were evaluated together it was concluded that aspirin did not have any positive effects. We do not use aspirin in assisted reproduction treatments. Apart from it having no proven benefits, we do not recommend the administration of aspirin as it might cause haemorrhage complications during and after egg pickup.
Heparin is a blood diluting agent injected subcutaneously. It is especially beneficial in patients with antiphospholipid syndrome (APLs). Patients with APLs have difficulty in getting pregnant and when pregnancy occurs there is a high risk of miscarriage. APLs may also cause repeated failure in assisted reproduction treatments. Use of Heparin in women who do not have APLs to increase pregnancy rates is a method with no proven effectiveness. It has been shown to have positive effects in only one study but the results were not confirmed later on.

Viagra
Based on the principle of increasing the blood flow into the uterus in cases where the internal lining of the uterus does not sufficiently thicken, vaginal administration of Viagra was tried and in one study it was shown to be beneficial. However, the results were not confirmed by any other scientists afterwards. In our studies we have not seen any benefits from Viagra administration. In women whose uterus lining does not sufficiently thicken the cause is usually interuteral adhesions. In order to diagnose and treat this hysteroscopy should be done.

Co-cultures
In this method, a specimen taken from the uterus before ovulation a month before the treatment is started and this specimen is developed as cell culture in laboratory conditions. The embryos are placed on this culture and their growth is monitored. Co-cultures was a method developed in the first half of 1990s when embryo culture environments did not support the embryos in later development stages. Today it is not used much outside research purposes. There is one study which shows that co-cultures increase pregnancy rates in couples with repeated failures (Spandorfer 2003). Other researchers have not published similar results to date. The most important weakness of the study is the non randomised selection of the groups. The most important reason behind the loss of popularity of co-cultures is the emergence of subsequent cultures that support embryo development up to the 5^th-6^th days. The ratio of embryos that enter blastocyte phase in these cultures is similar and even better than those of co-cultures. We do not employ co-cultures in our treatments.

Embryo glue
There are studies that show increase in pregnancy rates in older women and couples with repeated failures through the use of an adherent called embryo glue. In our studies on selected couples (women over 39 and with repeated failures) have seen that embryo glue was successful. Therefore we recommend it use in these groups. However, couples should not perceive this as a miracle treatment.

Lymphocyte injections
In this method the lymphocyte cells re isolated from the blood taken from the father and subcutaneously injected to the mother in order to modify the immunity system. It was a method suggested for couples with repeated failures but its effectiveness could not be proved even in these cases (Ober 1999). There has been only one study published regarding this method and in the study it was observed that pregnancy rates improved in couples in the first six months following lymphocyte injections (Kling 2002). However, just like in the other methods the effectiveness of this treatment could not be shown in well planned studies. We do not recommend this method as we believe that apart from increasing financial costs couples do not benefit from it.

Sequential Embryo Transfer
It is the name given to the treatment where part of the embryos are transferred in the 2^nd or 3^rd day and the rest on the 5^th or 6^th day. Especially now that the n umber of embryos to be transferred is regulated by laws, it is a method that has been stopped completely. While still used, no benefits could be shown.