IVF add-ons: which extras actually help
Around conventional IVF, a host of “extra” techniques and tests has grown — the so-called add-ons. They are often offered with the promise of higher success and at additional cost.
The crucial question for every couple is: which of them have genuinely proven benefit, and which simply add cost and hope without evidence?
What are add-ons?
Add-ons are the extra procedures offered beyond core IVF: laboratory techniques (e.g. assisted hatching, special culture media), tests (e.g. endometrial receptivity testing), pharmacological or immunological treatments, and embryo-imaging technologies.
Not all add-ons are the same. Some are supported by good evidence for specific patient groups, and others by little or none.
How are they evaluated?
The UK regulator HFEA uses a similar “traffic-light” system (green–amber–red). The key conclusion of both is the same: for the majority of add-ons, high-quality data proving an increase in births is lacking.
Which add-ons are not recommended for general use?
For the general patient population, the following are not recommended as routine, among others: assisted hatching, endometrial scratching, universal use of PGT-A in all patients, endometrial receptivity testing (ERA) in the general case, PRP injections, and immunological therapies (intralipids, corticosteroids, intravenous immunoglobulin, treatments for “NK cells”).
This does not mean they are necessarily harmful; it means they have not been shown to increase your chance of having a baby, while they add financial and sometimes physical burden.
Which may be considered in selected cases?
Some add-ons may be considered for specific groups, always with clear information. PGT-A, for example, does not increase the overall birth rate per cycle, but it may reduce miscarriage and shorten time to pregnancy in older women with enough embryos.
Time-lapse technology allows undisturbed embryo culture, but on its own it has not been shown to increase births. The “freeze-all” strategy has a clear role in preventing hyperstimulation, but not as a general rule for everyone.
How should you discuss add-ons with your doctor?
Ask three simple things about every add-on you are offered: Is there a randomized trial showing it increases the live-birth rate? Does that apply to my case? What is the cost and the possible risk?
A doctor practising evidence-based medicine will explain honestly where evidence exists and where it does not. The absence of add-ons does not mean inferior treatment — often it means more honest treatment.
Summary
Add-ons are many, but few have proven benefit for having a baby in the general population. The ESHRE (2023) recommendations and the HFEA system converge: the majority are not recommended as routine. A few (e.g. PGT-A, freeze-all) have a role in selected cases. The best strategy is a well-executed, individualized IVF cycle — and an honest discussion about every extra before you pay for it.
Sources: ESHRE, “Good practice recommendations on add-ons in reproductive medicine”, Hum Reprod 2023; HFEA add-ons list with traffic-light rating system.
⚕ Medically reviewed by Prof. Stratis Kolibianakis · Thessaloniki Medical Association Reg. No. 16340
ARTICLE 4 · MALE INFERTILITY
