What Are IVF Add-Ons? Which Ones Work & Do You Really Need Them?
IVF add-ons
When you are going through IVF, it is natural to want to do everything possible. So when a clinic mentions an extra test or technique that “might help”, it is hard to say no. But extras cost money, and not all of them do what they promise. Let’s look honestly at what the evidence says.
Quick answer: IVF add-ons are optional extra tests or treatments offered on top of standard IVF, such as PGT-A, endometrial scratching, EmbryoGlue, time-lapse imaging and immune treatments. The UK regulator, the HFEA, rates them on a five-colour scale. As of September 2026, none of the add-ons it rates is green for improving the chance of having a baby for most patients. Some may help specific people for specific reasons, such as PGT-A reducing miscarriage risk. For most patients, proven standard IVF works without add-ons.
Key takeaways
- An add-on is anything optional beyond core IVF or IUI treatment, usually at extra cost.
- The HFEA rates 17 add-ons. None is rated green for increasing live birth rates for most patients.
- Some add-ons have benefits for other outcomes or particular groups, which is where they can be justified.
- A few, including PRP, some immune treatments and endometrial receptivity testing, carry a red rating.
- If you are self-funding, the HFEA suggests another full cycle may be better value than add-ons with unproven benefit.
- A good clinic will explain why an add-on is being suggested for you, what it costs and what the evidence shows.
If you would like an honest conversation about what you do and do not need, you can Book a Free Consultation with our team.
What are IVF add-ons?
IVF add-ons are optional, non-essential tests or treatments offered alongside proven fertility treatment such as IVF or IUI. They usually claim to improve your chance of a baby, but the evidence behind them is limited, mixed or missing.
The HFEA defines an add-on as an extra offered to the general patient population in UK licensed clinics, where published studies claim a benefit but good evidence of effectiveness in real clinical practice is lacking.
Types of add-ons
Add-ons usually fall into four groups:
- Laboratory techniques – how embryos are grown, selected or prepared, such as time-lapse imaging, EmbryoGlue or assisted hatching.
- Genetic tests – such as PGT-A, which checks embryos for chromosome problems.
- Womb (endometrial) tests and procedures – such as endometrial scratching or receptivity testing.
- Immune and other medicines – such as intralipids, steroids, IVIG, androgens or platelet-rich plasma (PRP).
Why are IVF add-ons so common?
They appeal for understandable reasons. Treatment is emotionally and financially draining, and people want to leave no stone unturned. After a failed cycle, an add-on can feel like a way to change the outcome. Some add-ons are also genuinely promising and still being studied.
They are widely used. An HFEA national patient survey found around three-quarters of recent patients had at least one add-on. The most common were endometrial scratching, EmbryoGlue and time-lapse imaging.
What UK regulators expect from clinics?
In October 2023, the HFEA and professional and patient bodies agreed a consensus statement on the responsible use of add-ons. It says that treatments without strong evidence of safety or effectiveness should only be offered in research settings, and patients should not be charged extra to take part in research.
UK consumer law also applies. The Competition and Markets Authority expects clinics to give clear, upfront information on what add-ons cost and what the evidence shows.
The HFEA add-on ratings explained
The HFEA uses five colours to show what the evidence says about each add-on. The system replaced the older red, amber and green “traffic light” in October 2023.
| Rating | What it means |
|---|---|
| Green | High-quality evidence shows the add-on is effective at improving the outcome |
| Yellow | Unclear – good studies conflict; some show a benefit, others do not |
| Grey | Not enough good-quality evidence to rate it either way |
| Black | Good evidence shows it makes no difference to the outcome |
| Red | Potential safety concerns, or evidence it may reduce the chance of success |
Three things to understand about the ratings
- The main rating is about having a baby, for most patients. Each add-on is rated on whether it improves the chance of a live birth for most people having treatment.
- Some add-ons have extra ratings. An add-on can be rated for other outcomes, such as reducing miscarriage, or for specific groups, such as people over 40. PGT-A is the best example: red for improving the chance of a baby, but green for reducing miscarriage for most patients.
- The ratings do not say how big an effect is. They also do not cover every add-on on the market. Ratings are reviewed when new evidence emerges, or at least every five years.
The HFEA also makes a clear point for self-funding patients: paying for more cycles of proven treatment may be better than spending large sums on unproven add-ons in a single cycle.
Laboratory and embryo add-ons: what the evidence says
These add-ons change how eggs, sperm and embryos are handled, selected or tested in the lab. Ratings below are the HFEA’s ratings for improving the chance of a baby for most patients, as of September 2026.
PGT-A (pre-implantation genetic testing for aneuploidy) – Red, with a green rating for miscarriage
What it is: a few cells are taken from each embryo, usually at the blastocyst stage, and checked for the right number of chromosomes. Embryos with the wrong number are less likely to lead to a baby.
What the evidence shows: PGT-A is a selection tool. It does not make embryos healthier, and it often leaves fewer embryos to transfer. That is why it is rated red for improving the chance of a baby. However, it is rated green for reducing miscarriage for most patients. It is rated grey for older women, where there is not yet enough good evidence.
Things to know: results can occasionally be wrong. Some embryos are reported as “mosaic”, with a mix of normal and abnormal cells, and healthy babies have been born after mosaic embryo transfers. Ask your clinic how it handles mosaic results.
Who might consider it: people with recurrent miscarriage, or those who want to avoid transferring embryos unlikely to succeed, after a careful discussion. PGT-A is different from PGT-M, which tests for a known inherited condition and is not an add-on. Learn more about PGT-A at IVF London.
Time-lapse imaging and incubation – Black
What it is: embryos grow in an incubator with a built-in camera that photographs them every few minutes, such as an EmbryoScope. Embryologists can watch development without taking embryos out.
What the evidence shows: good-quality studies show no effect on the chance of having a baby for most patients. Some clinics still value it for stable culture conditions and detailed records, which is a lab-quality reason rather than a proven success boost.
EmbryoGlue (hyaluronate-enriched transfer medium) – Yellow
What it is: a culture medium rich in hyaluronan, used at embryo transfer to help the embryo attach to the womb lining.
What the evidence shows: studies conflict. Some suggest a small benefit; others do not.
Assisted hatching – Grey
What it is: a laser or chemical makes a small opening in the embryo’s outer shell to help it “hatch” and implant. See our assisted hatching page.
What the evidence shows: not enough high-quality evidence to show it improves live birth rates. It may occasionally be used for embryos that need a biopsy, or in specific lab situations.
Elective freeze-all cycles – Yellow
What it is: freezing all embryos instead of transferring a fresh one, then transferring in a later frozen embryo transfer.
What the evidence shows: for most patients, it is unclear whether freezing everything improves the chance of a baby. But there are good medical reasons to freeze all embryos in some cases, such as a high risk of ovarian hyperstimulation syndrome (OHSS), or when PGT-A results are awaited. In those situations it is a clinical decision, not an optional extra.
Sperm selection add-ons: IMSI (Grey) and PICSI (Black)
- IMSI uses very high magnification to select sperm. There is not enough good evidence to rate it.
- PICSI selects sperm that bind to hyaluronan, a substance around the egg. For people having ICSI for male factor infertility, good evidence shows it makes no difference to the chance of a baby.
Sperm DNA fragmentation testing – Grey
This test measures damage to the DNA in sperm. There is not enough good evidence yet to show that testing, and acting on the result, improves outcomes. It may still be discussed in some cases, such as recurrent miscarriage. Our male fertility investigations explain the standard tests.
Intrauterine culture – Grey
A device places the fertilised eggs inside the womb for early development before they are moved back to the lab. There is not enough evidence to rate it.
Not on the HFEA list, but worth knowing
- ICSI when there is no sperm problem. ICSI is essential for male factor infertility. But large studies have found no advantage over standard IVF for couples with normal sperm, so it should not be an automatic upgrade.
- AI embryo selection. Artificial intelligence tools that rank embryos from images are growing fast. They can support embryologists’ decisions, but strong evidence that they increase live birth rates is still developing. Read about Embryo Assist AI at IVF London.
- Artificial egg activation. This was removed from the HFEA’s rated list in 2023. UK guidance says it should only be used for selected patients, such as those with very low or failed fertilisation in previous ICSI cycles.
Womb, immune and medicine add-ons: what the evidence says
These add-ons aim to make the womb more receptive to an embryo, or to change how the body responds to pregnancy. This group contains most of the add-ons with red ratings.
Endometrial scratching – Yellow
What it is: a thin tube gently scratches the womb lining in the cycle before treatment. The idea is that the healing response makes the lining more receptive. See our endometrial scratching page.
What the evidence shows: studies conflict. Large trials, including a major UK trial, found no benefit for most people having their first IVF cycle. Whether it helps specific groups, such as people with repeated implantation failure, is still unclear. It can be uncomfortable and cause some spotting.
Endometrial receptivity testing (e.g. ERA) – Red
What it is: a small biopsy of the womb lining is tested to predict the best day for embryo transfer. Read about ERA and timed embryo replacement.
What the evidence shows: the HFEA rates it red. Current good-quality evidence does not show it improves the chance of a baby, and it may reduce effectiveness for most patients. It involves an extra mock cycle and biopsy.
Immune tests and treatments
Some clinics test for so-called “immune” causes of implantation failure, such as natural killer (NK) cells, and treat them with medicines. The science behind this is disputed.
| Treatment | HFEA rating | What to know |
|---|---|---|
| Intralipids (fat emulsion drip) | Grey | Not enough good evidence to rate it |
| Steroids (glucocorticoids, e.g. prednisolone) | Red | Evidence does not support benefit for most patients; potential side effects |
| IVIG (intravenous immunoglobulin) | Red | Potential safety concerns; a blood product with serious possible side effects |
If your clinic recommends immune treatment, ask what test result it is based on and what evidence supports it for you. Our page on autoimmune treatments explains when these may be discussed.
An important exception: some confirmed medical conditions, such as antiphospholipid syndrome, have established treatments like aspirin and heparin in pregnancy. Treating a diagnosed condition is standard care, not an add-on.
Platelet-rich plasma (PRP) – Red
What it is: your own blood is spun to concentrate platelets, then injected into the ovaries or womb, with the aim of “rejuvenating” them.
What the evidence shows: rated red due to potential safety concerns and a lack of good evidence. It should only be used within properly run research.
Androgen supplementation (DHEA, testosterone) – Grey
Sometimes suggested for people with low egg reserve or a poor response to stimulation. There is not enough good evidence to rate it. Speak to your specialist before taking any hormone supplement.
Microbiome testing – Grey
Testing the bacteria in the womb or vagina is a promising research area. There is not yet enough good evidence to show it improves outcomes.
What about hysteroscopy?
A hysteroscopy is not on the HFEA add-on list. Large trials found that routine hysteroscopy before a first IVF cycle does not improve live birth rates for people with a normal scan. But it is very useful when a problem is suspected, such as a polyp, fibroid, scarring or a septum. Read What Is a Hysteroscopy? to learn when it is recommended.
IVF add-ons at a glance: HFEA ratings (September 2026)
This table lists all 17 add-ons the HFEA currently rates, grouped by rating. The rating shown is for improving the chance of a baby for most patients.
| Add-on | HFEA rating | Other ratings or notes | When it may be discussed |
|---|---|---|---|
| PGT-A | Red | Green for reducing miscarriage; grey for older women | Recurrent miscarriage, after full counselling |
| Endometrial receptivity testing (ERA) | Red | – | Research settings, after careful discussion |
| Steroids (glucocorticoids) | Red | – | Only for specific diagnosed conditions |
| IVIG | Red | Safety concerns | Research settings only |
| Platelet-rich plasma (PRP) | Red | Safety concerns | Research settings only |
| Time-lapse imaging | Black | May support stable lab culture | Lab preference, not a success booster |
| PICSI (male factor ICSI) | Black | – | Rarely justified |
| Endometrial scratching | Yellow | Conflicting evidence | Possibly repeated implantation failure |
| EmbryoGlue | Yellow | Conflicting evidence | Case by case |
| Elective freeze-all | Yellow | Medically indicated for high OHSS risk | OHSS risk; awaiting PGT results |
| Assisted hatching | Grey | – | Specific lab situations |
| Intralipids | Grey | – | Research settings |
| IMSI | Grey | – | Case by case |
| Intrauterine culture | Grey | – | Research settings |
| Androgen supplementation | Grey | – | Poor responders, with specialist advice |
| Microbiome testing | Grey | – | Research settings |
| Sperm DNA fragmentation testing | Grey | – | Possibly recurrent miscarriage |
Ratings can change as new evidence is published. Always check the HFEA add-ons page for the latest information before you decide.
Do you really need IVF add-ons?
For most people, no. Standard, well-run IVF is effective on its own, and the HFEA is clear that add-ons are not needed for most patients. But “most” is not “all”. An add-on may be reasonable when there is a specific clinical reason, and you understand the trade-offs.
When an add-on may be worth discussing
- You have had recurrent miscarriages, and PGT-A may lower the chance of another loss.
- You are at high risk of OHSS, where freezing all embryos is a safety measure.
- You have had several failed transfers with good-quality embryos, and your team wants to investigate further, ideally within a structured plan or research.
- Your embryos need to be biopsied, where assisted hatching may be part of the lab process.
- There is a diagnosed condition, such as antiphospholipid syndrome, that has an established treatment.
When to be cautious
- An add-on is offered to everyone as a standard package.
- You feel pressured to decide quickly.
- The clinic cannot tell you what evidence supports it for your situation.
- The price is unclear, or you are charged extra for something described as research.
- It is sold as a way to “guarantee” or “maximise” success.
The cost question
Add-ons can add hundreds to a few thousand pounds to a single cycle. If you are self-funding, compare that with the cost of another embryo transfer or IVF cycle, which has proven value. Our price list shows costs upfront, and flexible payment is available through Humm.
10 questions to ask your clinic about any add-on
- Why are you recommending this for me specifically?
- What is its HFEA rating?
- What outcome is it meant to improve – live birth, miscarriage or something else?
- What is the evidence for someone with my age and history?
- What are the risks or side effects for me or my embryos?
- Could it reduce my chance of success, or my number of embryos?
- How much does it cost, and is that included in my treatment price?
- What happens if I say no?
- Is it offered as part of a research study, and if so, am I being charged?
- How many of your patients use it, and what are your outcomes?
The HFEA also publishes a list of questions to ask your clinic. It is always fine to take time to decide, or to ask for a second opinion.
What actually improves your chances of IVF success?
The factors with the strongest evidence are not optional extras. They are the foundations of good fertility care.
Factors backed by strong evidence
- Age and egg quality. The age of the eggs is the single biggest factor in IVF success. If you are planning ahead, egg freezing at a younger age can help.
- A thorough diagnosis. Understanding why you are not conceiving guides the right treatment. This includes female and male investigations.
- A tailored stimulation protocol. Matching drug doses to your egg reserve improves safety and egg numbers.
- High laboratory standards. Stable culture conditions and experienced embryologists matter a great deal.
- Single embryo transfer of a good-quality embryo, often at the blastocyst stage, which lowers the risks of twins without lowering overall success.
- Using all your embryos. Frozen embryos from one egg collection give extra chances, so cumulative success over several transfers is what counts.
- Treating diagnosed problems, such as polyps, fibroids affecting the womb cavity, blocked tubes filled with fluid, or thyroid disorders.
Lifestyle factors you can influence
- Stop smoking – both partners. Smoking lowers IVF success.
- Reach a healthy weight where possible, as a very high or very low BMI can reduce success.
- Cut down on alcohol and avoid recreational drugs.
- Take folic acid for at least three months before trying.
- Look after your mental health. Stress does not cause infertility, but support makes treatment easier to cope with.
Our preconception care and fertility coaching services can help you prepare. You can also see how outcomes vary by age on our success rates page.
IVF London’s approach to add-ons
At IVF London, we believe you should only pay for what is likely to help you. We are licensed by the HFEA and regulated by the CQC, and we follow HFEA guidance on add-ons.
- Evidence first: we explain each add-on’s HFEA rating and what the research shows, including when the evidence is weak.
- Personal, not packaged: we only discuss an add-on when there is a reason linked to your history, never as a default bundle.
- Transparent pricing: costs are listed clearly on our price list before you commit.
- Your decision: you can say no to any add-on without it affecting your care, and take the time you need.
- Focus on the fundamentals: careful diagnosis, tailored stimulation and high lab standards come first, including options like Mild IVF and Natural Cycle IVF.
- Support after setbacks: if a cycle has not worked, our previous IVF failure and miscarriage service looks for answers before adding extras.
If you have had treatment elsewhere, our embryologists can review your previous cycle notes and help you understand what happened. Learn about your initial consultation or meet our team.
Get honest advice before you spend more
Whether you are about to start IVF, have been offered add-ons elsewhere or are planning your next cycle after a setback, our specialists will talk you through what the evidence says for you.
Book a Free Consultation · Call 0208 075 8881 · Email info@ivflondon.co.uk
Frequently asked questions about IVF add-ons
1. Do any IVF add-ons actually work?
None of the add-ons rated by the HFEA is currently green for improving the chance of a baby for most patients. Some have proven benefits for other outcomes, such as PGT-A reducing miscarriage, or are medically useful in specific situations, such as freezing all embryos when OHSS risk is high.
2. Is PGT-A worth it?
For most patients, it does not increase the chance of a baby and may reduce the number of embryos available. It may be worth discussing if you have had recurrent miscarriages, because it is rated green for reducing miscarriage. The decision should be personal and well informed.
3. Is EmbryoGlue worth paying for?
The evidence is conflicting, so the HFEA rates it yellow. Some studies suggest a small benefit and others show none. Ask your clinic why it is recommended for you.
4. Does endometrial scratching improve IVF success?
For most people having their first IVF cycle, large trials found no benefit. The HFEA rates it yellow because evidence conflicts. Its role after repeated implantation failure is still uncertain.
5. Is the EmbryoScope (time-lapse) worth it?
The HFEA rates time-lapse imaging black, meaning good evidence shows it does not improve the chance of a baby for most patients. Some clinics use it routinely for lab quality reasons rather than as a paid extra.
6. Should I have immune testing after failed IVF?
The evidence behind most immune testing, such as NK cell tests, is weak and disputed. Treatments like steroids and IVIG are rated red. It is better to first review embryo quality, the womb cavity and other known causes. Treat a confirmed condition, such as antiphospholipid syndrome, as standard care.
7. Do intralipids help implantation?
There is not enough good-quality evidence to say, so the HFEA rates intralipids grey. They should ideally be used only within research.
8. Is the ERA test worth it after failed transfers?
The HFEA rates endometrial receptivity testing red, as current evidence does not show it improves live birth rates and it may reduce effectiveness. Discuss other investigations first.
9. Are IVF add-ons available on the NHS?
Generally, no. NHS-funded treatment usually covers standard IVF. Add-ons are mostly offered in private care, and some are only offered for specific medical reasons.
10. Why do clinics offer add-ons if they don’t work?
Some add-ons are promising but unproven, some help specific groups, and patients often ask for them. However, the HFEA’s consensus statement says unproven treatments should mainly be offered in research, and patients should not pay extra to take part in research.
11. Can add-ons harm my chances?
Some can. A red rating means potential safety concerns, or evidence that the add-on may reduce effectiveness. PGT-A, for example, can reduce the number of embryos available for transfer.
12. Is ICSI an add-on?
ICSI is standard treatment for male factor infertility. When sperm are normal, large studies show no advantage over conventional IVF, so it should not be added automatically.
13. What should I spend money on instead?
For self-funders, the HFEA suggests that extra cycles of proven treatment may be better value than add-ons. Investing in a clear diagnosis, a good clinic and frozen embryo transfers usually offers better value.
14. How do I check an add-on’s rating?
Visit the HFEA treatment add-ons page. Each add-on has its own page with the evidence and any safety concerns. UK clinics must link to it when offering add-ons.
15. Can I refuse an add-on my clinic recommends?
Yes. Add-ons are optional by definition. You can decline, take time to think or seek a second opinion.
