⚠️ The Hard Truth About IVF Add-Ons
- Most add-ons have NO proven benefit for improving live birth rates
- Some may actually reduce your chances or cause harm
- 73% of IVF patients use at least one add-on—often unnecessarily
- The money spent on add-ons could fund additional IVF cycles instead
- Desperate patients are vulnerable to hopeful marketing
When you're struggling to conceive and someone offers you something that "might help," it's hard to say no. Clinics know this. That's why IVF add-ons have become a multi-million dollar industry—even though most have little or no evidence of benefit.
This isn't about blaming clinics or patients. It's about giving you the information you need to make informed decisions about where to spend your money and emotional energy.
Understanding the HFEA Traffic Light System
The UK's Human Fertilisation and Embryology Authority (HFEA) evaluates IVF add-ons and rates them using a simple traffic light system:
Let's look at the most common add-ons and what the evidence actually shows:
The Add-Ons, Rated
Typical cost: $200-$500
This procedure intentionally scratches or "injures" the uterine lining before embryo transfer, based on the theory that healing creates a more receptive environment for implantation.
What the Evidence Shows
A landmark 2019 NEJM study of 1,364 women found NO benefit. Live birth rates were virtually identical: 26.1% with scratching vs. 26.1% without. The procedure is painful, carries infection risk, and costs money for no gain. Despite this, studies showed 27% of UK IVF cycles still included it as recently as 2021.
Typical cost: $500-$1,500
Instead of removing embryos from the incubator to check them, time-lapse technology takes continuous photos, theoretically causing less disturbance and helping select the best embryo.
What the Evidence Shows
Time-lapse is genuinely useful for the lab—it helps embryologists see development patterns. But no high-quality studies show it improves patient outcomes. ESHRE advises against offering it as an add-on. The images are fascinating, but "fascinating" doesn't mean "more babies."
Typical cost: $800-$1,200
ERA is a genetic test of your uterine lining to determine your "window of implantation"—when your uterus is most receptive. The idea is to time transfer precisely to your personal window.
What the Evidence Shows
Multiple randomized controlled trials show no benefit. The 2022 ERA-RCT found no difference in live birth rates. The test is expensive, requires an extra cycle for the biopsy, and delays treatment—all for no proven improvement. ERA is still heavily marketed despite the evidence.
Typical cost: $500-$800
A small hole is made in the embryo's outer shell (zona pellucida) to help it "hatch" and implant.
What the Evidence Shows
No benefit shown for fresh transfers. May slightly benefit frozen embryo transfers, as the freezing process can harden the shell. Some evidence it may help women over 38 or those with repeated implantation failure. But for most patients, it adds cost without clear benefit.
Typical cost: $500-$1,500
Your own blood is processed to concentrate platelets, then injected into your uterus to theoretically improve lining quality.
What the Evidence Shows
Very limited evidence, mostly poor-quality studies. Added to HFEA's red list in June 2025 due to lack of evidence and safety concerns. Some small studies show promise for thin linings, but no robust RCTs support routine use.
Typical cost: $500-$1,000
Uses extremely high magnification (6,000x vs. standard 400x) to select sperm with better-looking morphology.
What the Evidence Shows
Cochrane review found no evidence of benefit. Multiple RCTs show no improvement in pregnancy or live birth rates compared to standard ICSI. The logic is appealing but the results aren't there.
Typical cost: $200-$400
A culture medium containing hyaluronan, a naturally-occurring substance that may help embryos attach to the uterine lining.
What the Evidence Shows
Some studies suggest a small benefit, others show none. Cochrane review found it may slightly increase live birth rates, but the evidence quality is low. Relatively inexpensive and unlikely to cause harm, but don't expect miracles.
Typical cost: $75-$150 per session
Traditional Chinese medicine technique using needles at specific body points, sometimes performed on transfer day.
What the Evidence Shows
Studies are mixed and often low quality. A few suggest modest benefit; most show none. However, acupuncture is safe, may reduce stress, and some patients find it helpful for wellbeing during a stressful process. Don't expect it to boost success rates significantly, but it won't hurt.
Typical cost: $3,000-$6,000
Genetic testing of embryos to identify chromosomally normal (euploid) embryos for transfer.
What the Evidence Shows
PGT-A does improve success per transfer—transferring a tested euploid embryo has higher success than transferring an untested embryo. However, it doesn't improve cumulative success for young women with multiple embryos. Most beneficial for: women 35+, recurrent loss, failed transfers. Read our complete PGT-A guide.
Why Do Clinics Offer Unproven Add-Ons?
It's important to understand the dynamics at play:
- Revenue: Add-ons can represent significant income for clinics
- Patient demand: Patients often ask for "everything possible"
- Theoretical plausibility: Many add-ons make logical sense—they just don't work in practice
- Small study excitement: Promising early studies get marketed before larger trials disprove them
- Defensive medicine: Some doctors fear being blamed if they didn't try "everything"
This isn't necessarily malicious—it's a system that prioritizes doing something over doing what works.
of IVF patients used at least one add-on in 2024 UK survey—most unproven
The Opportunity Cost of Add-Ons
Here's a perspective that often gets lost: money spent on add-ons is money not spent on proven treatments.
Consider this math:
- Endometrial scratching: $300
- Time-lapse imaging: $1,000
- ERA test: $1,000
- EmbryoGlue: $300
- Assisted hatching: $600
Total: $3,200 on add-ons with minimal evidence
That $3,200 could fund:
- A significant portion of another IVF cycle
- Multiple frozen embryo transfer attempts
- High-quality genetic testing (which does have evidence)
💚 Where to Actually Invest Your Money
- Additional IVF cycles: More attempts = higher cumulative success
- PGT-A testing (if appropriate for your situation)
- Choosing an experienced clinic with good success rates
- Quality embryology lab: Lab quality matters more than add-ons
- Proper medical workup: Addressing underlying issues
- Mental health support: Stress management during treatment
Questions to Ask Before Any Add-On
If a clinic recommends an add-on, ask:
- "What's the HFEA rating for this?" — If they don't know, that's concerning
- "Can you show me the randomized controlled trials?" — Testimonials don't count
- "What's your clinic's data showing benefit?" — General hope isn't evidence
- "What are the risks?" — Even "minor" procedures have downsides
- "How much does it cost?" — Factor this into your total budget
- "Would this money be better spent on another cycle?" — Honest clinics will discuss this
🚩 Red Flags
Be cautious if a clinic: pushes multiple add-ons without discussing evidence, gets defensive when you ask for research, uses phrases like "it can't hurt" or "why not try everything," or makes you feel guilty for questioning recommendations.
Add-Ons That May Have a Place
Not everything is worthless. Some interventions have evidence in specific situations:
- PGT-A: Beneficial for women 35+, recurrent loss, or failed transfers
- Assisted hatching: May help with frozen embryos or older patients
- Hysteroscopy: Valuable if uterine pathology is suspected
- Endometrial biopsy for chronic endometritis: Treating infection can help
The key difference: these have evidence for specific patient populations, not blanket recommendations for everyone.
The Emotional Component
We understand why patients want add-ons. When you've experienced loss or repeated failure, you want to feel like you're doing everything possible. There's comfort in action, even if the action isn't proven.
But consider this reframe: protecting your resources for what actually works IS doing everything possible. Saying no to an unproven add-on and saving that money for another embryo transfer attempt is a rational, proactive choice.
💚 A Compassionate Approach
If an add-on makes you feel more in control and the cost isn't prohibitive, that psychological benefit may have value. Just go in with eyes open—you're buying peace of mind, not a higher success rate.
The Good News: IVF Works Without Add-Ons
Here's what gets lost in the add-on marketing: standard IVF is remarkably effective. Success rates have never been higher, and they've improved through better lab techniques, not add-ons.
The fundamentals matter most:
- Quality of the embryology lab
- Experience of your medical team
- Appropriate protocol for your situation
- Timing and technique of embryo transfer
- Your eggs, sperm, and uterine environment
A straightforward IVF cycle at an excellent clinic will outperform a mediocre clinic with every add-on available.
Get Honest Guidance
Our partner clinics focus on evidence-based medicine, not upselling. Get a consultation that prioritizes what actually works for your situation.
Request Free ConsultationThe Bottom Line
IVF add-ons are big business, but most don't improve your chances of having a baby. Before spending thousands on extras:
- Check the HFEA traffic light rating
- Ask for randomized controlled trial evidence
- Consider the opportunity cost—could that money fund another attempt?
- Trust the fundamentals—good clinic, good lab, appropriate protocol
You deserve honest information to make the best decisions for your family-building journey. 💜