Add-ons in IVF: which to consider, which to skip

IVF cycles increasingly come with a menu of optional add-ons: assisted hatching, embryo glue, intralipid infusion, time-lapse embryo imaging, PGT-A, endometrial scratching, EmbryoScope, ERA, and others. Some are evidence-based for specific patients. Many are not. Most clinics charge separately for each. Here is how to read the menu.

The rule that helps most

Ask, for each proposed add-on: what is my specific indication, what is the evidence in patients like me, what is the realistic effect size on live-birth rate, and what is the additional cost. If the indication is unclear or the evidence is weak, the right answer is usually no.

Add-ons with reasonable evidence in selected patients

Time-lapse imaging (EmbryoScope) for embryo selection – small possible benefit when used at clinics that have integrated the data into selection criteria. PGT-A in older patients (over 38) or with recurrent failure – real value in selected indications. ERA in repeated implantation failure – some evidence in that subset. ICSI for documented male factor or prior fertilisation failure – clearly indicated.

Add-ons with weaker or mixed evidence

Assisted hatching for routine IVF – some benefit in older patients or after frozen-embryo cycles, modest effect size. Embryo glue – small possible benefit, not unanimous. Intralipid for repeated implantation failure – mixed data. Endometrial scratching – the larger trials have been negative; older smaller trials suggested benefit.

Add-ons that often do not help

Routine PGT-A in younger patients with normal-looking embryos. Universal ERA before any transfer. Co-culture systems. Aspirin for unexplained patients without indication. Specific dietary supplements marketed as IVF boosters. Most “premium package” add-ons that bundle several minor services.

The cost-benefit honesty

If your clinic offers a la carte add-ons that nearly double the cost of an IVF cycle, that is information about the clinic. The base cycle is what determines most of the outcome. Add-ons should be selected for specific indications, not for reassurance.

Questions worth asking your doctor

• For each add-on you are recommending, what is my specific indication?
• What is the published effect size on live birth in patients like me?
• What is the cost of each add-on, and what is the total uplift over the base cycle?
• If I declined all add-ons, what would my honest cycle success rate be?

This essay is educational. Every patient’s situation is different – the right plan is shaped in conversation with a fertility specialist who knows the full picture.