IVF add-on evidence checker
Add-ons are optional extra tests and treatments offered on top of a standard IVF cycle, usually for an additional fee. For most patients, a standard, well-run cycle is the treatment with the strongest evidence behind it — most add-ons haven't been shown to improve your chance of a baby. Here is what HFEA, ESHRE, NICE and ISAR say about each of the 24 most common ones.
Genetic & embryo testing
PGT-A (preimplantation genetic testing for aneuploidy)Not recommended as a routine add-on; it may reduce your chance of a baby (especially under 35), though it can reduce the chance of miscarriage.
HFEARedESHRENot routineNICEDo not offerISARConsider
AI embryo selectionPromising but unproven — not shown to improve your chance of a baby over standard embryo selection.HFEANot ratedESHRENo positionNICENo positionISARNo position
Tests & transfer timing
Endometrial receptivity test (ERA)Not shown to improve your chance of a baby.
HFEARedESHRENot recommendedNICEDo not offerISARNo position
Endometrial scratchEvidence doesn't support routine use.HFEAYellowESHRENot recommendedNICEDo not offerISARNo position
Endometrial microbiome test (EMMA/ALICE)Not shown to improve your chance of a baby.HFEARedESHRENot recommendedNICEDo not offerISARNo position
Sperm DNA fragmentation testEvidence unclear; limited routine clinical value.HFEANot ratedESHRENot routineNICENo positionISARConsider
Sperm selection
PICSI (physiological ICSI)No effect on your chance of a baby.
HFEABlackESHRENot routineNICENo positionISARNot routine
IMSI (high-magnification sperm selection)Not shown to improve outcomes.HFEAGreyESHRENot routineNICENo positionISARNot routine
MACS / microfluidics sperm sortingLimited evidence — microfluidics may be considered; MACS not routine.HFEANot ratedESHREConsiderNICENo positionISARNot routine
Artificial oocyte activation (calcium ionophore)Only for specific fertilisation-failure cases, not routine.HFEANot ratedESHRERecommendedNICENo positionISARIndicated
Immune treatments
Intralipids (immune treatment)Not recommended outside research.
HFEAGreyESHRENot recommendedNICEDo not useISARNo position
IVIG (intravenous immunoglobulin)Not recommended; carries safety concerns.HFEARedESHRENot recommendedNICEDo not useISARNo position
Steroids / glucocorticoids (immune treatment)Not recommended routinely.HFEARedESHRENot recommendedNICEDo not useISARNo position
Lab & culture techniques
Time-lapse imagingNo effect on your chance of a baby.
HFEABlackESHRENot recommendedNICENo positionISARNot routine
EmbryoGlue (hyaluronate-enriched transfer medium)Weak, mixed evidence — ESHRE (and ISAR for recurrent implantation failure) are cautiously in favour; others less so.HFEAYellowESHRERecommendedNICENo positionISARConsider
Assisted hatchingNot shown to improve your chance of a baby.HFEAGreyESHRENot recommendedNICEDo not offerISARNot routine
Elective freeze-allUseful for specific medical reasons (e.g. OHSS risk), not as a routine default.HFEAYellowESHRENot routineNICENo positionISARNo position
Intrauterine cultureNot shown to improve outcomes.HFEAGreyESHRENot routineNICENo positionISARNo position
Adjunct & complementary
Growth hormone (adjuvant)Not shown to improve your chance of a baby, including for poor responders.
HFEANot ratedESHRENot recommendedNICENo positionISARNo position
Androgen supplementation (DHEA / testosterone)Insufficient evidence to rate.HFEAGreyESHRENot recommendedNICENo positionISARNo position
Platelet-rich plasma (PRP)Very limited evidence; possible safety concerns.HFEARedESHRENot recommendedNICENo positionISARNo position
AcupunctureThe traditional theory isn't scientifically supported, and rigorous trials show no live-birth benefit. Low-risk and fine for relaxation, but not a fertility treatment.HFEANot ratedESHRENot recommendedNICENo positionISARNo position
Established steps — not limited-evidence add-ons
These are sometimes billed alongside add-ons but are established, standard techniques in specific situations, not treatments with weak or limited evidence.
Blastocyst cultureA widely used, generally accepted step — not a limited-evidence add-on, though it may appear as a separate charge.
HFEANot ratedESHREStandardNICEStandardISARStandard
ICSI (intracytoplasmic sperm injection)Needed for male-factor infertility; not a general upgrade for everyone.HFEANot ratedESHREIndicatedNICEIndicatedISARIndicated
Last reviewed . Sources on each add-on's page.