Fertility Decoded

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.

Written by Fertility Decoded. Reviewed by D R, MS (OBG), FRM. Review date: 31 August 2026.

Check add-ons your clinic recommended

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

Sources last reviewed . Sources on each add-on's page.