An IVF add-on is an optional extra layered onto a standard cycle, usually at extra cost. For most add-ons, high-quality evidence of better live birth rates is lacking, and a few have been rated as unhelpful or potentially harmful by regulators. Ask your clinic why it is being offered to you, what evidence supports it for your situation, and what you give up by choosing it.
Walking out of an IVF consultation with a list of optional extras is common. Some of those options help specific patients. Others are sold broadly on hope. This guide will not tell you what to buy. It gives you a way to ask the right questions, using ratings from independent bodies rather than marketing language. If you want help judging the clinic as a whole, read our guides to fertility clinic red flags and getting a second opinion on an IVF protocol.
What Counts as an "Add-On"
Add-ons are extra tests, procedures, medicines or lab techniques offered alongside the core steps of IVF: stimulation, retrieval, fertilization, culture and transfer. They are not the same as medically necessary steps your doctor recommends because of a specific diagnosis. The key difference is whether the extra has solid evidence that it improves the chance of a baby for patients like you.
How One Regulator Rates Them
The UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), publishes a traffic-light rating of add-ons by evidence. The HFEA states that most patients do well with routine IVF or IUI and no add-ons. Its ratings, as published on its site in October 2026, are:
- Green: high-quality evidence the add-on improves outcomes. No add-on on its list currently has this rating.
- Yellow: evidence is conflicting, so it is unclear whether it works.
- Grey: not enough moderate or high-quality evidence to rate it.
- Black: good-quality evidence shows no effect on outcomes.
- Red: potential safety concerns, or good-quality evidence it may reduce effectiveness. A red rating does not automatically mean it is unsafe for you.
These are UK ratings, and US clinics are not bound by them, but they are useful because they come from a body reviewing the research without a sales interest. Ratings change, so check the current page before a decision.
| Add-on | What it is | HFEA rating for chance of a baby |
|---|---|---|
| Endometrial scratching | A minor procedure to disturb the uterine lining before transfer | Yellow |
| Embryo glue (hyaluronate-enriched medium) | A culture medium used during transfer | Yellow |
| Freeze-all cycles when elective | Freezing every embryo for a later transfer | Yellow |
| Assisted hatching | Thinning or opening the embryo's outer shell | Grey |
| Time-lapse imaging | Camera-monitored incubators | Black |
| PICSI (for male factor) | Sperm selection by binding to hyaluronan | Black |
| PGT-A | Chromosome screening of embryos | Red |
| Immune treatments such as steroids, IVIG | Medicines targeting the immune response | Red |
| Endometrial receptivity testing, platelet-rich plasma | Tests or treatments aimed at the lining or ovary | Red |
The UK's National Institute for Health and Care Excellence takes a similar line on several of these. Its current fertility guidance says not to offer endometrial scratching, endometrial receptivity testing, or intralipids, intravenous immunoglobulin and steroids as part of treatment, and not to offer PGT-A to improve live birth rates. Assisted hatching is also not recommended because it has not been shown to improve pregnancy rates. Elective freeze-all is covered in fresh vs frozen embryo transfer, and embryo testing in PGT-A: what it can and cannot tell you.
A yellow or grey rating means the evidence is mixed or missing, not that the add-on never works. It does mean you would be paying for something with an uncertain benefit, so the decision should be a deliberate one.
Questions to Ask Before You Pay
Bring This List to Your Consultation
The Money Question
If you are paying out of pocket, the HFEA's guidance is worth repeating: consider whether several cycles of standard IVF or IUI would give you a better chance than one cycle loaded with unproven extras. That is a personal calculation that depends on your age, your budget, and how many embryos you are likely to have. Our guides to financial planning for IVF and IVF insurance in 2026 can help you map the cost. For a reality check on common claims, see IVF myths debunked.
When an Add-On May Make Sense
Not every extra is a poor choice. Some are used for specific indications, such as a male-factor lab technique when sperm quality is a known problem, or a medication your doctor recommends for a diagnosed condition. The point is a reason tied to you. If your doctor can give one and point to evidence, you are in a stronger position to say yes. If they cannot, it is reasonable to say no or to ask for time.
If you feel pressured, a second opinion is a normal and respected step. You can also read about immune health during TTC and IVF for context on one category of extras that comes up often.
Frequently Asked Questions
The Bottom Line
Most people do not need add-ons to have a good IVF cycle, and none on the HFEA's list has top-tier evidence of improving the chance of a baby. That does not make every extra a bad idea, but it does mean your doctor should be able to explain why it fits you. Bring the questions above, get pricing in writing, and give yourself permission to take time or ask for a second opinion before you pay.