IVF Add-Ons Decoded: What the Evidence Actually Shows
A plain-language guide to IVF add-ons, the evidence behind each, and the questions to ask your clinic before adding anything to your cycle.
"Add-ons" is the IVF industry's term for extras stacked onto a base cycle — procedures, tests, or supplements beyond the standard protocol. Some have real evidence for specific patient groups. Many have uncertain or absent evidence. Knowing which is which — and knowing how to ask — is one of the most useful things you can do before your next cycle.
What are IVF add-ons?
IVF add-ons are procedures, tests, or supplemental interventions offered beyond the standard IVF cycle, sometimes at significant additional cost. Some make clinical sense for specific patients; others have been marketed far ahead of the evidence. The UK's Human Fertilisation and Embryology Authority (HFEA) runs a traffic-light rating system evaluating add-ons by evidence level — and most land at amber (uncertain benefit) or red (no benefit demonstrated, or possibly harmful). Very few add-ons are rated green. The HFEA framework is the most rigorous, publicly available reference for evaluating what your clinic may be recommending.
What is endometrial receptivity testing (ERA) and does the evidence support it?
ERA (Endometrial Receptivity Array) tests for your personalized "window of implantation" — the specific days in your cycle when your endometrium is most receptive to an embryo. It was widely adopted before the evidence caught up with the concept. A large 2022 randomized controlled trial by Simón et al. found no improvement in live birth rates for unselected patients who used ERA guidance compared to those who didn't. Current evidence supports ERA as potentially reasonable in repeated implantation failure — not as routine care for a first or second transfer. The add-on costs approximately $1,000–$1,500. If your clinic recommends it, ask whether your history specifically meets the repeated implantation failure indication.
Does assisted hatching improve IVF success rates?
Assisted hatching involves using a laser to thin the outer shell (zona pellucida) of an embryo before transfer, with the aim of making it easier for the embryo to hatch and implant. The evidence is mixed. It may offer a benefit in specific cases — advanced age, frozen embryos, or patients with a history of prior failed transfers — but it is not supported for use as routine care across all IVF patients. If your clinic recommends assisted hatching, ask what the specific indication is for your case rather than accepting it as standard protocol.
What is time-lapse embryo imaging and is it worth the cost?
Time-lapse imaging systems (such as EmbryoScope) allow embryologists to monitor embryo development continuously without removing embryos from the incubator for observation. This gives embryologists more data points for selecting which embryo to transfer. Studies suggest time-lapse may marginally improve embryo selection, but it has not been shown to broadly improve live birth rates. It is a reasonable option when offered at no additional charge; as a $500–$1,500 upcharge, the evidence does not clearly support the added cost for most patients.
Does PRP (platelet-rich plasma) improve IVF outcomes?
<!-- H2 from keyword doc — PRP is not covered in this source deck. Answered using adjacent source content on adjunct injectable therapies. PRP-specific source content should be added in a future deck revision. --> Platelet-rich plasma (PRP) for IVF is not covered in this source deck. The source deck addresses the related category of adjunct injectable therapies — intralipid infusions, IVIG, steroids, and heparin — which are marketed for "implantation failure" or immune-related causes of IVF failure. The evidence for routine use of these therapies is insufficient, their cost is significant, and some carry real risk. Where they may be reasonable is in confirmed autoimmune conditions under specialist involvement — not as off-label protocols for unselected patients. PRP falls into a similar investigational category; ask your clinic for the specific evidence and the indication that applies to you before agreeing.
Which IVF add-ons have the strongest evidence?
Among the add-ons covered in this deck, PGT-A (preimplantation genetic testing for aneuploidy) has the strongest evidence — but for specific patient groups, not across the board. PGT-A shows real benefit in patients with advanced maternal age, recurrent pregnancy loss, or known chromosomal factors. It is overused in patients under 35, where euploid rates are already high and mosaic results can lead to discarding embryos that may have been viable. Pre-cycle supplements such as CoQ10, DHEA, melatonin, and myo-inositol have some evidence in specific contexts like diminished ovarian reserve or PCOS, though most supporting studies are small. These are over-the-counter options, not clinic-billed procedures — a meaningful distinction when evaluating your cycle costs.