In vitro fertilisation (IVF) is an established and effective treatment for infertility. Alongside standard IVF protocols, many clinics now offer so-called “add-ons”, which are supplementary tests or treatments intended to improve success rates. While some may be appropriate in specific clinical contexts, others remain experimental or of uncertain benefit. Patients should approach these options with scrutiny.
IVF add-ons are offered in addition to conventional, well-established treatments. They usually come at extra cost and are marketed as improving implantation, reducing miscarriage, or enhancing embryo selection. Common examples include preimplantation genetic testing for chromosomal errors (PGT-A), time-lapse embryo imaging incubator systems, assisted hatching, and immune therapies, such as intralipids and steroids.
The key question is whether an add-on improves live birth rates rather than simply laboratory indicators. Professional bodies, such as the European Society of Human Reproduction and Embryology (ESHRE), have repeatedly emphasised that many add-ons lack high-quality scientific evidence demonstrating improved live birth outcomes in the general IVF population. Immune therapies, for instance, are commonly recommended in some clinics, yet their use remains controversial outside clearly defined indications in carefully selected patients. Many add-ons are, therefore, considered experimental, and they should not be assumed to provide benefit.
Beyond financial implications, some interventions carry procedural or pharmacological risks. Patients deserve transparent discussions about the scientific evidence supporting any add-on and its potential harms. The perceived rationale for using an add-on should be weighed carefully against the possibility that it may be unnecessary.
Before consenting, patients should ask important questions: Does this add-on improve live birth rates in patients like me? Is the recommendation supported by robust scientific data? What are the additional costs? Are there known risks or side effects? What happens if I decline it? A responsible fertility clinic should welcome such discussions.
Not all add-ons are inappropriate. Some are clearly indicated in particular clinical scenarios. For example, genetic testing may be suitable for couples with known chromosomal conditions. The key lies in individualised recommendations grounded in sound science. IVF success primarily depends on established factors, such as maternal age, embryo quality, uterine health, and laboratory standards, rather than supplementary technologies. In fertility care, more intervention does not necessarily mean better outcomes.
Dr Alfred Murage is a Consultant Gynaecologist and Fertility Specialist
