Fertility clinics often offer expensive add-ons to IVF treatments, but a growing body of research suggests many of these extras do not improve the chances of a live birth. A 2023 Cochrane review found that for most adjuncts—such as embryo glue, time-lapse imaging, and pre-implantation genetic testing for aneuploidy (PGT-A)—there is insufficient evidence to confirm they increase success rates.
The review, which analyzed data from over 100 trials, highlighted that while some add-ons may show promise in small studies, the overall quality of evidence is low. For example, embryo glue (hyaluronic acid) showed a possible small benefit, but the authors rated the evidence as low certainty. Similarly, time-lapse imaging, which monitors embryo development without disturbing it, has not been proven to improve live birth rates compared to standard incubation.
Experts emphasize that patients should be informed about the lack of evidence for many add-ons and their potential costs. The UK's Human Fertilisation and Embryology Authority (HFEA) maintains a 'traffic light' system for add-ons, rating them as green, amber, or red based on evidence. Many popular add-ons, including PGT-A and endometrial scratching, are currently rated amber or red, meaning they are not recommended for routine use.
Financial implications are significant: add-ons can add thousands of dollars to an IVF cycle, often without insurance coverage. A 2022 study in the journal Fertility & Sterility found that the average cost of add-ons in the US ranged from $500 to $5,000 per cycle, with some clinics bundling them into packages.
For patients, the message is to ask clinics for evidence of benefit and to consider whether the add-on is necessary. The HFEA advises that any add-on should be supported by robust evidence of improved live birth rates before being offered to patients.
