Many fertility clinics offer optional add-ons during IVF cycles. The evidence behind these add-ons varies enormously. This guide adapts the HFEA traffic-light system so you can ask informed questions before agreeing to anything — and avoid paying CAD/USD $500–$5,000 for procedures with no real evidence.
Per the HFEA 2024 National Patient Survey, only 37% of patients said add-on risks were explained to them before they agreed to the upgrade.
Embryo biopsy to screen for chromosomal abnormalities before transfer.
Mixed evidence. May improve per-transfer success rates for patients ≥38 or with recurrent loss. No clear live-birth benefit for younger patients with good prognosis; can reduce cumulative success by discarding euploid mosaics.
Laser- or chemical-thinning of the zona pellucida (embryo shell) before transfer.
Limited evidence. Possibly helpful for frozen embryo transfers and older patients. No clear benefit for general use.
Transfer medium containing high-concentration hyaluronic acid.
Some evidence of small benefit on clinical pregnancy rate. Live birth benefit less clear. Low risk of harm.
Continuous video monitoring of embryos during culture, with software-assisted selection.
No clear live-birth advantage over standard morphology assessment. May be a convenience tool that reduces handling. Not unsafe but typically priced as a premium add-on.
Adjunctive growth hormone added to ovarian stimulation protocols.
Mixed evidence. Possibly small benefit for poor responders. Insufficient evidence for routine use.
Lab test measuring DNA damage in sperm cells.
Useful in specific scenarios (recurrent IVF failure, unexplained miscarriage) but not as a routine screening test. Results should change treatment plan to be worth doing.
Intracytoplasmic sperm injection — injecting a single sperm directly into each egg. Standard of care when male factor is confirmed; routinely used by many clinics regardless.
No benefit over conventional IVF when sperm parameters are normal. Cochrane reviews and ASRM guidance both recommend against routine use without diagnosed male factor.
Biopsy of the uterine lining to time embryo transfer to the "window of implantation".
Recent large RCTs (Doyle 2022, Riestenberg 2021) show no improvement in live birth rate. Earlier observational support not replicated.
Tests for microbial composition and chronic infection in the endometrium.
Insufficient evidence that altering treatment based on results improves outcomes. Not recommended routinely.
Intentional minor injury to the endometrium intended to improve receptivity.
Earlier positive studies not replicated. Large RCT (Lensen 2019 NEJM) found no benefit. No longer routinely recommended.
Various immunosuppressive interventions intended to reduce miscarriage or implantation failure.
Not evidence-based for unselected recurrent implantation failure. Should not be used outside of specific autoimmune diagnoses.
Information only. Not medical advice. The Fertility Link is a decision-support directory. Always discuss treatment decisions with your reproductive endocrinologist.