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Do IVF Add-Ons Work?

Most IVF add-ons, such as PGT-A, time-lapse imaging, endometrial scratching and immune treatments, have not been shown to increase the chance of having a baby.

By Vireon Medical Editorial TeamFirst published Evidence checked through

Short answer

Mostly, they have not been shown to increase the chance of having a baby. “Add-ons” are optional extras offered alongside IVF, such as embryo screening, time-lapse imaging, endometrial scratching and immune treatments. Reviews by the UK regulator and by the European Society of Human Reproduction and Embryology (ESHRE) found that very few rest on good evidence, and ESHRE recommends against routine use of most of them. A small number have a clear role for specific problems, so the answer depends on the add-on and the reason it is being suggested.

Key points

  • ESHRE made 42 recommendations on add-ons; none could be based on high-quality evidence.
  • The HFEA rates add-ons by whether randomised trials show they improve live birth rates.
  • Immune treatments such as Intralipid and IVIG are not recommended by ESHRE.
  • Some techniques are useful in narrow situations, such as oocyte activation after complete fertilisation failure.
  • Standard IVF on its own is an effective option for most patients.

What counts as an add-on?

The Human Fertilisation and Embryology Authority (HFEA), the UK regulator, describes add-ons as optional extras that may be offered on top of routine treatment. They include tests, medicines, laboratory equipment, surgical procedures and holistic or alternative therapies.1 The HFEA’s position is that patients should not be charged extra for red-rated add-ons used to try to improve live birth rates.1

The HFEA rates add-ons using randomised controlled trials, which compare outcomes between groups assigned by chance. Green means more than one good-quality trial shows the add-on improves live birth rates and is safe. Amber means the evidence is conflicting and the add-on should not be recommended for routine use. Red means there is no evidence that it improves live birth rates, or evidence that it is unsafe.1

Types of study and how Vireon labels evidence Two columns. The left column is a ladder of study designs from generally stronger at the top to generally weaker at the bottom: systematic reviews and meta-analyses of randomised controlled trials; randomised controlled trials; cohort and case-control studies; case series and case reports; and expert opinion or reasoning from first principles. Beneath it, a note says that manufacturer claims are not counted as evidence that a treatment works or is safe. The right column lists the six evidence labels Vireon uses, with their meanings: Strong, consistent high-quality evidence or authoritative guidance supports the claim; Moderate, useful evidence with meaningful limitations; Limited, evidence that is small, non-randomised or otherwise restricted; Mixed, reasonable studies or guidance disagree; Insufficient, the claim has not been established; Uncertain incidence, a risk is plausible or has been reported but how often it happens cannot be reliably calculated. A note across the bottom says that quality within a level also matters, for example a poorly designed randomised trial may rank no higher than a cohort study. Type of study Vireon evidence labels Generally stronger to weaker Systematic reviews and meta-analyses of RCTs Randomised controlled trials (RCTs) Cohort and case-control studies Case series and case reports Expert opinion and reasoning from first principles Manufacturer claims not counted as proof it works or is safe Strong Moderate Limited Mixed Insufficient Uncertain incidence Consistent high-quality evidence or authoritative guidance Useful evidence, with meaningful limitations Small, non-randomised or otherwise restricted evidence Reasonable studies or guidance do not agree The claim has not been established A risk is plausible or reported, but how often it happens is unclear Quality within a level also matters. A poorly designed RCT may rank no higher than a cohort study.
Study design is a rough guide to how much weight a finding can bear, but quality within each level matters too; Vireon’s labels describe the overall evidence behind a specific claim.

What the major reviews found

In 2023, ESHRE published good practice recommendations covering add-ons in diagnosis, the laboratory and clinical management. Of its 42 recommendations, none could be based on high-quality evidence and only four on moderate-quality evidence.2 For most add-ons, its conclusion was that they are not recommended, or not recommended for routine clinical use.

Add-onWhat it isWhat reviews sayEvidence of more births
PGT-AChromosome screening of embryosNot recommended for routine use2; HFEA red for live birth in most patients3Insufficient
Time-lapse imagingIncubators that photograph embryos as they growNo good evidence it is more or less effective than standard incubation5Insufficient
Endometrial scratchingDeliberately disturbing the womb lining before treatmentEffect on live birth unclear in higher-quality trials4Mixed
Assisted hatchingThinning or opening the embryo’s outer shellNot recommended2Insufficient
Endometrial receptivity testsBiopsy to time the transferNot recommended2Insufficient
Immune tests and treatmentsNK-cell tests; Intralipid, IVIG and similarNot recommended2Insufficient
Sperm selection (IMSI, PICSI) and sperm DNA testingLaboratory methods to choose spermNot recommended for routine use2Insufficient
Common IVF add-ons and the conclusions of major evidence reviews.

A closer look at three common add-ons

Embryo screening (PGT-A). A 2020 Cochrane review found insufficient good-quality evidence of a difference in live births with or without PGT-A.6 The HFEA rates it red for live birth in most patients but green for reducing miscarriage.3 It also has downsides, including inaccurate results and fewer embryos to transfer; see what PGT-A is and whether it improves outcomes.

Time-lapse imaging. A 2019 Cochrane review of 9 trials with 2,955 couples found no good evidence that time-lapse systems are more or less effective than conventional incubation. The certainty of evidence was low to very low.5

Endometrial scratching. A Cochrane review updated in 2026 analysed eight higher-quality trials with 4,402 women and found the effect on live birth unclear. The procedure caused mild to moderate pain, around 4 out of 10.4 When all trials were included, the analysis hinted at a possible benefit, but the authors were less confident in that result because many trials were at high risk of bias.4 The evidence for scratching is therefore best described as Mixed.

When an add-on can make sense

“Not for routine use” is not the same as “never useful”. ESHRE recommends artificial oocyte activation (a laboratory step that helps an egg start developing after sperm injection) when fertilisation has completely failed before, and in some rare sperm conditions.2 It also says screening hysteroscopy (a camera examination of the womb) can be considered after recurrent implantation failure.2

The HFEA also notes that some add-ons may help particular groups of patients, or affect outcomes other than live birth, such as miscarriage risk.1 It stresses that routine fertility treatment on its own is an effective option for most patients.1

How to judge an add-on you are offered

The HFEA advises asking the clinic for the evidence behind any add-on it offers.1 Useful questions include: what outcome is it meant to improve; was that shown in randomised trials; what are the risks; and what would happen if you did not have it. The HFEA’s consensus position is that add-ons without robust evidence of safety and effectiveness should be offered only in a research setting.1

Common questions

If a clinic offers an add-on, does that mean it works?

No; ESHRE’s recommendations explicitly do not endorse any of the technologies they review, and most add-ons lack strong evidence.2

Can add-ons cause harm?

Some can; the older form of PGT-A was judged probably harmful, and the HFEA gives a red rating where evidence shows an add-on is unsafe.61

Do add-ons help after several failed transfers?

Rarely in a proven way; ESHRE says screening hysteroscopy can be considered after recurrent implantation failure, but it does not recommend immune tests or immune treatments.2 Our page on how many IVF cycles might be needed puts repeated attempts in context.

Bottom line

Most IVF add-ons have not been shown to increase the chance of a baby, and leading bodies advise against their routine use. A few have a defined role in specific situations, so the most useful step is to ask what a particular add-on is for and what trial evidence supports it.

Sources

  1. Human Fertilisation and Embryology Authority. Treatment add-ons with limited evidence. HFEA. https://www.hfea.gov.uk/treatments/treatment-add-ons/. Accessed 5 November 2026.
  2. ESHRE Add-ons Working Group; Lundin K, et al. Good practice recommendations on add-ons in reproductive medicine. Human Reproduction; 2023. doi:10.1093/humrep/dead184. https://discovery.ucl.ac.uk/10178220/1/dead184.pdf
  3. Human Fertilisation and Embryology Authority. Pre-implantation genetic testing for aneuploidy (PGT-A). HFEA; 2023. https://hfea.gov.uk/treatments/treatment-add-ons/pre-implantation-genetic-testing-for-aneuploidy-pgt-a/. Accessed 5 November 2026.
  4. Perera AK, Gan J, Afroz A, Armstrong S, Raine-Fenning N, Martins WP, Lensen SF. Endometrial injury in women undergoing in vitro fertilisation (IVF). Cochrane Database of Systematic Reviews; 2026: CD009517. https://www.cochrane.org/evidence/CD009517_does-injury-lining-womb-improve-outcomes-women-undergoing-vitro-fertilisation-ivf. Accessed 5 November 2026.
  5. Armstrong S, Bhide P, Jordan V, Pacey A, Marjoribanks J, Farquhar C. Time-lapse systems for embryo incubation and assessment in assisted reproduction. Cochrane Database of Systematic Reviews; 2019: CD011320. https://www.cochrane.org/evidence/CD011320_time-lapse-systems-embryo-incubation-and-embryo-assessment-couples-undergoing-vitro-fertilisation. Accessed 5 November 2026.
  6. Cornelisse S, Zagers M, Kostova E, Fleischer K, van Wely M, Mastenbroek S. Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro fertilisation. Cochrane Database of Systematic Reviews; 2020. doi:10.1002/14651858.CD005291.pub3. https://www.cochrane.org/evidence/CD005291_preimplantation-genetic-testing-aneuploidies-abnormal-number-chromosomes-vitro. Accessed 5 November 2026.

Article history

  • — First published.