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Guide

Treatment add-ons: what's proven?

Add-ons are optional extras offered on top of IVF or IUI, often at extra cost. The HFEA rates whether the evidence shows they improve your chance of having a baby. None of the commonly offered add-ons is currently rated green for most patients.

What the ratings mean

  • Green

    High-quality evidence shows it's effective at improving the outcome.

  • Amber

    Conflicting evidence – it's not clear whether it's effective.

  • Grey

    Not enough good-quality evidence to rate it.

  • Black

    Good evidence shows it has no effect on the outcome.

  • Red

    Potential safety concerns, or evidence it may reduce the chance of success.

The HFEA's ratings

Rating for improving the chance of a baby for most patients. Some add-ons have separate ratings for other outcomes or groups.

  • Elective freeze-all cycles – Amber

    Freezing all embryos and transferring later, rather than a fresh transfer.

  • Embryo glue (hyaluronate-enriched medium) – Amber

    A culture fluid the embryo is placed in before transfer.

  • Endometrial scratching – Amber

    Scratching the womb lining before treatment.

  • Androgen supplementation (DHEA, testosterone) – Grey

    Male hormones taken before IVF, usually suggested for 'poor responders'.

  • Assisted hatching – Grey

    Thinning or making a hole in the embryo's outer shell to 'help it implant'.

  • IMSI – Grey

    Selecting sperm for ICSI using high magnification.

  • Intralipids – Grey

    An immune treatment given by drip.

  • Intrauterine culture – Grey

    Growing the embryo inside the womb in a device for a short time.

  • Microbiome testing – Grey

    Testing bacteria in the womb or vagina.

  • Sperm DNA fragmentation testing – Grey

    Testing for damage to the DNA in sperm.

  • PICSI (for male-factor ICSI) – Black

    Choosing sperm that bind to a hyaluronan gel.

  • Time-lapse imaging and incubation – Black

    Taking continuous photos of embryos as they develop.

  • Endometrial receptivity testing (e.g. ERA) – Red

    A biopsy of the womb lining to time embryo transfer.

  • Intravenous immunoglobulin (IVIG) – Red

    An immune treatment made from blood products.

  • PGT-A (aneuploidy testing) – Red

    Testing embryos for an abnormal number of chromosomes.

  • Platelet-rich plasma (PRP) – Red

    Injecting a concentrate of your own blood into the ovaries or womb.

  • Steroids (glucocorticoids) – Red

    Immune-suppressing steroids during treatment.

Before you pay for an add-on

  • For most people, proven treatment on its own is effective. If you're paying, extra cycles may be a better use of money than unproven add-ons.
  • An October 2023 consensus statement by the HFEA and professional bodies says add-ons without strong evidence should only be offered in research – and you shouldn't be charged to take part.
  • Ask why an add-on is being suggested for you specifically, and ask to see the evidence.
  • The Competition and Markets Authority's guidance says clinics must give clear, upfront pricing and not mislead you about add-ons.

Sources

Ratings checked November 2026.