If you’re going through IVF, or starting to think about treatment, you may have heard the term “add-ons”. These are optional treatments, tests or technologies that can be offered alongside an IVF cycle, such as time-lapse embryo imaging, endometrial scratching, specialist sperm preparation, or genetic testing.
For many people, the idea of an add-on comes from a very human place: wanting to give treatment the best possible chance. When you’re investing so much emotionally, physically and financially, it’s completely understandable to want to explore every option that might help.
That’s why clear information matters.
A recent review, published in The Lancet Obstetrics, Gynaecology, & Women’s Health in June 2026, looked at the evidence behind some of the most commonly offered IVF add-ons. It has also been discussed more widely in the media, including on BBC Radio 4’s Woman’s Hour, showing just how important this conversation is for patients, clinics and anyone thinking about fertility treatment. Around the same time, the HFEA, the UK’s fertility regulator, responded by reminding clinics how important it is to be open with patients about what the evidence does, and does not, show.
This doesn’t mean every add-on should be dismissed, and it doesn’t mean every patient’s situation is the same. Some add-ons may have a role in specific circumstances or may offer useful information that helps guide treatment decisions. What it does mean is that patients deserve honest, personalised conversations before deciding whether an add-on is right for them.
Here’s what the latest research says, what the HFEA has said in response, and how we help you make decisions that feel right for you.
Quick jump:
IVF add-ons are optional treatments, tests or technologies that may be offered alongside a standard IVF cycle. They are not usually part of routine treatment and are usually an additional cost on top of your IVF cycle yet more than 70% of IVF patients in the UK report using at least one during their treatment.
They can include:
Laboratory add-ons, such as time-lapse embryo monitoring, assisted hatching, or specialist sperm preparation
Genetic testing, such as pre-implantation genetic testing for aneuploidy, also known as PGT-A
Womb preparation, such as endometrial scratching or ERA testing
Medications and infusions, such as growth hormone or immunological treatments
Complementary therapies, such as acupuncture or platelet-rich plasma
For some people, an add-on may feel like a way to do something extra, especially after a previous unsuccessful cycle or a difficult fertility journey. That feeling is valid. IVF can feel like a lot is outside your control, and it’s natural to want to understand every possible route forward.
Our role is to help you separate what sounds promising from what is proven, and to make sure you never feel pressured into a decision.
The 2026 Lancet review looked at the ten most commonly offered IVF add-ons and assessed the quality of evidence behind them. The researchers focused on clinical trials they considered reliable, which is important because research in this area can vary in quality.
The main message was that most IVF add-ons have not been proven to improve live birth rates for most patients. That may feel disappointing to read, especially when you’re hoping there might be something extra that could make all the difference. But this finding is not about taking options away. It’s about making sure patients are given information that is clear, fair and grounded in evidence.
The review did find early signs of possible benefit for three add-ons: EmbryoGlue®, endometrial scratching, and physiological intracytoplasmic sperm injection, known as PICSI. The evidence was described as weak, which means it is not strong enough to say these treatments definitely improve outcomes, but there are some encouraging signals that may be worth discussing in the right circumstances.
The researchers also raised an important point about how add-ons are offered. When a clinic offers something, patients may naturally assume it must be recommended or essential. That’s why the way we talk about add-ons matters just as much as the science itself. You should always know whether something is optional, what it costs, what the evidence says, and why it may or may not be relevant for you.
The HFEA is the UK’s independent fertility regulator. It reviews the evidence for treatment add-ons and gives them ratings, helping patients understand what is currently known about their safety and effectiveness.
Following the 2026 Lancet review, the HFEA said the findings were broadly in line with what it has been advising for some time: no add-on it has reviewed is currently rated as proven to increase the chances of having a baby for most fertility patients.
That sentence can sound stark, so it’s worth pausing on what it really means.
It does not mean that every add-on is pointless. It does not mean that no patient could ever benefit. And it does not mean that technology, laboratory techniques or personalised care have no value. It means that, when we look across the general IVF population, the evidence is not strong enough to say these add-ons reliably improve live birth rates for most people.
There may still be individual reasons to consider an add-on. For example, a treatment may be relevant because of your age, your embryo history, previous miscarriage, sperm quality, or repeated unsuccessful cycles. In those cases, the conversation should be personal, not generic.
The HFEA’s Code of Practice says clinics must give patients clear information about what an add-on involves, how likely it is to help, what it costs, and where to find the HFEA’s ratings system. At Care Fertility, we fully support that approach. You should feel informed, not overwhelmed, and supported, not sold to.
One of the most powerful parts of the research is not just what it says about treatment outcomes, but what it tells us about how patients feel.
A 2023 study published in BMJ Open explored how patients and fertility professionals make decisions about add-ons. It found something many patients will recognise straight away: hope plays a huge role.
That makes sense. IVF can be emotionally demanding. There can be waiting, uncertainty, difficult results, and moments where you wish you could do more. After a failed cycle or pregnancy loss, an add-on may feel like a way to regain some control, to try something different, or to know you’ve explored every option.
Those feelings are not naïve. They are normal.
The same study found that recommendations from doctors, nurses and embryologists carry a lot of weight. If a professional mentions an add-on, patients may assume it is something they need, even when it is optional. Personal stories online can also be powerful. Reading that someone else used a certain add-on and went on to have a baby can feel more meaningful than statistics, especially when you are searching for reassurance.
We understand that. Hope is part of fertility treatment, and it matters. But hope should be supported by honesty. Our job is not to tell you what to do, or to make choices feel more complicated than they need to be. It is to help you understand what is known, what is uncertain, and what makes sense for your circumstances.
At Care Fertility, we believe the best decisions are made together, with clear evidence, expert guidance, and space for what matters to you.
The 2026 Lancet review found weak but notable signals of benefit for three add-ons. It's important to be clear about what "weak evidence" means: these treatments showed some indication of benefit in clinical trials, but the evidence is not yet strong enough to be definitive, and more research is needed before firm conclusions can be drawn.
EmbryoGlue® is a transfer medium enriched with hyaluronan, a natural substance found throughout the body, which increases in the uterus around the time of implantation. When used in an IVF cycle, EmbryoGlue® replaces the standard culture medium at the point of embryo transfer, with the aim of mimicking the natural environment of the womb and potentially helping the embryo attach to the uterine lining.
The HFEA has given EmbryoGlue® an amber rating, meaning the evidence is conflicting and it is not yet clear whether it improves treatment outcomes. There are no known risks associated with its use.
"EmbryoGlue® is one of the add-ons where we feel the scientific rationale is genuinely interesting. Hyaluronan plays a real role in implantation biology, and the new Lancet review does identify a weak signal of benefit. That said, we are careful to be honest with patients that 'weak evidence' is not the same as 'proven to work'. We discuss it openly as an option, explain what the evidence does and doesn't show, and always make clear it is a choice."
— Dr Alison Richardson, Group Medical Director, Care Fertility
You can read more about EmbryoGlue® by clicking here
Endometrial scratching is a minor procedure carried out in the cycle before IVF treatment. A fine instrument is used to gently scratch the lining of the womb, which is thought to trigger the release of hormones and chemicals that may make the endometrium more receptive to an implanting embryo. The procedure is similar to a smear test and usually takes just a few minutes.
The HFEA has given endometrial scratching an amber rating for most fertility patients, reflecting conflicting evidence. For patients with recurrent implantation failure specifically, the rating is grey, meaning there is currently insufficient evidence to draw conclusions for this group.
At Care Fertility, endometrial scratching is available to patients having IVF with their own eggs (fresh or frozen) or with donor eggs and may be considered for those who have experienced previous failed cycles.
You can read more about Endometrial Scratching by clicking here
Physiological Intracytoplasmic Sperm Injection (PICSI) is a modified version of the standard ICSI technique, where sperm are selected based on their ability to bind to hyaluronan — a process thought to indicate higher-quality, lower-DNA-damage sperm. The Lancet review found weak evidence of some possible benefit, though as with the other two add-ons above, this remains preliminary.
At Care Fertility, we also offer ZyMōt, an advanced microfluidic sperm preparation device that takes a different approach to the same underlying goal: aiming to select the strongest, healthiest, most motile sperm for treatment. ZyMōt works by having sperm actively swim through a membrane filter, mimicking the natural barriers sperm encounter on their journey to the egg, and avoids centrifugation, which some research suggests may place stress on sperm.
"Sperm selection is one of the areas in IVF laboratory science where I think we're genuinely making progress. The evidence base is still developing, but devices like ZyMōt represent a more physiological approach to preparing sperm — it's not forcing a result, it's allowing the best sperm to demonstrate their quality by navigating through the device themselves. All of our scientists are fully trained in its use, and we have achieved successful fertilisation, embryo development and pregnancies using ZyMōt for many patients. We’ve presented our research at international conferences which demonstrated how ZyMōt concentrated sperm with lower DNA fragmentation levels than standard methods. It won't be suitable for everyone — we need a minimum level of sperm with progressive motility to use it — but where it is appropriate, I think it's a promising refinement of the standard approach."
— Prof Alison Campbell, Chief Scientific Officer, Care Fertility
You can read more about ZyMōt on the Care Fertility ZyMōt page
PGT-A, or pre-implantation genetic testing for aneuploidy, is an embryo screening test that looks at whether an embryo has the expected number of chromosomes.
Chromosomes carry the genetic information that helps an embryo develop. If an embryo has too many or too few chromosomes, this is known as aneuploidy. Aneuploid embryos are less likely to implant and are more likely to result in miscarriage. PGT-A is designed to help identify embryos that are chromosomally balanced, so they can be prioritised for transfer.
This makes the conversation around PGT-A a little different from many other IVF add-ons. It is not just about trying to improve success rates for everyone. For some patients, particularly those who have experienced recurrent miscarriage, repeated implantation failure, or those aged 38 and over, PGT-A may provide useful information to help guide embryo selection and treatment planning.
The evidence is nuanced. The 2026 Lancet review found no proven benefit for PGT-A in improving live birth rates across the general IVF population. The HFEA reflects similar uncertainty in its ratings, giving PGT-A a red rating for increasing the chances of having a baby for most fertility patients, partly because testing can reduce the number of embryos available for transfer.
However, the HFEA gives PGT-A a green rating for reducing the chance of miscarriage for most fertility patients, meaning the evidence suggests it can be effective for this purpose. For some people, it may also help reduce the time it takes to achieve a pregnancy by helping your care team prioritise embryos with the strongest potential sooner.
At Care Fertility, our group success rates are higher in cycles where PGT-A is used compared with cycles without PGT-A, based on our HFEA-validated data. You can view our latest PGT-A success rates to see how outcomes compare.
PGT-A won’t be right for everyone, and it is not something every patient will need. If it is discussed with you, your Care team will explain what the test involves, what the evidence shows, what it costs, and whether it may be relevant for your individual circumstances.
You can learn more about PGT-A by clicking here
Embryo selection is one of the most important decisions in the IVF journey. Our embryologists bring years of specialist training and scientific expertise to this process, and we’ve invested in technology that gives them even more information to work with.
Time-lapse embryo imaging lets us see how embryos develop in a way that simply wasn’t possible before. Rather than checking embryos at fixed points, our time-lapse systems capture regular images while embryos grow safely inside a specialist incubator. This creates a detailed picture of each embryo’s development, giving our embryologists richer information to inform their assessment.
We believe in being honest about what technology can and can’t do. The 2026 Lancet review and the HFEA both note that time-lapse imaging has not been shown to improve live birth rates for most patients. The HFEA currently gives it a black rating for that outcome, meaning moderate to high-quality evidence shows no effect on the chances of having a baby.
What time-lapse does offer is real value in the lab: a stable incubator environment, a continuous view of embryo development, and more information to support our embryologists’ expertise. We use it as one part of a considered, evidence-led approach, not as a standalone promise.
Where we’ve gone further is with Caremaps Ai, our own embryo selection tool developed by Care Fertility scientists. Caremaps Ai uses artificial intelligence and time-lapse imaging to analyse and rank embryos based on their potential to implant and lead to a live birth. It’s been trained on data from more than 60,000 embryos and built from nearly half a billion time-lapse images, making it one of the most developed tools of its kind.
Caremaps Ai doesn’t interfere with embryos in any way. It gives our embryologists an additional layer of insight, helping them make more informed decisions when choosing which embryo to transfer. For patients with more than one viable embryo, that extra information can help support a clearer, more confident decision, and many find it reassuring to know that advanced technology is working alongside our team.
We’ll always talk you through what Caremaps Ai involves, what the evidence shows, what it costs, and whether it may be right for your situation. Because the best decision is always an informed one.
You can learn more about Caremaps Ai by clicking here
The message from the latest research is not that IVF add-ons are “good” or “bad”. It’s more personal than that.
Add-ons sit in a place where science, hope and individual circumstances all meet. Patients want to feel they have explored every option. Fertility teams want to offer support where they believe it may help. And in some areas, the evidence is still developing.
What matters most is that you feel informed, supported and never pressured.
If an add-on is discussed as part of your treatment, it’s always okay to ask questions. In fact, we encourage it. You may want to ask:
There is no judgement in wanting to explore every possible avenue. That instinct often comes from care, hope and the wish to do everything you can. Our role is to help you make sense of your options, so any decision you make feels clear, considered and right for you.
At Care Fertility, we follow the HFEA’s guidance and Code of Practice on treatment add-ons. We also draw on our own clinical experience, laboratory expertise and data from across our clinics to guide personalised conversations with patients.
When we talk to you about any optional treatment, we’ll explain what it involves, what the evidence shows, where the evidence is limited or still emerging, and whether the information comes from published research, HFEA guidance, or our own Care Fertility data. We’ll also be clear about costs and make sure you know whether something is optional, not required.
We believe informed choices are better choices. Not because the answer should always be “yes” or “no”, but because the decision should feel like yours.
If you have questions about any add-ons you’ve been offered or are considering, please speak to your consultant or Care Fertility team. We’re here to help you understand your options with honesty, care and no pressure.