The Upsell Menu
Once you start an IVF cycle, you'll often be offered a menu of optional extras — each one promising to boost your odds, and each one carrying its own price tag, usually from a few hundred to a few thousand dollars. They're called add-ons, and deciding which to pay for can feel impossible when you're already stressed and hopeful.
Here's a calm, plain-English look at the common ones and what the evidence really shows. The goal isn't to talk you out of everything — it's to help you spend where it counts.
How to Judge an Add-On
There's really only one question that matters: does this raise my chance of taking home a baby? Not "does it sound advanced," not "did a clinic mention it" — does it actually move the live birth rate?
For most add-ons, the honest answer is "not proven." The UK's fertility regulator keeps a public rating system for IVF extras, and the majority are rated as not yet shown to improve your chance of a baby for most patients. That doesn't mean they never help anyone — it means the strong evidence isn't there yet. Keep that in mind as a clinic walks you through the list.
The Common Add-Ons, One by One
Time-lapse imaging (EmbryoScope). A special incubator photographs your embryos continuously so they can be watched without being disturbed. It's a genuinely nice technology, but studies haven't clearly shown it produces more babies than standard embryo monitoring. Pleasant to have; not proven to change your odds.
Assisted hatching. The lab thins the embryo's outer shell to help it "hatch" and implant. Evidence suggests it may help in specific cases — older patients or previous failed cycles — but it isn't a clear win for everyone, and it carries a small risk.
EmbryoGlue. A transfer solution containing a substance that's naturally present in the uterus, meant to help the embryo stick. The evidence here is mixed and modest. Some studies hint at a small benefit; it's far from settled.
Endometrial scratch. A deliberate light scratch of the uterine lining before transfer, on the theory it helps implantation. Once popular, but larger recent studies have mostly failed to show a benefit. Enthusiasm for it has cooled for good reason.
ERA (Endometrial Receptivity Analysis). A biopsy that tries to pinpoint the exact window when your lining is ready for transfer. It can matter for patients with repeated unexplained implantation failure, but for most people doing IVF, big studies haven't shown it improves birth rates.
Immune therapies (steroids, intralipids, and similar). Treatments aimed at calming the immune system so it doesn't "reject" an embryo. Outside of specific diagnosed conditions, the evidence is weak, and some of these carry real side effects. Be especially cautious here.
PGT-A (genetic testing of embryos). Not exactly an add-on, but often offered as one. It screens embryos for the right number of chromosomes. It can reduce miscarriage and time-to-pregnancy for some patients, particularly older ones — but it's not right for everyone, and it has trade-offs. We cover it in depth in our PGT decision guide.
When an Add-On Might Actually Make Sense
The pattern you may notice: most add-ons have their best (though still limited) evidence in specific situations — older patients, or people who've had several cycles fail for reasons no one can explain. If that's you, a targeted add-on might be a reasonable conversation. If you're on your first cycle with a good prognosis, you usually don't need to load up on extras to give yourself a strong shot.
Questions to Ask Your Clinic
- What's the evidence this improves live birth rates for someone like me — not just embryo quality on a screen?
- How much does it cost, and is it bundled or separate?
- Would you recommend it if I were your family member?
- What happens to my odds if I skip it?
A good clinic will give you straight answers and won't pressure you. If an add-on is pitched as essential for everyone, that's a yellow flag.
The Bottom Line
Most IVF add-ons are not proven to give the average patient a better chance of a baby. A few may help in specific situations. The strongest version of your cycle is usually a good clinic, a solid lab, and the core treatment done well — not a long list of paid extras. Spend your money and your hope where the evidence actually points.
And remember that the single biggest factor is the clinic itself. See how clinics really compare in our guide to reading IVF success rates, then find and compare fertility clinics in our directory.