Which IVF add-ons have evidence, and which do we decline?

An add-on is an extra test, procedure or medicine offered in addition to standard IVF or ICSI in the hope of improving the chances.

Add-ons usually cost more, and some add a whole cycle of waiting. They are most often offered after a failed cycle, when a couple wants a reason and a plan. That is exactly when they need the most scrutiny.

The HFEA gives each add-on a traffic-light colour for a named outcome, based on the quality of the evidence.

Green means high-quality evidence shows it works. Amber (yellow) means the evidence conflicts, so it is not clear. Grey means there is not enough good evidence to say. Black means good evidence shows it has no effect. Red means it may reduce the chance of success or raise safety concerns. One add-on can have different colours for different outcomes, such as a baby or a lower miscarriage risk. The ratings below were checked on the HFEA site in September 2026.

The HFEA rates endometrial receptivity testing red because good evidence suggests it may reduce treatment effectiveness; our own experience had already led us to stop.

ERA takes a sample of the womb lining in a practice cycle to time the transfer. It adds about a month, a biopsy and a bill. ESHRE's 2023 add-ons recommendations also say receptivity tests are not recommended.

A small number, only for couples whose file gives a reason, and we tell you the HFEA rating before you agree.

PGT-A is considered from 38, or after repeated failure or loss, discussed with you. PGT-M and PGT-SR are used where a known genetic condition or chromosome rearrangement calls for them. For selected women with repeated implantation failure or loss, we may test the lining for harmful bacteria (EMMA/ALICE). Immune testing is kept for a specific subgroup. Assisted hatching is used for day-3 frozen embryos.

Most couples do not need them: ESHRE does not recommend routine immune tests or immune treatments, and the HFEA rates IVIG and steroids red.

Intralipid drips are rated grey. These treatments are often offered after repeated failure, sometimes by a reproductive immunologist. At Jananam, immune testing is kept for a specific subgroup of women with repeated implantation failure or miscarriage, and Dr Vani will tell you if you are in it.

The HFEA lists freeze-all as an add-on: amber for raising the chance of a baby, and green for lowering the risk of ovarian hyperstimulation (OHSS).

Most transfers at Jananam are frozen, for three reasons Dr Vani gives: the womb lining can be prepared under calmer hormone conditions, freezing all protects women at risk of OHSS, such as some women with PCOS, and embryos that are tested must be frozen while results come back. It is a clinical choice for your cycle, not something sold as an extra.