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IVF Add Ons Explained with Professor Tim Child, Evidence You Can Trust

IVF Add Ons Explained with Professor Tim Child, Evidence You Can Trust
Authored by
Shaun Greenaway

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IVF add-ons are optional tests, treatments or technologies offered in addition to established fertility treatment. Many cost extra, and most reviewed by the HFEA have not been shown to increase the chance of a baby for most patients. Check the current HFEA rating, the outcome being measured, safety, total cost and why it is recommended specifically for you.

What is an IVF treatment add-on?

The Human Fertilisation and Embryology Authority, or HFEA, describes treatment add-ons as optional, non-essential tests or treatments offered on top of established IVF or IUI.

Examples can include:

  • Tests claimed to select a different treatment or transfer time
  • Additional laboratory techniques for sperm, eggs or embryos
  • Medicines or immune treatments outside routine care
  • Embryo culture, imaging or selection technologies
  • Procedures involving the womb or endometrium

Not everything outside the basic package is an add-on. A procedure may be clinically necessary for a particular diagnosis, and an add-on may have a purpose other than increasing live birth, such as reducing ovarian hyperstimulation syndrome in a defined situation.

The key question is not simply “Is this an add-on?” It is “Why is it being recommended to us, and what reliable evidence supports that intended outcome?”

Are IVF add-ons proven to increase the chance of a baby?

For most patients, the answer is usually no. In June 2026, the HFEA stated that none of the add-ons it had reviewed showed an increased chance of having a baby for most fertility patients. Some may have a justifiable medical use or evidence for another outcome or a specific group.

This distinction matters. A treatment can:

  • Change a laboratory measurement without increasing live birth
  • Show promise in a small or poor-quality study
  • Benefit a narrow patient group but not routine patients
  • Reduce one risk without increasing pregnancy
  • Have no useful evidence and still be marketed confidently

Ask for evidence about live birth whenever the claim is that the add-on improves the chance of a baby.

What did the HFEA’s 2024 patient survey find?

The HFEA’s National Patient Survey 2024 found that 73% of respondents had used an additional test, treatment or emerging technology. This included a wider category than only the add-ons on the HFEA’s rated list. Commonly reported examples included additional medication or supplements, acupuncture and time-lapse imaging.

The figure should not be rewritten as “73% of patients used add-ons without clear benefit”. The survey measured use; it did not establish that every intervention used was unnecessary or ineffective for every respondent.

The important message is that optional interventions are common, so patients need clear, unbiased evidence and cost information before agreeing to them.

How does the HFEA add-on rating system work?

The HFEA uses five colour ratings. Ratings apply to a particular outcome and may also differ for a patient group.

Green

  • What it means: High-quality evidence shows the add-on is effective for the stated treatment outcome

Yellow

  • What it means: Moderate or high-quality evidence conflicts, so effectiveness is unclear

Grey

  • What it means: There is not enough moderate or high-quality evidence to rate effectiveness

Black

  • What it means: Moderate or high-quality evidence shows no effect on the stated outcome

Red

  • What it means: There may be safety concerns and/or evidence that the add-on reduces treatment effectiveness

A colour is not a permanent property of a treatment. Evidence and ratings can change, and one add-on can have different ratings for live birth, miscarriage or a subgroup.

Always open the individual add-on page and note:

  • The date of the review
  • The outcome attached to the rating
  • Whether it applies to most patients or a defined group
  • The safety section
  • The studies and committee discussion

Do not rely on a clinic screenshot, brochure or social-media post that may show an old rating.

Does a grey or yellow rating mean it might be worth trying?

It means uncertainty, not a hidden positive result.

A grey rating indicates insufficient moderate or high-quality evidence. A yellow rating means suitable evidence conflicts. Neither shows that the add-on is likely to work for you.

When treatment feels urgent, “it might help” can sound persuasive. Ask the clinic to convert the claim into an absolute estimate:

  • What is our chance of live birth without the add-on?
  • What is the estimated chance with it?
  • What is the uncertainty around that difference?
  • Is the estimate based on patients like us?
  • Would you recommend it if it were free?

If the evidence cannot answer those questions, that uncertainty belongs in the decision.

Are red-rated add-ons unsafe?

A red rating signals potential safety concerns and/or evidence that the add-on may reduce effectiveness. It does not mean every use will cause harm, but it requires a serious explanation.

Ask:

  • What exact safety concern has been identified?
  • Does it apply to me or to the embryo, pregnancy or future child?
  • What monitoring or regulation applies?
  • Is the treatment being offered only within research?
  • What proven alternative is available?

Do not accept “we have used it for years” as evidence of safety or benefit.

What does “clinically indicated” mean?

An intervention may be appropriate for a specific medical reason even when it is not proven as a routine method of increasing live birth. For example, freezing all embryos may be used to reduce the risk of ovarian hyperstimulation syndrome in a patient at high risk, even though routine freeze-all for all patients is a different question.

The clinic should state:

  • The diagnosis or risk the intervention addresses
  • The intended outcome
  • Why standard treatment is not enough
  • What evidence applies to your subgroup
  • Whether it is optional or necessary for the planned treatment

“Personalised” should mean matched to a defined clinical reason, not simply additional testing followed by a product sale.

Which male-fertility add-ons need particular scrutiny?

Men may be offered extra semen or sperm tests and selection methods after an abnormal result, failed fertilisation or miscarriage.

Sperm DNA-fragmentation testing

The 2026 NICE fertility guideline says not to carry out sperm DNA-integrity or fragmentation testing. NICE found uncertainty about the relationship with subfertility, suitable assay, threshold and effective response. It also says not to offer supplements, antioxidants or medical treatments to improve sperm DNA integrity.

PICSI and IMSI

NICE says not to use PICSI in preference to standard ICSI and not to use IMSI as an adjunct to ICSI. Ask why either is being suggested and whether the claim relates to fertilisation, embryo development, miscarriage or live birth.

Other sperm-selection technologies

Methods such as microfluidic selection may change laboratory sperm characteristics, but a laboratory improvement is not automatically evidence of more live births. Check whether the method is on the HFEA’s current list, what outcome has been assessed and whether the clinic is charging you to take part in what is effectively research.

Read IVF vs ICSI before deciding whether an additional laboratory technique is necessary.

Why can add-on research be misleading?

Fertility research is difficult to interpret because:

  • Studies may include small numbers of patients
  • Patient age and diagnosis can differ between groups
  • Several add-ons may be used at the same time
  • Clinics may report pregnancy rather than live birth
  • Results per embryo transfer can exclude people who never reached transfer
  • A laboratory marker can improve without a patient-important outcome
  • Positive studies are more likely to be published than negative studies
  • Retrospective comparisons cannot fully remove selection bias

Randomised controlled trials with enough participants and live birth outcomes can provide stronger evidence, but the study population must still match the patient being advised.

How much do IVF add-ons cost?

Costs vary between clinics and can reach hundreds or thousands of pounds. The headline price may not include medication, scans, anaesthesia, biopsy, laboratory fees, freezing, storage or repeat testing.

Ask for a written itemised cost showing:

  • The core IVF or ICSI treatment
  • Every optional add-on
  • Medication and monitoring
  • Laboratory and procedure charges
  • Freezing and storage
  • What happens financially if treatment is cancelled
  • Whether the add-on must be repeated in a frozen transfer

The HFEA advises self-funding patients to consider whether money might be better used for more cycles of established treatment rather than several unproven extras in one cycle.

Can a clinic charge for an add-on in a research study?

The HFEA and professional and patient organisations state that treatments without strong evidence of safety or effectiveness should be offered only in a research setting. Patients should not be charged extra to participate in research, including clinical trials.

If a clinic says an add-on is innovative or part of evidence gathering, ask:

  • Is this a registered research study?
  • Who approved the study ethically?
  • What are the inclusion criteria and study outcomes?
  • Will I be randomised or have a control group?
  • Why am I being charged?
  • Where will the results be published?

Routine data collection by a clinic is not automatically the same as a properly designed trial.

How should you decide whether to use an add-on?

Use a structured decision rather than deciding in the pressure of an appointment.

  1. Write down the exact name of the add-on.
  2. Identify the specific outcome it is supposed to improve.
  3. Check the current HFEA page and rating.
  4. Ask for the evidence in your patient group.
  5. Compare absolute live-birth chances with and without it.
  6. Review risks, side effects and unknowns.
  7. Obtain the complete additional cost.
  8. Ask what standard treatment would be used without it.
  9. Take time to discuss the choice together or seek an independent opinion.

Declining an unproven extra is not failing to do everything possible. It can be a rational evidence-based decision.

Questions to ask your fertility clinic

  • Why are you recommending this add-on specifically for us?
  • What exact outcome is it intended to improve?
  • What is its current HFEA rating for that outcome?
  • Does evidence show more live births in patients like us?
  • What is the absolute benefit and how uncertain is it?
  • What are the risks and long-term unknowns?
  • Is there a standard-treatment alternative?
  • Is the intervention clinically necessary or optional?
  • What will it cost in total, including associated tests and medication?
  • Is it being offered as research, and if so, why would we pay?
  • What would you recommend if cost were not part of the decision?

The most important thing to remember

An IVF add-on should earn its place in your treatment plan. Ask what problem it addresses, which outcome it improves, what the HFEA currently says, how certain the evidence is and what it costs. Hope and urgency should be acknowledged, but they are not substitutes for evidence or informed consent.

The original webinar with Professor Tim Child explains add-ons, the HFEA rating system, patient use and the influence of headlines and cost. Any statement attributed personally to Professor Child should be checked against the recording and approved before publication.

For the wider treatment process, read IVF for Men, or join The Male Fertility Hub community for peer support.

Sources

This article provides general information and does not replace individual advice from your fertility clinic or another qualified healthcare professional.