8 common IVF add-ons / adjuvant therapies: What are they and are they right for you?
Understanding IVF add-on therapies to improve egg quality and embryo quality
When going through in vitro fertilization (IVF), it’s natural to want to try everything possible to improve your chances of success. This is where IVF “add-on” therapies come in. These are additional treatments offered alongside standard IVF to potentially improve outcomes. However, not all add-ons are backed by strong scientific evidence—and some come with a hefty price tag. In this post, we’ll break down some of the most common IVF add-ons, explain what they are, and explore the evidence behind them.
What Are IVF Add-Ons?
Add-ons are optional procedures or medications that are offered in addition to standard IVF cycles. They are marketed with the goal of increasing the chances of success, but they’re not always supported by strong clinical data.
We will cover these IVF add-ons or adjuvant therapies:
- Embryo glue
- Time-lapse imaging or embryoscope
- Preimplantation Genetic Testing for Aneuploidy (PGT-A)
- Endometrial Receptivity Analysis (ERA)
- Immune Therapy (Intralipids, Steroids, IVIG)
- Assisted Hatching
- Endometrial Scratch
- Embryo freezing
Common IVF Add-On Therapies
1. Embryo Glue
Definition: A substance added to the embryo transfer media that contains hyaluronic acid—a naturally occurring substance in the female reproductive tract.
Purpose: It’s designed to help the embryo stick to the uterine wall after transfer.
Evidence: There is some evidence suggesting a slight improvement in implantation and live birth rates, but results are mixed. A Cochrane review found a potential benefit, but the quality of evidence was low.
2. Time-Lapse Imaging (Embryoscope)
Definition: A special incubator that takes pictures of developing embryos every 5–10 minutes without removing them from their optimal environment.
Purpose: Helps embryologists select the most viable embryo based on development patterns.
Evidence: Some clinics report improved success rates using time-lapse imaging, but a 2019 Cochrane review concluded there’s no strong evidence that it improves live birth rates.
3. Preimplantation Genetic Testing for Aneuploidy (PGT-A)
Definition: A screening method used to check embryos for chromosomal abnormalities before transfer.
Purpose: To increase the chances of selecting a healthy embryo and reduce miscarriage risk.
Evidence: It may benefit certain groups, like older patients or those with recurrent pregnancy loss. However, it’s not routinely recommended for all patients, especially younger ones, as it can reduce the number of viable embryos for transfer.
4. Endometrial Receptivity Analysis (ERA)
Definition: A biopsy-based test that examines the timing of the endometrial lining’s readiness to accept an embryo.
Purpose: Helps determine the optimal day for embryo transfer by identifying the “window of implantation.”
Evidence: While some studies report improved pregnancy rates, the test is controversial. A large trial found no significant difference in outcomes between those who used ERA-guided transfer and those who didn’t.
5. Immune Therapy (Intralipids, Steroids, IVIG)
Definition: Treatments designed to modulate the immune system, based on the idea that immune dysfunction could lead to implantation failure.
Purpose: To reduce natural killer (NK) cell activity or inflammation thought to interfere with implantation.
Evidence: There is limited and conflicting evidence. Many experts consider these treatments experimental, and they are not routinely recommended.
6. Assisted Hatching
Definition: A lab technique that thins or makes a small hole in the outer shell of the embryo (zona pellucida) to help it hatch and implant.
Purpose: May be helpful for older patients or those with poor prognosis.
Evidence: Some studies suggest a benefit in specific cases, but overall, evidence is weak, and it’s not recommended for routine use.
7. Endometrial Scratch
Definition: A procedure that intentionally injures the uterine lining to promote better implantation in a subsequent cycle.
Purpose: Believed to increase implantation rates by triggering an inflammatory response.
Evidence: Once considered promising, more recent and robust studies have shown no significant benefit. A large randomized controlled trial concluded that endometrial scratching did not improve live birth rates.
8. Embryo Freezing (Freeze-All Strategy)
Definition: A method where all embryos are frozen after fertilization, and transferred in a later, non-stimulated cycle.
Purpose: Aims to improve uterine environment by avoiding high hormone levels during a stimulated cycle.
Evidence: This approach may be beneficial for women at risk of ovarian hyperstimulation syndrome (OHSS) or those with high progesterone levels. However, routine freeze-all is not advised for every patient.
The big question: Do IVF Add-Ons Work?
While the idea of “extra help” can be tempting, especially after unsuccessful cycles, the reality is that many IVF add-ons lack strong scientific backing. In fact, the UK’s Human Fertilisation and Embryology Authority (HFEA) uses a traffic light system to rank these therapies:
- Green: Good evidence of safety and effectiveness (very few, if any, add-ons qualify).
- Amber: Some evidence, but more research needed.
- Red: No evidence of benefit and/or evidence of harm.
Patients should be cautious and informed when considering these treatments. Dr. Westphal emphasizes the importance of individualized care: “What’s right for one patient may not be right for another. And just because something is available doesn’t mean it’s helpful or harmless.”
Always discuss any add-ons with your fertility doctor. Ask what the evidence says, what the risks are, and whether the treatment is right for your specific situation.