During your IVF journey, your clinic may recommend — or offer — additional procedures alongside the core treatment protocol. These "add-ons" are presented in various ways: as routine enhancements, as personalised care, or as treatments specifically relevant to your situation. The price tag is real regardless of framing: individual add-ons cost between £150 and £2,500 each, and a package of several can add £3,000–£6,000 to the overall cost of a cycle.
The evidence for most of them is limited.
What Add-On Treatments Are
An IVF add-on is any procedure or test offered in addition to the standard IVF protocol — ovarian stimulation, egg collection, fertilisation, and embryo transfer — that is not included in the base cycle price.
The Competition and Markets Authority's 2025 investigation into the UK fertility sector highlighted add-on treatments as one of the most significant areas of concern, noting that many are sold without adequate explanation of the evidence basis, and that patients in an emotionally vulnerable position are poorly placed to evaluate clinical claims critically.
The HFEA Traffic Light System
The HFEA maintains a rating system for add-on treatments based on the strength of evidence for their effectiveness:
- Green: Good evidence from randomised controlled trials that the treatment improves live birth rates for defined patient groups.
- Amber: Some evidence of possible benefit, but studies are too small, inconsistent, or not randomised to draw firm conclusions.
- Red: No evidence of benefit, or evidence of potential harm.
As of 2025–2026, very few add-ons are rated green. The majority are amber or red. This does not mean individual patients cannot benefit — it means the evidence is not yet sufficient to recommend these treatments as standard practice.
Common Add-Ons: What the Evidence Shows
Time-Lapse Embryo Monitoring (EmbryoScope / Geri)
Time-lapse incubators photograph developing embryos continuously, generating video of embryo development without removing embryos from the controlled environment. The idea is that continuous monitoring provides more data for selecting the best embryo for transfer.
HFEA rating: Amber.
There is some evidence that time-lapse imaging may help identify embryos with abnormal development. However, randomised trials have not consistently shown that this improves live birth rates compared to standard incubation with periodic checks. The cost typically ranges from £200–£700.
Endometrial Receptivity Analysis (ERA)
ERA is a biopsy of the uterine lining taken to assess gene expression and identify the "window of implantation" — the optimal timing for embryo transfer. The premise is that some implantation failures occur because the embryo is transferred at the wrong point in the cycle.
HFEA rating: Amber.
A randomised trial published in the New England Journal of Medicine in 2021 (the PREDICT study) found no improvement in live birth rates from ERA-guided transfers compared to standard transfers in women with repeated implantation failure. More recent work is ongoing. Current evidence does not support routine use. Cost: £500–£1,500.
Endometrial Scratch
A procedure in which the lining of the uterus is lightly scratched in the cycle before embryo transfer. The rationale is that this may trigger a healing response that improves implantation.
HFEA rating: Red.
A large randomised trial (SCRATCH trial, New England Journal of Medicine 2019) found no improvement in live birth rates. The HFEA rates this as ineffective based on current evidence. Cost: £150–£350.
Preimplantation Genetic Testing for Aneuploidies (PGT-A)
PGT-A involves biopsying embryos at the blastocyst stage to test for chromosomal abnormalities before transfer, with the aim of selecting only euploid (chromosomally normal) embryos.
HFEA rating: Amber.
For some patient groups — particularly women over 38 with recurrent miscarriage — PGT-A may reduce the number of embryo transfers needed to achieve a live birth by avoiding transfer of chromosomally abnormal embryos. However, the biopsy itself carries a small risk of damaging the embryo, and in younger women with no history of miscarriage, the benefit is less clear. Cost: £2,000–£3,500.
Sperm DNA Fragmentation Testing
A test that measures the degree of DNA damage in sperm, beyond what standard semen analysis measures. High DNA fragmentation is associated with poorer embryo quality and higher miscarriage rates in some studies.
HFEA rating: Amber.
The test itself is diagnostic rather than a treatment. If high fragmentation is found, some clinics recommend testicular sperm extraction (TESE) or antioxidant supplementation — both also amber-rated. Cost of the test: £150–£350.
Reproductive Immunology Treatments (IVIG, Intralipids, Steroids)
Some clinics offer immunological treatments — intravenous immunoglobulin (IVIG), intralipid infusions, and immunosuppressant drugs such as prednisolone — on the basis that implantation failure may result from an immune response to the embryo.
HFEA rating: Red (IVIG); Amber (intralipids, steroids in defined contexts).
IVIG is rated red by the HFEA. There is currently insufficient evidence to recommend immunological treatments routinely. IVIG can cause significant side effects. Cost: £800–£3,000.
Hysteroscopy
A procedure to examine the interior of the uterus with a small camera, typically to identify and treat conditions such as polyps, fibroids, or adhesions.
HFEA rating: Amber/Red depending on indication.
Where there is a suspected structural problem — a polyp or fibroid visible on scan — investigating and treating it is clinically sensible and supported by evidence. As a routine pre-IVF investigation in all patients regardless of scan findings, the evidence is less clear. Cost: £800–£2,000 for surgical hysteroscopy.
How to Evaluate a Recommendation
When your clinic recommends an add-on, ask:
- What is the HFEA rating for this treatment? (The answer should be green, amber, or red — the information is public.)
- What specific evidence are you basing this recommendation on? (Ask for a study or reference, not a general claim.)
- Is there a specific clinical reason in my case? (A recommendation based on your test results or history is more defensible than a blanket offer.)
- What is the alternative? (Proceeding without the add-on is always an option; ask what the expected impact is.)
- What does it cost, and is this included in any package pricing?
Financial Context
Individually, an add-on might seem affordable relative to the total cost of an IVF cycle. But add-ons are often presented as a package, and saying yes to several can add a substantial sum. For a full picture of what IVF costs in the UK and how to budget across a multi-cycle pathway, see IVF costs in the UK: a complete 2026 breakdown.
If you are financing treatment through a personal loan or clinic payment plan, add-ons increase the total principal you are borrowing. See IVF loans versus clinic payment plans for a comparison of borrowing costs.
For patients over 40 in particular, the pressure to try every available option is understandable given the lower per-cycle success rates. But the HFEA data on success rates — see HFEA success rates explained — does not currently show that add-ons systematically improve outcomes for this age group.
Frequently Asked Questions
Q: Should I refuse all add-on treatments?
A: Not necessarily. Some add-ons are clinically justified in specific situations — PGT-A for patients with recurrent miscarriage, or hysteroscopy when a structural problem is suspected. The question is whether the recommendation is based on your specific clinical profile and a legitimate evidence base, or on routine upselling.
Q: My clinic is very highly rated and recommends ERA. Should I trust their recommendation?
A: A clinic's overall reputation is separate from the evidence for a specific add-on. Even well-regarded clinics recommend amber and red add-ons. Ask for the specific evidence basis for the recommendation in your case, and check the HFEA rating independently.
Q: Can add-ons ever be covered by the NHS?
A: NHS-funded IVF covers the standard treatment protocol. Add-ons are generally not funded by ICBs unless there is a specific clinical indication — for example, a hysteroscopy to investigate a finding on ultrasound may be funded separately. Ask your fertility unit what is and is not included in your NHS funding.
Q: How do I find the HFEA's traffic light ratings?
A: The HFEA publishes its add-on rating tool at hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/. The ratings are updated as new evidence is published.
Q: My embryologist is recommending time-lapse monitoring as standard. Should I decline?
A: Time-lapse monitoring is amber-rated — there is some evidence of potential benefit but it has not been shown to consistently improve live birth rates in randomised trials. If it is offered as part of your package pricing at no additional cost, there is no reason to decline. If it is an additional charge, ask what evidence supports it specifically for your situation.
This article is for information only and does not constitute medical or legal advice. HFEA ratings are updated periodically; always check the current rating at hfea.gov.uk before making decisions.