IVF Add-ons: Which Expensive Add-ons Really Help — and Which Do Not
Laura Chrobok 06.07.2026
An unfulfilled desire to have children is one of the most emotionally distressing experiences many people will ever face. When pregnancy does not occur despite every effort, many couples place their hopes in in vitro fertilisation (IVF). Additional tests, medications or laboratory procedures that are claimed to improve the chances of IVF success therefore sound especially appealing. Yet these so-called IVF add-ons are increasingly coming under scrutiny. Recent scientific evaluations show that, for many of these optional treatments, there is currently no convincing evidence of benefit — even though they continue to be offered by fertility clinics around the world.
This article is about what IVF add-ons are, which procedures are most commonly offered, what the current scientific evidence shows and what you should consider before deciding to pay for additional fertility treatments.
What Are IVF and ICSI? – Key Terms Explained
In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are among the most commonly used assisted reproductive technologies. In both procedures, eggs are first retrieved from the woman. During IVF, fertilisation takes place in the laboratory by bringing eggs and sperm together. During ICSI, a single sperm cell is injected directly into the egg. One or more embryos are then transferred into the uterus (Ata et al., 2026).
Whether IVF or ICSI is appropriate depends on the underlying cause of infertility and is determined individually by the treating physician. Depending on the specific procedure, the additional treatments described in this article may be offered alongside either IVF or ICSI.
What Are IVF Add-ons?
IVF add-ons are additional tests, medications or laboratory techniques that go beyond standard IVF or ICSI treatment. Their aim may be, for example, to improve embryo implantation, select embryos with a greater developmental potential or increase the likelihood of pregnancy.
Some of the best-known IVF add-ons include:
· Preimplantation genetic testing for aneuploidy (PGT-A)
· Endometrial receptivity analysis (ERA)
· EmbryoGlue
· Endometrial scratching
· PICSI
· Time-lapse embryo culture
· Platelet-rich plasma (PRP)
· Intralipid infusions
· Corticosteroids
· Acupuncture.
Some of these procedures have been offered for many years, whereas others are relatively new. What many of them have in common is that their perceived benefit often appears greater than has actually been demonstrated scientifically.
The Costs of IVF Add-ons
Published price overviews from the UK fertility sector show that the financial burden associated with IVF add-ons is far from negligible (Perrotta, 2024):
· PGT-A: approximately £2,100–3,500 (around €2,500–4,100)
· Endometrial receptivity tests: approximately £450–1,500 (around €530–1,760)
· Immunological tests and treatments: approximately £1,270–2,890 (around €1,490–3,390)
· Endometrial scratching: approximately £150–400 (around €180–470)
· Hyaluronan-rich embryo transfer media such as EmbryoGlue: approximately £160 (around €190)
Actual costs vary depending on the country, fertility clinic and individual treatment plan. Nevertheless, these figures illustrate that many IVF add-ons can lead to substantial additional expenses.
High Costs, Uncertain Benefits: Why IVF Add-ons Are Facing Increasing Criticism
The most comprehensive scientific evaluation of controversial IVF add-ons was published in 2026. The researchers included only randomised controlled trials and additionally assessed their scientific quality. Of the 157 studies initially considered suitable, 72 were excluded because of serious concerns regarding their trustworthiness. Consequently, the final analysis included 85 randomised controlled trials.
The findings were clear: for most of the IVF add-ons examined, there was no convincing evidence that they improve live birth rates. Only a small number showed weak indications of a possible benefit. The authors explicitly emphasised that the overall evidence remains limited and that further high-quality studies are required (Lensen et al., 2026).
Admittedly, statements of this kind are frequently made in conventional medicine — this time, however, the criticism is directed at conventional medical interventions themselves. Even so, the following principle still applies: the inability to fully explain or conclusively prove a treatment’s effectiveness is not the same as proving its ineffectiveness. Nevertheless, one cannot help the unfortunate impression that some providers of IVF add-ons only care about … your money.
Which IVF Add-ons Are Currently Being Questioned Most — and Why?
Under certain conditions, health insurance contributes to the costs of standard fertility treatments such as IVF or ICSI. However, many additional tests, laboratory procedures and accompanying treatments are not part of standard care and usually have to be paid for privately.
People experiencing infertility are often under considerable emotional and financial strain. Understandably, many do not want to leave any possible opportunity unexplored. Additional treatments offer hope — particularly when they are presented as modern, personalised or biologically plausible.
This does not automatically mean that fertility clinics are acting irresponsibly. Many clinics openly explain that the evidence supporting certain IVF add-ons is limited. The situation becomes problematic, however, when expensive add-ons are presented as improving success rates, as being particularly important or even almost indispensable, despite the fact that their ability to increase live birth rates has not been well demonstrated scientifically.
Here
are a few examples:
· Endometrial Receptivity Analysis (ERA): Promising More Precision Than Has Been Proven
The ERA test is intended to determine the supposedly optimal timing for embryo transfer. To achieve this, the endometrial lining is examined during a prepared treatment cycle in order to identify the woman's individual window of implantation. The procedure creates an impression of precision and individualisation. This makes it attractive to patients — and commercially highly attractive for providers. The test generates additional costs and is generally not covered as a routine component of IVF or ICSI by Germany's statutory health insurance. To date, however, no convincing evidence has shown that it increases the likelihood of a live birth. Consequently, ESHRE does not recommend its routine use outside selected individual cases (Lundin et al., 2023).
· Immunomodulatory and Immunosuppressive Therapies: High Costs, Uncertain Evidence
Among the most controversial IVF add-ons are so-called immunotherapies, including corticosteroids, intralipid infusions and intravenous immunoglobulins (IVIG). These treatments are based on the assumption that, in some women, the immune system may interfere with embryo implantation and/or adversely affect an early pregnancy.
This hypothesis is fundamentally plausible — particularly after repeated unsuccessful treatment cycles. However, no convincing evidence has yet demonstrated that immunotherapies increase live birth rates. The current Lancet meta-analysis found no robust evidence of effectiveness, and ESHRE likewise sees no basis for their routine use (Lensen et al., 2026; Lundin et al., 2023).
Immunotherapies may be particularly expensive because they are often offered as repeated treatments rather than as a one-off intervention. Furthermore, they are not always harmless supportive measures. Corticosteroids and other immunologically active treatments may cause side effects and should therefore be used only when there is a clear medical indication.
· Preimplantation Genetic Testing for Aneuploidy (PGT-A): An Expensive Genetic Test with Limited Benefits
During preimplantation genetic testing for aneuploidy (PGT-A), embryos are genetically analysed in an attempt to exclude those with abnormal chromosome numbers. At first glance, the concept appears convincing, as chromosomal abnormalities are among the most common causes of early miscarriage.
However, PGT-A is also one of the most expensive IVF add-ons and is paid for privately. To date, no convincing evidence has demonstrated that routine use of PGT-A in all IVF patients improves live birth rates. The American Society for Reproductive Medicine (ASRM) therefore does not recommend its routine use for all patients. Whether certain patient groups may benefit remains the subject of ongoing research (Practice Committees of ASRM and SART, 2024; Lensen et al., 2026).
The criticism here is therefore not that PGT-A is being researched or may be considered in selected cases. Rather, concern arises when patients are led to believe that they are missing a crucial opportunity without this expensive genetic test, despite the fact that its benefit has not been established for many patients.
· PRP: Intensively Marketed as Innovative
PRP stands for platelet-rich plasma. During this procedure, blood is taken from the patient, enriched with platelets and then introduced into the uterus or ovaries. The aim is to stimulate tissue regeneration and thereby improve embryo implantation or ovarian function.
Some fertility clinics promote PRP as an innovative additional treatment option, for example for women with a thin endometrium, diminished ovarian reserve or recurrent implantation failure.
The critical issue is not that PRP is being researched, but rather the claims made about its benefits (sometimes also to justify its high cost). The treatment is usually paid for privately, even though no convincing clinical benefit with regard to live birth rates has yet been demonstrated (Lensen et al., 2026).
EmbryoGlue, PICSI and Endometrial Scratching: Do They Really Offer Additional Benefits?
Current evidence shows that not all IVF add-ons should be assessed equally, as there are indeed some more encouraging examples:
· EmbryoGlue: A Promising IVF Add-on
EmbryoGlue is a specialised embryo transfer medium used immediately before embryo transfer. It contains a higher concentration of hyaluronic acid (hyaluronan), a natural component of the endometrial lining, and is intended to promote the attachment of the embryo to the uterus (Heymann et al., 2020).
Like many other IVF add-ons, EmbryoGlue is offered as an additional paid service and usually has to be financed privately. For this reason, the question of its actual benefit is particularly important. Unlike many other IVF add-ons, however, the latest Lancet meta-analysis reached a somewhat more favourable conclusion. The researchers found weak evidence suggesting a possible benefit, while explicitly emphasising that the overall evidence remains limited and that further high-quality randomised controlled trials are required before EmbryoGlue can be recommended for routine use. Same old story …
· Endometrial Scratching: Initial Indications of a Possible Benefit
During endometrial scratching, the endometrial lining is deliberately subjected to minor injuries using a thin catheter. The resulting local inflammatory and healing response is intended to increase endometrial receptivity and thereby promote embryo implantation (Lundin et al., 2023).
This procedure is likewise offered as an additional paid service and usually has to be financed privately.
Endometrial scratching is one of the few IVF add-ons for which weak evidence of a possible benefit has been identified. At the same time, researchers stress that the available evidence remains limited and is currently insufficient to support routine use (Lensen et al., 2026). If you are considering this treatment, you should be aware of this.
· PICSI: Positive Signals, Unanswered Questions
Physiological Intracytoplasmic Sperm Injection is a development of conventional ICSI. Sperm cells are selected according to their ability to bind to hyaluronic acid. This binding ability is regarded as an indicator of greater maturity and potentially better biological quality of the sperm (Lundin et al., 2023).
Like other IVF add-ons, PICSI generates additional costs and is generally not part of standard treatment. This makes it all the more important to ask whether the extra expense is justified by proven clinical benefit.
According to the latest Lancet meta-analysis, PICSI is among the few add-ons for which weak evidence of a possible benefit was identified. Here again, however, the authors explicitly point out that the current evidence is not yet sufficient to support a general recommendation (Lensen et al., 2026).
And now to one intervention that we would like to describe as a special case…
· Acupuncture: Greater Relaxation, Not Higher IVF Success Rates
A For many patients, acupuncture offers an important benefit. Several studies suggest that it may temporarily reduce IVF-related anxiety and perceived stress, thereby helping women cope better psychologically during treatment — as a possible means of supporting emotional well-being throughout what are often emotionally demanding procedures (Hullender Rubin et al., 2022).
And that can hardly do any harm. Still, acupuncture session provided alongside IVF or ICSI treatment generally costs €30–80. (Several sessions are often recommended.) However, acupuncture as an adjunct to IVF or ICSI is generally not covered by Germany's statutory health insurance and therefore usually has to be paid for privately (Techniker Krankenkasse, 2026).
What Should You Consider Before Choosing From IVF Add-ons?
If you are offered an additional treatment as part of IVF or ICSI, you should specifically ask whether it forms part of the approved treatment plan or whether it must be paid for privately. Equally important is the question of whether the treatment has been shown to increase live birth rates — or whether it merely improves certain laboratory values or intermediate outcomes.
The following questions may also be helpful:
o What risks or side effects are known?
o What additional costs will be incurred?
o Which benefits are scientifically well established — and which are currently supported only by preliminary evidence?
o Is the treatment recommended by international professional societies?
Reputable fertility clinics should be able to explain…
o which claims are supported by robust scientific evidence,
o which risks and side effects are known — or where uncertainties remain,
o which costs are not covered by health insurance.
These Natural Substances May Support Pregnancy
There are, of course, a number of substances that can be obtained through food or dietary supplements.
For example:
o Vitamin D3.
IVF Add-ons: Hope Can Be Expensive...
Sometimes we want something so desperately that we are “willing to do anything” to make it happen. Yet it is precisely in such situations that caution is essential. Important decisions should not be made hastily.
Many IVF add-ons are promoted with claims that they improve the chances of a successful fertility treatment. However, current scientific evidence shows that for many of these expensive additional procedures, there is still no convincing proof that they improve live birth rates.
The most important message is therefore this: Ask which additional treatments are supported by robust scientific evidence, which are still being investigated, and whether the potential benefits genuinely justify the additional financial costs in your individual situation. Making an informed decision based on current scientific evidence remains the best investment in your future family planning.
FAQ — Frequently Asked Questions About IVF Add-ons
1. Why is the live birth rate considered the most important measure of IVF success?
A suitable embryo or successful implantation are important intermediate steps — but they do not guarantee that a child will ultimately be born. Pregnancies can end, for example, in early or later miscarriage. For this reason, the live birth rate is considered the most meaningful endpoint in reproductive medicine: it shows how often a treatment ultimately leads to a live birth and therefore allows a realistic assessment of the actual benefit of an IVF add-on. This is why international professional societies and current studies also assess IVF add-ons primarily according to their effect on live birth rates (Lensen et al., 2026; Practice Committees of ASRM und SART, 2024).
2. Why do recommendations from different fertility clinics sometimes differ considerably?
Fertility clinics do not always assess scientific data in the same way and may set different treatment priorities. Some clinics offer new procedures at an early stage, while others deliberately wait for more robust studies. For patients, it may therefore be useful to obtain a second medical opinion before agreeing to expensive add-ons.
3. How can I tell whether an add-on is being recommended to me for medical reasons — or primarily for financial reasons?
You should ask your fertility clinic why this specific treatment is being recommended in your particular case. If the clinic can clearly explain which individual medical situation justifies its use and which scientific data support it, this is more likely to indicate a patient-centred recommendation. If, by contrast, mainly general claims about improved success rates are made or you feel under time pressure, you should ask critical follow-up questions.
4. Is a high price an indication of a particularly effective treatment?
No. The price of an add-on says nothing about how well its effectiveness has been scientifically demonstrated. Some of the most expensive IVF add-ons are also among those for which no convincing evidence of additional benefit with regard to live birth rates has yet been shown.
5. Should I avoid an IVF add-on if the scientific evidence is limited?
Not necessarily. What matters most is that you understand the potential benefits, risks and costs of an add-on and are able to make an informed decision.
6. Where can I find independent information about IVF add-ons?
International professional societies such as the European Society of Human Reproduction and Embryology (ESHRE), the American Society for Reproductive Medicine (ASRM) and the UK regulator Human Fertilisation and Embryology Authority (HFEA) regularly publish evidence-based assessments of IVF add-ons and their supporting evidence.
Further information on supporting pregnancy and many other topics can be found not only on our blog, but also in our “Medizinskandale” book series and the “Codex Humanus” — the fifth volume of which was recently published. Feel free to visit our online shop.
Sources:
· Ata, B. et al. (2026): “ESHRE guideline: ovarian stimulation for IVF/ICSI: an update in 2025,” Human Reproduction.
· Perrotta, M. (2024): “Biomedical Innovation in Fertility Care: Evidence Challenges, Commercialization, and the Market for Hope,” Bristol University Press.
· Lensen, S. et al. (2026): “Safety and Effectiveness of Ten Common In-vitro Fertilisation Add-ons: A Systematic Review and Meta-analysis of Randomised Controlled Trials,” The Lancet Obstetrics, Gynaecology & Women’s Health.
· Lundin, K. et al. (2023): “Good Practice Recommendations on Add-ons in Reproductive Medicine,” Human Reproduction.
· Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology (2024): “The Use of Preimplantation Genetic Testing for Aneuploidy: A Committee Opinion,” Fertility and Sterility.
· Heymann, D.; Vidal, L.; Or, Y.; Shoham, Z. (2020): “Hyaluronic Acid in Embryo Transfer Media for Assisted Reproductive Technologies,” Cochrane Database of Systematic Reviews.
· Hullender Rubin, L. E. et al. (2022): “Effect of Acupuncture on IVF-Related Anxiety: A Systematic Review and Meta-analysis,” Reproductive BioMedicine Online.
· Techniker Krankenkasse (2026): “Akupunktur – Anwendung, Wirkung und Kosten.“