If you have a question related to Fertility Exeter or your fertility treatment, please read the information on this page. If you still can’t find an answer to your enquiry, please get in touch with us using our online contact form.
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What does ‘add-on’ for IVF treatment mean?
“Add-ons” are drugs, procedures or processes that can be used in conventional IVF with the aim of increasing the chance of having a successful outcome (a live birth).
However, not all “add-ons” that are used by clinics are safe or effective. The HFEA has developed a rating system and published a list of “add-ons” on their website. This is a good place to start looking for impartial advice: https://www.hfea.gov.uk/treatments/treatments-add-ons
‘Add-ons’ are marked as green, amber, grey, black or red accordingly. The ratings are determined by a Scientific and Clinical Advance Advisory Committee and indicate whether the ‘add-on’ is effective or safe according to published studies.
“It should be noted that currently there are no “add-ons” that are rated green. This category would include treatments where safety and effectiveness are supported by high-quality evidence (randomised controlled studies) in more than one study. Randomised control studies are difficult to undertake in fertility settings often due to ethical issues or small numbers of patients requiring specific treatments.
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What are the processes used in IVF that ARE NOT classed as ‘add-ons’?’
There are a number of procedures which initially were experimental and were considered an “add-on”. They have now, through rigorous research, been shown to be of benefit and they are considered to be part of a standard IVF package. These include:
• ICSI treatment for sperm problems – such as very low numbers of sperm, a high percentage of abnormally-shaped sperm or a low percentage of motile sperm. Sperm is injected directly into the egg to reduce the chance of failed fertilisation where this is considered to be clinically appropriate.
• Blastocyst culture – assessments of embryos on day 3 of development determine if culture to day 5-6 (blastocyst stage) is beneficial for the cycle. Where this is the case, this provides more information for selecting embryos for transfer and those embryos that become blastocysts have an increased chance of creating a pregnancy.
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Which ‘add-ons’ are available for selected cases?
Fertility Exeter only offers “add-ons” which have reasonable evidence in the fertility journals of being of proven benefit and no evidence of causing harm.
- Endometrial scratch – this is offered for cases of recurrent implantation failure which is when two or more optimal embryos have been transferred but the woman has failed to become pregnant. For more information, please see our patient information leaflet.
- Time lapse – embryos are monitored by a camera built into the incubator so that embryo development can be monitored without needing to take the embryos out of the incubator. Evidence supporting this is building but at present it hasn’t been proven to significantly increase live births. Please see our patient information leaflet about time lapse monitoring.
- Steroids – there is a lack of robust evidence to support the routine use of corticosteroids empirically. However, limited evidence demonstrated improvement in pregnancy rates in the subgroup of women with autoimmune conditions. Although steroids are frequently used in pregnancy to treat some conditions, its use has been associated with certain risks. Therefore, it is important to weigh up the decision to use steroids against any possible risks.
- Embryo Glue – this is a commercial media used at the point of embryo transfer which contains Hyaluronan which was thought to increase the chance of pregnancy. However, there is insufficient evidence to support the benefits of use to improve outcome or to confirm long-term safety.
- EmbryoGen/BlastGen – the limited evidence suggests it may be of benefit for women with a history of miscarriages, either naturally or after IVF, and for recurrent implantation failure. It can be used for selected cases but requires the EmbryoGen/BlastGen to be specially ordered and those costs are passed directly on to the patient.
- Sperm DNA Fragmentation testing – there are research studies which show that having an increased level of sperm DNA damage can reduce the chance of conception but currently there is a lack of validated methods for testing in the context of treatment cycles and no available treatments to treat this; so, testing is currently not offered in Fertility Exeter.
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Which ‘add-ons’ ARE NOT provided by Fertility Exeter?
• Intralipid infusions – there is no convincing evidence of benefit but there are reported cases of serious harm from these infusions; so, this is not offered in Fertility Exeter.
• Pre-implantation genetic screening – this is a process of sampling a few cells from a day 5 blastocyst and checking for a normal number of chromosomes before deciding to transfer or discard the embryo. The evidence across the world is conflicting and hotly debated. At present it is felt that, on balance, PGT-A results in reduced chance of pregnancy as embryos that could make a successful pregnancy are being discarded. This is not currently offered in Fertility Exeter.
• Immune factor infusions – there is no evidence that immune factor infusions increase the chance of pregnancy and there are significant risks with some of these treatments so these are not offered in Fertility Exeter.