Published online by Cambridge University Press: 25 February 2021
In this chapter, the evidence and use of in vitro fertilisation (IVF) add-ons in the UK is explored. In addition, the stance of professional and regulatory bodies is described. The term ‘add-on’ has been coined to describe the additional ‘extras’ to a routine or intracytoplasmic sperm injection cycle that are commonly offered to those undergoing treatment with the aim of improving livebirth rates. A summary of the highest quality available evidence for the following add-ons is presented: endometrial scratching; time-lapse imaging; assisted hatching; preimplantation genetic testing (PGT-A); endometrial receptivity array; GM-CSF containing culture media; Embryo Glue (hyaluronic acid); artificial egg activation with calcium ionophore; intracytoplasmic morphologically selected sperm injection (IMSI); physiological intracytoplasmic sperm injection (PICSI); sperm DNA test; and reproductive immunology procedures. There remains a paucity of evidence to support the routine use of add-ons based on the available randomised controlled trial and systematic review evidence. This is particularly important given that most patients pay additional fees to utilise add-ons. In order for patients to receive high- quality care in IVF clinics, clinicians must be prepared to discuss the relevant evidence regarding efficacy and safety of the specific add-on being considered.