Human Fertility

Add-ons in IVF: do they work, and are they worth it?

Add-ons refer to non-essential interventions added to routine infertility treatments, mainly In Vitro Fertilisation (IVF), aimed at improving chances of pregnancy or live birth. There has been a rapidly expanding array of add-ons, with nearly 50 different interventions currently in use, and the prices range from 200 AUD to 1500 AUD.  While some may offer benefits in specific contexts, many are backed by limited or low-quality evidence. As a result, patients are often offered interventions that may not demonstrably increase success rates but can substantially add to the overall cost of treatment or even harm their chances.

While existing guidelines provide recommendations on the use of add-ons, they often overlook the trustworthiness of the underlying randomized controlled trials (RCTs), which may lead to misleading conclusions. The good practice recommendations on add-ons by ESHRE and the Human Fertilisation and Embryology Authority (HFEA) website have provided guidance on the rational use of IVF add-ons, but neither has systematically screened the included RCTs for trustworthiness issues or considered the cost-effectiveness of these interventions.

It is therefore critical to determine which add-ons are effective—and, if so, whether they are cost-effective—based on trustworthy evidence. Doing so improves the chance of a live birth by focusing care on interventions that truly work, supports transparent shared decision-making, and protects patients from unnecessary financial burden.

To provide a comprehensive overview, we invite submissions covering, but not limited to, the following areas:

1. Diagnostic add-ons, such as screening hysteroscopy and endometrial receptivity testing.
2. Laboratory add-ons, such as sperm evaluation and selection techniques (e.g., physiological intracytoplasmic sperm injection [PICSI]), artificial sperm activation, growth factor–supplemented embryo culture medium, preimplantation genetic testing for aneuploidy (PGT-A), etc.
3. Clinical add-ons, such as endometrial scratching, intrauterine infusion of human chorionic gonadotropin, peripheral blood mononuclear cell therapy, intravenous immunoglobulins (IVIG), acupuncture, etc.

The preferred article type is systematic reviews and meta-analysis or individual participant data meta-analysis.

We recommend a framework for the rational use of add-ons. Evaluation should begin with systematic reviews of trustworthy RCTs, excluding those not meeting trustworthiness criteria. Effectiveness must be assessed using outcomes aligned with the biological mechanism, not solely live birth. For diagnostic add-ons, analyses should target patients whose results change clinical management. Once effectiveness is established, cost-effectiveness should be evaluated, comparing cost per additional live birth against a benchmark (e.g., $27,000 for standard IVF).

All manuscripts submitted to this Article Collection will undergo a full peer-review; the Guest Advisor for this Collection will not be handling the manuscripts.  

Please review the journal scope and author submission instructions prior to submitting a manuscript.  

The deadline for submitting manuscripts is June 30th, 2026. 

Please contact Menghan Li at [email protected] with any queries and discount codes regarding this Article Collection. 

Please be sure to select the appropriate Article Collection from the drop-down menu in the submission system.