Treatment add on’s – Do they add up?

With progress within the fertility world changing every day and new emerging treatments, clinic’s may well offer you some different add on’s alongside your treatment cycle. On Saturday 4th November I attended the Fertility Show at London Olympia, I had pre-booked a few seminars to attend, one of which was showing evidence from the HFEA (Human Fertilisation & Embryology Authority) regarding treatment add on’s. Add on’s are optional extras that you may be offered on top of your fertility treatment and at an additional cost. According to the HFEA they are emerging techniques that may have shown some promising results in initial studies but haven’t necessarily been proven to improve pregnancy or birth rates. This information is of great interest to me, not only because I think most people would love to improve their chances of having a baby but also because I had one of these “add ons” both times we have done IVF.

From the seminar I attended, below is a list of some of those additional extras you may be offered at your clinic. It’s quite a list! My brain was a little frazzled reading through all the info! For a detailed explanation of each one please go to the HFEA web page here 

Assisted Hatching

Artificial Egg Activation

Elective Freeze all cycles

Embryo Glue

Endometrial Scratching

Intrauterine Culture

Pre-implantation Genetic Screening (PGS)

Reproductive Immunology Test

Time-lapse Imaging

I was quite shocked about how many there were, most of which I had not heard of. The one I want to talk about is the Endometrial Scratch. When I started my fresh IVF cycle back in 2016 I was advised to have an Endometrial Scratch the month before my IVF cycle started. This was at an additional cost of £200. This was standard procedure at my clinic and they offer this to every patient regardless of failed or successful cycles. This was something I also took time to research myself as I have always felt it is my responsibility to look into any treatment I have regardless of trusting your clinic and consultant (which I did thoroughly). You should always have the option to say no or question why? You should always want confirmation that any additional treatments are safe and there is adequate evidence to support this.

So what is the endometrial scratch and what does the research say? The procedure, which is very similar to a smear test involves ‘scratching’ the endometrial lining of the womb with a very small catheter prior to month of your stimulation medication. Scientists involved with various studies believe that you can increase implantation rates, thus significantly raising success rates with this simple procedure. The procedure itself of scratching the endometrium is believed to increase the white blood cells and the endometrial injury increases the production of white blood cells which secrete so-called growth factors which in turn control embryo implantation.

The procedure itself was over very quickly and only a little more uncomfortable than a smear. I did bleed a little after and I had some cramping but it was relatively painless. With my fresh IVF cycle I bled exactly seven days after the scratch (which is what they plan for) and then I started my medication. I went on to have a successful egg collection (22 eggs) and a 5 day blastocyst transfer which resulted in my son Austin. When we started the process for our Frozen Embryo transfer back in June I didn’t even question whether I would have the scratch again – after a previous successful IVF I wanted to mirror everything I had done before.

This time though I didn’t bleed seven days after the procedure that was the only difference from my fresh cycle, so I took some tablets to induce a bleed. The implantation was again successful but unfortunately I suffered a bio-chemical pregnancy.

So what do the HFEA say? You can check the supporting evidence with each add-on and the HFEA have a very simple colour symbol which lets you know how they are rated. A yellow symbol shows  growing body of evidence with promising results but further research needed. If there is a red symbol there is no evidence to show that it is an effective or safe treatment.

So I’ve grouped the above add on’s so you can see which colour symbol they fall into.

Yellow Symbol (Further research needed but showing promising results)

Pre-implantation genetic screening (PGS) (Early results for PGS carried out on day 5 embryos are promising but further evidence is needed)

Artificial egg activation

Elective freeze all cycles

Embryo Glue

Endometrial scratch

Time lapse imaging


Red Symbol (no evidence to show effective or safe)

Pre-implantation genetic screening (No evidence to show that PGS carried out on day 3 embryos is of benefit)

Assisted Hatching

Intrauterine Culture

Reproductive Immunology Tests

So as you can see further research is needed with follow-up studies to be sure the procedures are effective and safe but there are some promising results so far for some. It is important to discuss with your clinic any treatment add on’s, I am not sure how many are available within the NHS and is best you check with your specialist. Some may be included with the cost of your treatment. I did quite a lot of research before my scratch and we weighed up the extra cost of £200 versus what we were already paying. It is important to bear in mind I have many friends who have had successful IVF without any add on’s and who knows if my fresh IVF would have still resulted in our son without the scratch?? I guess that’s a question I will never have the answer but I am happy to always consider some optional extras if I feel the evidence is adequate and the cost is relative. Most importantly that they are safe.

We are all striving for better success rates especially as most fertility journeys are expensive as well as emotionally and physically draining to say the least. The opportunity to increase your chances of becoming a mum are all too appealing. That is why it is important to feel happy with your clinic and any additional treatments they offer. We are all so vulnerable when desperate to have a baby and it is easy to just accept what we are told. But at what price?





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