When going through IVF, you may be offered a treatment add-on to improve your chances of having a baby. Treatment add-ons are supplementary treatments that can be performed during your IVF cycle. For most patients, having a routine cycle of fertility treatment is effective without using any treatment add-ons. As treatment add-ons come at an additional cost, you are not only a patient, but you also become a consumer paying for parts of your treatment. This can be really difficult to navigate, so we’ve put together this guide to help you.
What is the HFEA traffic light rating?
The HFEA (Human Fertilisation and Embryology Authority) regulates fertility clinics through licensing, inspecting and setting standards for operating processes. They have published a guide with all of the treatment add-ons available, with a rating to indicate if the add-on is effective at improving the chances of having a baby for someone undergoing fertility treatment. However, it’s important to remember that they look at most fertility patients in general, not your personal circumstances. Therefore, your clinic should provide you with the evidence of effectiveness of any treatment they offer you. The rating system has recently been updated by the HFEA - please bear with us as we update this page.
Which treatment add-ons are available?
Assisted hatching
Assisted hatching is a laboratory process where embryologists use a laser, chemicals or a needle to create a hole in the zona, the outer layer of the embryo. Assisted hatching is meant to encourage the process of implantation in the uterus. This may be offered if there’s an indication of the embryos having thick zonas, or in cases where multiple embryo transfers have taken place without implantation. It is safe to perform on the embryos.
The HFEA says: "We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence."
Elective freeze all
An elective freeze all cycle is a cycle of IVF where an embryo transfer does not take place; instead, all good quality embryos are frozen and an embryo transfer is planned for a different cycle. The procedure is safe.
The HFEA says: "On balance, it is not clear whether this add-on is effective at improving the treatment outcome."
Endometrial receptivity assay (ERA)
ERA is a test that is meant to find the optimal time for an embryo to be transferred into a woman’s uterus for the embryo to implant, known as the window of implantation. ERA involves taking a biopsy of the endometrial lining of the uterus and testing the tissue to determine the optimal window to hopefully improve the chances of a successful implantation.
The HFEA says: "There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness."
Endometrial scratch
Endometrial scratching is a procedure performed by your doctor where the lining of the uterus is scratched using a small sterile plastic tube. The theory is that this procedure triggers the body to repair the site of the scratch, making the womb lining more receptive to an embryo implanting. There is a small risk of infection as it is an invasive procedure, but it is otherwise considered safe.
The HFEA says: "On balance, it is not clear whether this add-on is effective at improving the treatment outcome."
EmbryoGlue
EmbryoGlue is a hyaluronate enriched medium that is used at the time of embryo transfer. It contains hyaluronan, a component which is usually present during implantation, and the theory is that the enriched medium promotes implantation, to improve chances of having a baby. EmbryoGlue is a safe treatment.
The HFEA says: "On balance, it is not clear whether this add-on is effective at improving the treatment outcome."
Immunological tests and treatments
One theory widely shared for unexplained infertility is that the cause may be the patient’s immune system. A range of tests and treatments may be offered, but the treatments involved could have a serious impact on the patient’s immune system. Because there is no evidence that any immune cells ever do prevent a pregnancy, there is no reason for any patient without an immunological disease to take these therapies.
The HFEA says: "There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness."
Intracytoplasmic morphologic sperm injection (IMSI)
IMSI is a sperm selection method used in ICSI. The technique involves using a microscope to view sperm under very high magnification, over x6000, compared to standard ICSI which uses x200 and x400. This is a safe add-on that allows embryologists to view detailed images of sperm. Scientific reviews suggest that IMSI could be beneficial in specific situations such as previously failed ICSI attempts.
The HFEA says: "We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence."
Intrauterine culture
Intrauterine culture uses a device that allows the patient to carry their embryos in the uterus for several hours during early development before the embryos can be transferred or frozen. The theory is that the embryos will develop better in a more natural environment as opposed to an incubator in the laboratory. There are no known risks to the treatment.
The HFEA says: "We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence."
Physiological intracytoplasmic sperm injection (PICSI)
PICSI is a technique used to select sperm to use for ICSI treatment. It involves placing sperm with hyaluronic acid (HA), a natural compound found in the body. PICSI identifies sperm that can bind to HA and these sperm are selected to be injected. It is a non-invasive test used on sperm prior to ICSI and considered to be safe.
The HFEA says: "On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the treatment outcome."
Pre-implantation genetic testing for aneuploidy (PGT-A)
PGT-A involves checking embryos for abnormalities in the number of chromosomes. Embryos with an abnormal number of chromosomes have less chance of developing into a baby and carry an increased risk of miscarriage. PGT-A identifies embryos that are unsuitable for fertility treatment. Embryologists perform a biopsy on the embryos to remove cells that can be tested for any chromosomal abnormalities. In some cases, the cells may not yield a result, or have a mix of both normal and abnormal chromosomes. There is a small risk that the biopsy can cause damage to the embryo, but it is otherwise considered safe. Some studies show that it can reduce the risk of miscarriage in older patients.
The HFEA says: "There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness" for improving chances of having a baby.
The HFEA also says: "On balance, findings from high quality evidence shows this add-on is effective at improving the treatment outcome" for reducing the chances of miscarriage.
Time-lapse imaging
Time-lapse imaging is available through an incubator with a built-in camera that takes thousands of images of embryos while they’re growing. It allows for uninterrupted culture and it gives a continuous view of each embryo as it develops, rather than just viewing them once a day. Time-lapse incubation and imaging is safe and does not carry any additional risks to the embryos in culture or children born from them.
The HFEA says: "On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the treatment outcome."
Artificial egg activation
Artificial egg activation is a laboratory process where embryologists use a chemical called calcium ionophore in order to attempt to improve fertilisation rates. This method may be offered if there has been a previous cycle where fertilisation has failed with ICSI. There’s not enough information to show if the procedure carries a risk of abnormal embryo development.
The HFEA have removed artificial egg activation as it should only be used in specific circumstances.
Speak with your doctor
If you’ve been offered a treatment add-on or are considering one, please speak with your doctor about why it may be recommended and how it may improve your chances of having a baby.
References:
This information is accurate as of the publishing date but it’s important to note the HFEA reviews these add-ons annually and changes may occur. Please get in touch with us if you think the above information has changed.
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Intracytoplasmic sperm injection (ICSI)
Egg freezing