If you’ve gone through IVF or you’re just starting out, you’ve probably heard about “add-ons.” EmbryoGlue. Endometrial scratching. Acupuncture. PGT-A. PRP. The list keeps growing, and so does the price tag attached to it.

Here’s the question nobody quite asks out loud at the clinic: does any of this actually work?

A major new study published in The Lancet Obstetrics, Gynecology & Women’s Health in June 2026 tried to answer exactly that. Researchers reviewed every trustworthy randomized trial they could find on ten of the most common IVF add-ons, and the findings are worth understanding before you say yes to anything extra on your treatment plan. The ten most common add-ons they reviewed were:

1. Acupuncture
A complementary therapy involving the insertion of thin needles into specific points on the body. In the context of IVF, acupuncture has been proposed to increase blood flow to the reproductive organs, regulate fertility hormones, and reduce stress, with the goal of improving the chances of conception. Current evidence does not show a clear benefit for live birth rates.

2. Corticosteroids
   Anti-inflammatory medications, such as prednisolone and dexamethasone, are used in some IVF protocols to suppress immune system activity around the time of embryo transfer. The theory is that some patients with repeated implantation failure or recurrent miscarriage may have elevated immune cell activity that interferes with implantation. Current evidence shows little to no effect on live birth rates.
3. EmbryoGlue
   A specialized embryo transfer medium containing hyaluronic acid, a substance naturally found in the reproductive tract believed to support embryo implantation. EmbryoGlue is used during embryo transfer to help the embryo adhere to the uterine lining. Evidence for its effect on live birth rates is weak and inconsistent across study types.
4. Endometrial Receptivity Testing
   A diagnostic test, such as the Endometrial Receptivity Array (ERA), involves a biopsy of the uterine lining to assess gene expression patterns thought to indicate whether the endometrium is receptive to an embryo. Results may be used to recommend earlier or later embryo transfer timing than the standard protocol. Current evidence shows little to no effect on live birth rates.
5. Endometrial Scratching
   A minor procedure in which the lining of the uterus is deliberately scratched or disturbed prior to an IVF cycle. The resulting inflammatory and healing response is theorized to improve endometrial receptivity to an embryo. Of common IVF add-ons, this has shown the most consistent evidence of a modest benefit to live birth rates.
6. Intralipid Infusion
   An intravenous infusion containing fats (such as soybean oil and egg yolk), proposed to reduce the activity of natural killer cells and other immune cells in the endometrium in patients experiencing repeated implantation failure or recurrent miscarriage. Evidence supporting its effectiveness is very limited and of low certainty.
7. PICSI (Physiological Intracytoplasmic Sperm Injection)
   A sperm selection technique used during ICSI in which sperm are chosen based on their ability to bind to hyaluronic acid, a quality thought to indicate sperm maturity and fertilization potential. Evidence suggests PICSI may reduce the risk of miscarriage, though its effect on live birth rates remains unclear.
8. Platelet-Rich Plasma (PRP) — Intraovarian Injection
   A procedure in which platelet-rich plasma, derived from the patient’s own blood and containing a higher concentration of platelets than normal blood, is injected directly into the ovaries. It is proposed to improve blood flow to the ovary and support egg quality, primarily in patients with diminished ovarian reserve. Evidence remains very limited and inconclusive.
9. Platelet-Rich Plasma (PRP) — Intrauterine Infusion
   A procedure in which platelet-rich plasma is infused into the uterus, providing additional cytokines and growth factors theorized to improve the endometrial environment before embryo transfer. Most commonly used for patients with repeated implantation failure. Evidence remains very limited and inconclusive.
10. Preimplantation Genetic Testing for Aneuploidy (PGT-A)
    A screening test performed on embryos before transfer to check for the expected number of chromosomes. Only embryos identified as chromosomally normal (euploid) are selected for transfer. While PGT-A may reduce miscarriage risk for a single embryo transfer, its effect on cumulative live birth rates across an entire IVF cycle remains uncertain, as some embryos identified as abnormal and discarded may have had the potential to result in a healthy pregnancy.

We’re going to walk you through what they found in plain language and explain why this matters just as much for your bank account as it does for your chances of having a baby.

The Big Picture First

Out of ten common add-ons studied, researchers found:

• Three showed some possible benefit, though the strength of that evidence varies a lot between them
• Four showed no clear benefit at all
• Three simply haven’t been studied well enough yet to know one way or the other

That’s a sobering ratio. Most of what’s being offered to IVF patients today, including things you may have already paid for, lacks strong evidence.

Add-On by Add-On: What We Actually Know

Endometrial Scratching — The Strongest Signal of the Group

Of everything studied, this had the best evidence. Across 19 trials and over 6,300 patients, scratching showed a modest increase in the chance of live birth. Not dramatic, but real, and backed by good-quality research.

Bottom line: If your clinic offers this and the cost is reasonable, it’s one of the more evidence-backed choices on this list.

EmbryoGlue — A Weaker “Maybe”

Here’s where it gets nuanced. When researchers used a more careful, conservative analytical method, EmbryoGlue showed no effect on live birth. It only showed a possible benefit using a less rigorous method. In plain terms, the strongest evidence says this probably doesn’t move the needle on whether you take home a baby, even though some studies hint that it might.

Bottom line: Don’t assume this is a “must-have.” If your clinic charges extra for it, you’re paying for a maybe that leans toward “probably not” under the most careful analysis.

PICSI — Helps with Miscarriage, Not Necessarily Live Birth

This is an important one to understand correctly. PICSI did not show a clear effect on your chances of live birth. What it did show, in a large, well-designed trial, is a real reduction in miscarriage risk.

That’s a meaningful distinction. This isn’t “PICSI helps you get pregnant.” It’s “PICSI may help you stay pregnant once you are.” If you’ve experienced pregnancy loss before, that nuance might matter a great deal to you. If you haven’t, it may matter less.

Bottom line: Worth a conversation with your doctor specifically if miscarriage, not just achieving pregnancy, is your bigger concern.

PGT-A — The Most Complicated One on This List

Here is the single most important thing for you to understand about PGT-A, and it’s something most patients are never told clearly: when researchers looked only at your first embryo transfer, PGT-A appeared to reduce miscarriage risk but made no real difference to your chance of a live birth.

But when they looked at your entire IVF cycle, including every embryo you started with, the picture became much less certain. Here’s why this matters so much: PGT-A results in discarding embryos labeled as abnormal. It’s biologically possible — though the evidence suggests this happens in only a small percentage of cases — that some of those discarded embryos could have gone on to become a healthy baby; testing isn’t perfect. So it’s possible that PGT-A makes your first transfer look more successful while actually reducing your overall chances across the entire batch of embryos you produced.

Think about it this way: if you started with five embryos and PGT-A says only two are “normal,” you transfer those two. But what if testing was wrong about one of the other three? You’ll never know, because that embryo was never given a chance. Your one successful transfer might look great on paper while your true odds, accounting for everyone you started with, may not have actually improved.

Bottom line: PGT-A is one of the more expensive add-ons on the market, and the science genuinely does not yet support the idea that it improves your overall odds of a baby. This is a conversation to have carefully with your doctor, especially if you’re not in a high-risk category for chromosomal abnormalities.

Corticosteroids, Endometrial Receptivity Testing — No Clear Benefit

These two showed essentially no effect on live birth, pregnancy, or miscarriage in the available research. If a clinic recommends either of these, it’s worth asking directly what evidence supports it for your specific situation, since the general population data doesn’t show a clear benefit.

Acupuncture, Intralipid Infusion, PRP (Ovary and Uterus) — We Just Don’t Know Yet

These four add-ons aren’t necessarily ineffective. They simply haven’t been studied well enough yet for anyone to say with confidence whether they help, hurt, or do nothing.

Acupuncture is a good example of why this matters. Across ten trials, there was no clear effect on live birth. But here’s an interesting wrinkle: studies that used a fake (sham) acupuncture control group showed no benefit at all, while studies with no control group showed a slight trend toward benefit. That pattern is a classic sign of a placebo effect, not a real physical mechanism. It doesn’t mean acupuncture can’t help you feel calmer or less stressed during a difficult process. It does mean there isn’t good evidence that it improves your odds of having a baby.

Bottom line: Although the evidence doesn’t show these add-ons improve live birth rates, many patients report feeling calmer, more relaxed, and better able to cope with the emotional weight of IVF — and that benefit shouldn’t be dismissed just because it doesn’t show up in pregnancy statistics. If you’re choosing acupuncture, intralipid infusion, or PRP for stress relief and general well-being rather than to improve your odds of success, that’s a perfectly reasonable reason to pursue them. Just don’t expect strong proof that they’ll change your IVF outcome, and factor that into how much you’re willing to spend.

Why This Matters for Your Wallet, Not Just Your Hope

IVF is already one of the most expensive medical journeys a person can go through. Add-ons can pile thousands of dollars onto an already overwhelming bill, and clinics offer them at the exact moment you are most hopeful, most anxious, and most likely to say yes to anything that might help.

That’s not a criticism of patients. It’s simply human nature, and it’s exactly why having clear, honest information matters so much before you’re sitting in that exam room being asked to decide in the moment.

IVF is both financially costly and emotionally draining, and both deserve equal recognition. Patients are often willing to say yes to add-ons because they understandably want to do everything possible to increase their chances of success. However, as this article explains, the evidence supporting many of these add-ons remains uncertain, and more high-quality research is needed. While INCIID can’t solve the uncertainty surrounding the science, we can help patients make more informed financial decisions. That’s exactly why we’re building our IVF Cost Registry and Cost Checklist resources — to provide transparency around what these add-ons actually cost, so you can weigh both the evidence and the expense before making a decision that fits both your hopes and your budget.

When you’re deciding whether to spend an extra $500, $1,000, or more on an add-on, you deserve to know two things: what the evidence says about whether it works, and what a reasonable price for it actually looks like. Our cost tools are built to answer the second question. This article is our attempt to answer the first.

The One Question Worth Asking at Every Add-On Conversation

Before you agree to any add-on, ask your clinic this simple question:

“How strong is the evidence that this will improve my actual chances of taking home a baby?”

Not “is this available.” Not “Do other patients do this?” Specifically, how strong is the evidence? A good clinic should be able to answer honestly, even if the honest answer is “we don’t fully know yet.”

Hope is one of the most important things you carry through IVF. But informed consent means understanding not just what a treatment promises, but also how much real evidence supports that promise. You deserve both: hope and the truth about what the research actually shows.

This article is based on findings published in: Lensen S et al. Safety and effectiveness of ten common IVF add-ons: a systematic review and meta-analysis. The Lancet Obstetrics, Gynecology & Women’s Health. June 2026.

For cost information on IVF treatments and add-ons across clinics nationwide, visit INCIID’s IVF Cost Registry (inciid.org/ivf-cost-registry/) and IVF Cost Checklist (inciid.org/ivf-cost-checklist/).

This article is for educational purposes only and is not a substitute for personalized medical advice from your fertility doctor.