IVF add-ons

IVF add-ons: what they cost, and whether they work

Clinics offer optional extras on top of a standard IVF cycle, from genetic testing of embryos to an embryo glue. Here is what each one costs in the US, how often US clinics use it, and what the best evidence says it does for your chance of a baby.

Reference data · checked 11 h ago
0 of 16add-ons shown to raise birth odds
82.0%US transfers under 35 using ICSI

IVF add-ons are optional extras sold on top of a standard cycle, such as PGT-A genetic testing of embryos, ICSI, assisted hatching, embryo glue, endometrial scratching and the ERA test, costing from about $300 for embryo glue to $3,000–$6,000 for PGT-A. The UK fertility regulator, the HFEA, rates 16 add-ons, and none is rated as improving the chance of a baby for most patients: on its list, 5 red, 2 black, 6 grey and 3 amber. In the US they are routine anyway: in 2022, ICSI was used in 82.0% of embryo transfers for patients under 35, while male-factor infertility, the problem it was designed for, was a reason in 28.0% of cycles.

The useful question is not whether an add-on is offered but whether it fits your diagnosis: ICSI is proven for male-factor infertility, and PGT-A lowers the chance of a miscarriage even though it does not raise the chance of a baby. Each add-on below says who it may genuinely help.

At a glance

The add-ons US patients are most often offered

What each costs, how the UK fertility regulator rates it for the chance of a baby, and what the best trial or review found. Tap a name for the detail.

ICSI and PGT-A show the national range our cost calculator uses; the others span the prices US clinics publish on their own sites. Ratings are the HFEA's, for the chance of a baby for most patients.

US practice

In the US, ICSI and genetic testing are the norm

The CDC collects every IVF cycle performed in the US. Its latest national data, for 2022, shows how often embryo transfers used each technique, by the patient's age.

Share of US embryo transfers using ICSI, genetic testing and frozen embryos in 2022, by age
Patient ageUsed ICSIGenetic testingFrozen
Under 3582.0%53.6%86.8%
35-3779.8%63.8%88.8%
38-4077.6%65.6%87.9%
Over 4066.7%52.9%83.4%

Across 206,271 US embryo transfers in 2022, ICSI was used in 66.7% to 82.0% of transfers depending on age, and genetic testing of the embryo in 52.9% to 65.6%. Male-factor infertility, the problem ICSI was designed for, was listed as a reason in 28.0% of the 435,426 cycles.

The two figures count different things (transfers versus all cycles, and one cycle can list several reasons), so the gap is not an exact count of unneeded ICSI, and ASRM names a few non-male reasons it may help. But it is far wider than male-factor infertility alone explains. The CDC's genetic-testing figure counts any preimplantation testing, not only PGT-A. Most transfers now use frozen embryos, which matters for embryo glue below; see frozen embryo transfer for how fresh and frozen compare.

Source: CDC ART 2022 Patient and Cycle Characteristics (national). The CDC reports these per cycle, not per patient.

Add-on by add-on

What each one is, costs, and does

The rating, the best trial or review, the specialty-society position, who it may genuinely help, and the question to ask before you pay.

PGT-A (genetic testing of embryos)

Also called: Preimplantation genetic testing for aneuploidy, embryo screening, PGS

Red$3,000–$6,000

A few cells are taken from each embryo at the blastocyst stage and tested for the wrong number of chromosomes, so only embryos that test normal are transferred. The embryos are frozen while the results come back.

HFEA rating
Rated red for improving the chance of a baby for most patients, because it is a selection tool that often reduces the number of embryos available to transfer. Rated green for reducing the chance of miscarriage.HFEA
What the evidence shows
In the largest randomized trial, 1,212 women aged 20 to 37 with at least three good-quality blastocysts, the cumulative live-birth rate was 77.2% with PGT-A and 81.8% with conventional IVF. Pregnancy loss was 8.7% with PGT-A and 12.6% without it.Yan et al., Live birth with or without preimplantation genetic testing for aneuploidy (N Engl J Med, 2021)
Specialty societies
ASRM and SART: the value of PGT-A as a routine screening test for all patients undergoing IVF has not been demonstrated. ESHRE does not recommend it for routine clinical use.ASRM and SART Practice Committees, The use of preimplantation genetic testing for aneuploidy (Fertility and Sterility, 2024)ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
HFEA rates it green for lowering the chance of a miscarriage, so a patient whose priority is avoiding another loss may weigh it differently. It does not raise the overall chance of a baby from a cycle. It is also not the same test as PGT-M, which checks embryos for a specific inherited condition a parent carries and has a clear medical purpose.
Cost. Typically $3,000 to $6,000 per cycle, the national range our cost calculator uses (ovu). Clinics' own published prices: Onto Health (Illinois, Colorado) $4,500 (testing for up to 6 embryos; more embryos cost more); Pacific Northwest Fertility $3,625–$5,000 (PGT-A testing); Assisted Fertility Program (Florida) $3,000 (embryo genetic testing, self-pay add-on); Virginia Fertility & IVF $2,750 (the biopsy only; the outside lab adds $195 per embryo plus shipping). Used in 52.9% to 65.6% of US embryo transfers in 2022.
Ask your clinic: What will PGT-A cost for the number of embryos I am likely to have, and what are my chances of ending up with no embryo to transfer?
where genetic testing fits in a cycle →

ICSI (sperm injection)

Also called: Intracytoplasmic sperm injection

Core treatment$1,000–$2,500

Instead of letting sperm fertilize the eggs in a dish, an embryologist injects a single sperm directly into each egg. It was developed for male-factor infertility, where sperm cannot fertilize an egg on their own.

HFEA rating
Not on the HFEA add-on list, because it is a core treatment for male-factor infertility. HFEA states there is currently no scientific evidence to support using ICSI when infertility is not related to the sperm.HFEA
What the evidence shows
In a randomized trial of 1,064 couples whose male partner had a normal sperm count and motility, live birth after the first transfer was 35% with ICSI and 31% with conventional IVF, a difference that was not statistically significant.Dang et al., ICSI versus conventional IVF when sperm count and motility are normal (Lancet, 2021)
Specialty societies
ASRM and SART (2026): routine use of ICSI for nonmale factor infertility is not recommended, including for unexplained infertility, low egg numbers, diminished ovarian reserve, older maternal age, or PGT-A. ESHRE also does not recommend it for non-male factor infertility.ASRM and SART Practice Committees, ICSI for nonmale factor indications (Fertility and Sterility, 2026)ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
Male-factor infertility, the problem it was designed for. ASRM says it may also benefit select patients without male factor: those having PGT-M, those with poor or no fertilization in an earlier conventional cycle, and those using previously frozen eggs.
Cost. Typically $1,000 to $2,500 per cycle, the national range our cost calculator uses (Center for Reproduction). Clinics' own published prices: Onto Health $800–$1,000 (self-pay add-on; $800 in Colorado, $1,000 in Illinois); Assisted Fertility Program (Florida) $800 (self-pay add-on). Used in 66.7% to 82.0% of US embryo transfers in 2022.
Ask your clinic: Is ICSI recommended because of my partner's semen analysis, or is it your default for every cycle, and what does it add to my bill?
how fertilization works in a cycle →

Assisted hatching

Also called: Laser hatching, AH

Grey$700–$1,100

Before transfer, a laser or chemical is used to thin or open a small gap in the embryo's outer shell (the zona pellucida), on the theory that it helps the embryo hatch and implant.

HFEA rating
Rated grey: there is not enough good-quality evidence to rate it, and HFEA notes there is no high-quality evidence to support its use for any patient.HFEA
What the evidence shows
The Cochrane review of 14 randomized trials (2,849 women) is uncertain whether assisted hatching improves live birth, based on low-quality evidence, and found it may slightly increase multiple pregnancies.Lacey et al., Assisted hatching on assisted conception (Cochrane review, 2021)
Specialty societies
ASRM (2022): moderate evidence that assisted hatching does not significantly improve live-birth rates in fresh cycles, and laser hatching should not be routinely recommended for all patients undergoing IVF. ESHRE does not recommend it.ASRM Practice Committee, The role of assisted hatching in IVF: a guideline (Fertility and Sterility, 2022)ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
No group has good evidence of benefit. ASRM finds insufficient evidence for it even in patients with a poor prognosis or those having a frozen embryo transfer.
Cost. Published US prices we found: Assisted Fertility Program (Florida) $700 (self-pay add-on); Specialists in Reproductive Medicine & Surgery (Florida) $880–$1,100 (frozen-transfer add-on on its 2026 self-pay price list; $880 with a limited-time 20% discount). Some clinics include it at no extra charge, for example CNY Fertility.
Ask your clinic: Do you add assisted hatching to every transfer, and is it billed as a separate line item?

Embryo glue

Also called: Hyaluronan-enriched transfer medium, EmbryoGlue

Amber$300–$400

The embryo is placed in a transfer medium rich in hyaluronan, a substance found naturally in the uterus, for a short time before and during the transfer, intended to help it attach to the lining.

HFEA rating
Rated amber: on balance it is not clear whether it improves the outcome, because good-quality studies conflict.HFEA
What the evidence shows
The Cochrane review found moderate-quality evidence that it probably increases live birth: if 33% of patients would have a baby without it, 37% to 44% would with it. Multiple pregnancies also rose, which the authors link to transferring more than one embryo at a time.Heymann et al., Hyaluronic acid in embryo transfer media (Cochrane review, 2020)
Specialty societies
ESHRE, the European society, recommends it and advises monitoring the multiple-pregnancy rate, but notes the benefit was seen after fresh transfers, with no effect after frozen transfers. ASRM has no position on it.ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
Of the common add-ons, the only one with moderate-quality evidence of benefit, seen after fresh transfers. ESHRE found no effect after frozen transfers, and frozen embryos were used in 83.4% to 88.8% of US transfers in 2022, so for a frozen transfer the evidence gives no reason to pay for it.
Cost. Published US prices we found: Onto Health $300–$400 (self-pay add-on; $300 in Colorado, $400 in Illinois). Some clinics include it at no extra charge, for example CNY Fertility (fresh transfers).
Ask your clinic: Will my transfer be fresh or frozen, and do you charge separately for the transfer medium?

Endometrial scratching

Also called: Endometrial scratch, endometrial injury, pipelle biopsy

AmberNot published

In the cycle before IVF, a thin tube is passed through the cervix to lightly scrape the uterine lining, on the theory that the healing response makes the lining more receptive.

HFEA rating
Rated amber for IVF and ICSI patients: on balance it is not clear whether it improves the chance of a baby. HFEA says the rating does not apply to IUI.HFEA
What the evidence shows
In the largest randomized trial, 1,364 women having IVF, the live-birth rate was 26.1% in both groups: 180 of 690 women who had the scratch and 176 of 674 who did not.Lensen et al., A randomized trial of endometrial scratching before IVF (N Engl J Med, 2019)
Specialty societies
ESHRE: endometrial scratching is currently not recommended for routine clinical use.ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
No group has shown a clear benefit in large trials. It is an extra procedure with its own discomfort, done in the cycle before treatment.
Cost. No US clinic we checked publishes a price for it, so ask for one in writing.
Ask your clinic: Which trial makes you recommend a scratch for someone with my history, and what does the extra visit cost?

Endometrial receptivity testing (ERA)

Also called: Endometrial Receptivity Analysis or Array, receptivity test

RedNot published

A biopsy of the uterine lining, taken in a mock cycle, is analyzed to predict a personal best day for the embryo transfer, which is then timed to match. It needs an extra cycle of medication and monitoring before the real transfer.

HFEA rating
Rated red: moderate or high quality evidence shows it may reduce treatment effectiveness for most patients.HFEA
What the evidence shows
In a double-blind randomized trial of 767 patients whose genetically tested embryos were transferred frozen, live birth was 58.5% when the transfer was timed by receptivity testing and 61.9% with standard timing, no significant difference. The authors concluded the findings do not support routine use.Doyle et al., Endometrial receptivity testing vs standard timing of frozen embryo transfer (JAMA, 2022)
Specialty societies
ESHRE: the presently available endometrial receptivity tests are not recommended.ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
No group has shown a benefit in randomized evidence. The main trial excluded patients with recurrent implantation failure or recurrent pregnancy loss, so it does not settle the question for them, but ESHRE does not recommend the currently available tests for anyone. It also adds a mock cycle, a biopsy and a lab fee.
Cost. No US clinic we checked publishes a price for it, so ask for one in writing. The mock cycle it requires is itself priced: Onto Health lists a mock cycle at $2,000 in Colorado and $2,250 in Illinois, before any biopsy or lab fee.
Ask your clinic: Does the price include the mock cycle, the biopsy and the lab fee, and what evidence do you have that it improves live birth for someone like me?

Time-lapse embryo imaging

Also called: EmbryoScope, time-lapse incubator, AI embryo selection

BlackNot published

Embryos grow in an incubator with a built-in camera that photographs them every few minutes, so they can be assessed without being taken out, sometimes with software that scores which embryo to transfer.

HFEA rating
Rated black: good-quality evidence shows it has no effect on the chance of a baby, whether embryos are assessed by an algorithm or by an embryologist.HFEA
What the evidence shows
In the TILT trial, a large double-blind randomized trial, live birth was 33.7% with time-lapse imaging and embryo selection, 36.6% with undisturbed culture, and 33.0% with standard care, with no significant difference.Bhide et al., The TILT trial of time-lapse imaging systems (Lancet, 2024)
Specialty societies
ESHRE: time-lapse imaging is not recommended as a tool to improve live-birth rates.ESHRE, Good practice recommendations on add-ons in reproductive medicine (Human Reproduction, 2023)
Who it may help
None shown for the chance of a baby.
Cost. No US clinic we checked publishes a price for it, so ask for one in writing. Some clinics include it at no extra charge, for example Labryo Fertility Center (California).
Ask your clinic: Is time-lapse imaging charged as an extra, or is it simply the incubator your lab uses for everyone?
The full list

All 16 add-ons the HFEA rates

The UK fertility regulator grades the published worldwide research on each add-on for the outcome that matters most, the chance of a baby for most patients. Worst-rated first.

RedMay lower success, or safety concerns

“There are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness.”

BlackShown to make no difference

“On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the treatment outcome.”

GreyNot enough good evidence to rate

“We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence.”

AmberUnclear: good studies conflict

“On balance, it is not clear whether this add-on is effective at improving the treatment outcome. This is because there is conflicting moderate/high quality evidence.”

GreenShown to work

“On balance, findings from high quality evidence shows this add-on is effective at improving the treatment outcome.”

The HFEA is the UK's fertility regulator. Its ratings grade the published worldwide research, which is why they bear on a treatment decision in the US as well; ratings are set by its scientific advisory committee and reviewed when new evidence appears, or at least every five years. In its own words: “For all the treatment add-ons the HFEA has reviewed, none indicate they increase the chances of having a baby for most fertility patients.” Sources: HFEA, Treatment add-ons with limited evidence (last reviewed 18 September 2026); HFEA statement on a new study into fertility treatment add-ons (24 June 2026).

Before you pay

Four questions to ask about any add-on

An add-on is a purchase decision as much as a medical one. These questions separate the two.

“If you are paying for your own treatment, you may want to think about whether it might be better to pay for multiple cycles of IVF or IUI, rather than spending large sums of money on a single treatment cycle with treatment add-ons that haven't been proven to be effective.”
  1. What is the evidence that it raises the chance of a live birth, not just a pregnancy or a better-looking embryo, for someone with my diagnosis?
  2. What will it cost in total, including per-embryo fees, extra monitoring and any extra cycle it requires?
  3. Does it reduce the number of embryos I can transfer, or add a cycle before the transfer?
  4. Would the same money pay for another full cycle, which the HFEA suggests may be the better use of it?

If cost is the deciding factor, see how people pay for IVF and price your own plan with and without each add-on.

Questions

Common questions about IVF add-ons

What are IVF add-ons?

IVF add-ons are optional extra tests, techniques or treatments offered on top of a standard IVF cycle, such as PGT-A genetic testing of embryos, ICSI, assisted hatching, embryo glue, endometrial scratching, the ERA receptivity test and time-lapse embryo imaging. They are usually billed separately, from about $300 for embryo glue to $3,000 to $6,000 for PGT-A, and most have not been shown to raise the chance of having a baby for most patients.

Are IVF add-ons worth it?

For most patients, the evidence says no. The UK fertility regulator, the HFEA, rates 16 add-ons, and none is rated as improving the chance of a baby for most patients: on its list, 5 red, 2 black, 6 grey and 3 amber. Some add-ons do have a real use for specific patients, such as ICSI for male-factor infertility or PGT-A for lowering the chance of a miscarriage, so the useful question is whether one fits your diagnosis, not whether a clinic offers it.

Is PGT-A testing worth it?

It depends on what you want it to do. The HFEA rates PGT-A red for improving the chance of a baby for most patients, because it often leaves fewer embryos to transfer, but green for reducing miscarriage. In the largest randomized trial, the cumulative live-birth rate was 77.2% with PGT-A and 81.8% without it, while pregnancy loss was 8.7% versus 12.6%. It typically costs $3,000 to $6,000 per cycle, and more when the lab charges per embryo. Genetic testing was used in 52.9% to 65.6% of US embryo transfers in 2022.

Do I need ICSI if there is no male-factor infertility?

Usually not. ASRM's 2026 committee opinion says routine ICSI for non-male-factor infertility is not recommended, including for unexplained infertility, low egg numbers, older maternal age or PGT-A, and in a randomized trial of couples with normal sperm counts, live birth was 35% with ICSI and 31% with conventional IVF, not a significant difference. Yet in the US it is close to the default. In 2022, ICSI was used in 82.0% of US embryo transfers for patients under 35, and in 66.7% to 82.0% across all age groups, according to CDC data. Male-factor infertility was a reason in 28.0% of cycles. ICSI typically adds $1,000 to $2,500 to a cycle.

Does the ERA test improve IVF success?

Not on current evidence. The HFEA rates endometrial receptivity testing red because the evidence shows it may reduce treatment effectiveness, and in a double-blind randomized trial live birth was 58.5% with receptivity-timed transfer and 61.9% with standard timing. ESHRE does not recommend the currently available tests. It also needs an extra mock cycle and a biopsy, and no US clinic we checked publishes its fee.

Does embryo glue work?

It is the one common add-on with moderate-quality evidence of benefit. A Cochrane review found it probably raises live birth, from 33% to between 37% and 44% in its example, but the benefit was seen after fresh transfers: ESHRE found no effect after frozen transfers, which were 83.4% to 88.8% of US transfers in 2022. Multiple pregnancies also rose, which the authors link to transferring more than one embryo. The HFEA rates it amber because good studies conflict. Onto Health lists it at $300 to $400.

Next

Put the add-ons in the whole bill

What IVF costs, line by line

The base cycle, medications, freezing and transfers, itemized and cited, plus clinic-published prices.

IVF cost calculator

Switch ICSI and PGT-A on and off and see what they do to the all-in cost across your cycles.

The IVF process, step by step

Where each add-on happens in a cycle, and how long every stage takes.

Informational only, not medical advice. Ratings are the HFEA's, for the chance of a baby for most patients; your own diagnosis can change what is worth doing, so discuss any add-on with your doctor. US usage figures are the CDC's national data for 2022; prices are national ranges or clinics' own published prices, and your clinic's quote is what you will pay. Every figure links to its source. Last checked 2026-09-24.