IVF Add-Ons Decoded: Assisted Hatching, Embryo Glue, and Endometrial Scratch, and Whether They Work
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The moment a patient becomes most willing to try anything is usually right after a cycle has failed. That is also, not coincidentally, the moment when a menu of optional extras tends to come up in the conversation, each one promising to improve the odds next time, most of them carrying an additional cost. Some of these add-ons have decent evidence behind them. The majority sit somewhere on the spectrum between unproven and actively disproven, and the difference between the two is worth understanding before any money changes hands.
A useful reference point exists for exactly this. The UK fertility regulator runs a public rating system for IVF add-ons, scoring each one by the strength of the evidence that it actually improves the chance of a baby. Most common add-ons sit at the cautious end of that scale, and the body maintaining it has no commercial stake in whether clinics sell these treatments, which makes it a more reliable guide than a clinic's own price list.
The reasoning behind endometrial scratching is that deliberately causing a small injury to the uterine lining in the cycle before a transfer triggers a repair response that leaves the endometrium more receptive when the embryo arrives. It became popular for a while, helped along by early small studies suggesting benefit and by the fact that it is cheap and quick to perform.
A large international trial published in 2019 involving more than a thousand women found no meaningful difference in live birth rates between those who had scratching and those who did not. Because of the scale and quality of that evidence, routine use has largely fallen out of favour. It is also uncomfortable and carries minor risk, further weakening the case for standard use.
EmbryoGlue is a culture medium containing a high concentration of hyaluronan, a substance naturally present in the uterus around implantation. The embryo is placed in this medium just before transfer with the aim of improving its ability to adhere to the endometrium.
This is one of the better-supported IVF add-ons. A Cochrane review suggests that hyaluronan-enriched transfer media probably improves clinical pregnancy and live birth rates. The benefit is modest and the evidence certainty is moderate rather than high, but the intervention is low cost and low risk, which strengthens its practical appeal compared to more invasive add-ons.
Assisted hatching involves thinning or breaching the outer shell of the embryo (zona pellucida) before transfer to help implantation. The idea is that some embryos may struggle to hatch naturally.
The evidence remains inconsistent. Some studies show small improvements in pregnancy rates in specific groups such as older patients or those with repeated implantation failure, but this does not reliably translate into higher live birth rates. There is also a theoretical concern about an increased risk of identical twinning.
The key distinction is between pregnancy rates and live birth rates. A treatment that improves early pregnancy outcomes is not necessarily improving the number of babies born.
A clinic should be able to justify any add-on with reference to your profile, not just general marketing claims.
If you are planning IVF and want a clear breakdown of which parts of your protocol are evidence-based and which are optional add-ons, book a consultation with MMC IVF to review your treatment plan.
Schedule a consultation with our expert team at MMC IVF. We are here to provide personalized care and support.
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