IVF add-ons: evidence and the HFEA traffic-light system; fertility preservation in cancer, social egg freezing, and ovarian transposition

It is Tuesday morning, and you have two patients in the corridor. The first is a 30-year-old nullipara with a new diagnosis of breast cancer needing chemotherapy in 3 weeks; she has 8 oocytes the oncologist wants to keep. The second is a 36-year-old solicitor who wants to "freeze her eggs" because she is single and her career is taking off; she has read about PGT-A and embryo glue and asks why you do not recommend them. The single most important hour in your day is the next one — one patient needs urgent preservation, the other needs honest evidence-based counselling against an industry that is selling unproven adjuncts as if they were guarantees. Both deserve the consultant's voice: the first a rapid, multidisciplinary, structured plan; the second a careful, time-stamped, evidence-anchored refusal to sell false hope.^[1][4][16]

Overview and definition

An IVF add-on is any procedure, technique, or drug offered to an IVF patient in addition to the standard protocol that is intended to improve outcomes (pregnancy, live birth, miscarriage reduction) but is not part of the standard IVF cycle. The HFEA in the UK maintains a public traffic-light league table that classifies add-ons by evidence base — green (robust RCT evidence), amber (some evidence, conflicting or insufficient), red (no evidence of effectiveness or evidence of harm). Add-ons span three categories: laboratory (assisted hatching, time-lapse imaging, embryo glue, PGT-A), procedure (endometrial scratching, endometrial receptivity analysis, intrauterine platelet-rich plasma), and drug (growth hormone, testosterone, DHEA, sildenafil).^[2][10][17]

Fertility preservation is the umbrella of interventions offered to patients whose fertility is at risk from medical treatment (chemotherapy, radiotherapy, surgery) or from advancing age (social egg freezing). The three core strategies are oocyte cryopreservation (mature oocyte vitrification), embryo cryopreservation (fertilised oocyte), and ovarian tissue cryopreservation (laparoscopic cortical biopsy with later reimplantation). The aim is to preserve the option of future genetic motherhood for the patient or, in the case of prepubertal girls, for the option of restored ovarian endocrine function and possibly fertility later in life.^[4][15][16]

^{[1] [2] [5] [11] [17]}

References18ShowHide

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