IVF add-ons: the 101

Now, with the HFEA about to change its 3-tier ‘traffic light’ system to five tiers, and review the evidence it considers, it’s a good time to revisit these treatments. We caught up with Professor Scott Nelson, Medical Director at Access Fertility, Muirhead Professor of Obstetrics & Gynaecology at the University of Glasgow and a consultant for NHS Greater Glasgow and Clyde to get the lowdown.

While the HFEA may be making changes to their IVF add-on traffic light system, the definition is staying the same. Essentially an IVF add-on is an additional treatment or service that is designed to improve live birth rates for all women. To be an ‘add-on’, it has to be a treatment that is not part of routine treatment. With the new 5-tier system, they’re not expecting many treatments to actually be ‘green’, because if it could be very commonly used and improve outcomes for the majority of women with few risks, then it would become part of standard treatment and no longer be classed as an “add-on”

Generally speaking, IVF add-ons carry an additional charge on top of your routine IVF cycle. Some clinics may include certain treatments ‘as standard’, while others won’t.

The first thing to point out is that for most patients coming to IVF for the first time, the most appropriate course of action is to do a routine IVF cycle, without any add-ons. Doing so in a good clinic (see Access Fertility’s partner clinics), is the best first step, and in many cases, that cycle will be effective. If sadly it isn’t, the information you’ll get from that cycle will help you plan your next move.

The same is true of some very in-depth testing, such as DNA fragmentation for guys concerned about their fertility due to having a low sperm count. It’s an add-on you’d pay more for, but actually the treatment you’d likely receive (ISCI) is what you likely would have received anyway. All of the lifestyle changes that would be recommended would be the same for anyone with male factor infertility. So you’ve paid for something you might not have needed and may not change your tretament.

That’s the issue with the ‘traffic light’ system. It’s a useful tool for ‘the average patient’, but few people actually fit that category. Many of the treatments on that list may actually be highly beneficial to a patient who meets a certain criteria or want to reduce the risk of a specific complication e.g. older women who want to reduce the risk of miscarriage or the risk of an affected child by undertaking PGT-A.

The key is to discuss your treatment with your fertility consultant – they are in the best position to advise you on what is the best course of action for your specific needs.

• Write down the questions you want to be covered in advance and bring them to your appointment. If you have a lot of questions, consider mentioning this when you book, in case you need more time than usual (note that you may need to pay for a longer consultation).
• Ask questions at every opportunity. All doctors should be asking if you have any questions, and if they don’t, you should ask them anyway. If it’s towards the end of your consultation and you’re out of time, they should offer a follow-up appointment or an email conversation (again, note that this might incur a charge).
• Don’t be shy – most people think they’re asking their doctor a question no one has asked before, when in fact he or she has probably been asked several times that very day. This is especially so when there’s been a big story in the press. Ask whatever is on your mind – it’s important you feel informed and reassured.

Any patient is welcome to seek a second opinion, and I would always strongly recommend that patients are well-informed about the treatment they’re undergoing.

If you’re looking for a second opinion, there are plenty of internationally-renowned consultants across the UK who can help you. You need only look up their clinics and contact them to request a meeting, a call or even an email. Again, just be aware they are likely to charge for that consultation / second opinion and the preparation time particularly if your case is complex. The analogy I would use is think what would happen if you approached a lawyer with a stack of documents for some advice.

Otherwise, for more general advice, the professional bodies such as ASRM, the British Fertility Society and ESHRE have a wealth of information and research, which is likely the same information that your care team is reading. Similarly Pubmed is a national library of medicine that you can search and filter on the topic you’re interested in. They always have a summary in the abstract that covers the main findings. Again, that’s likely the information your consultant will have seen.

For a more accessible source of information, explained in a way that’s easier to digest, websites like IVF Babble and their social platforms are really useful. Of course the HFEA themselves have a great website, with clear information on there. Just be wary that the section on IVF add-ons is going to change very soon, and you really do need to take that information with a pinch of salt because it’s very general, not specific to your needs.

All I’d caution is to be very careful with unmoderated online patient forums. These are fantastic for emotional support from other patients, but it’s unlikely there will be someone with the knowledge to interpret the medical evidence for your clinical question.

It depends on the clinic you’re with. For example some clinics class time lapse and use of the embryoscope as an add on and not part of routine cycle. For others, it’s part of the standard cost and would be covered by Access Fertility. So it very much depends who you’re with. Meanwhile PGT-A, which is considered an ‘add on’ because it’s only really appropriate for certain patients (see Access Fertility’s article on PGT-A), is compatible with our programmes, even though there will usually be an additional cost for the service.

The best course of action is to have a chat with our patient advisors once you’ve spoken to your consultant about the right treatment for you. They can talk you through the options that are right for you and your specific needs.