Add-on treatments ‘Add-ons’ or ‘Adjuvant therapies’ are names given to something extra that can be done at the same time as standard fertility treatment to try to increase the chance of success. Most have a reason why they might work but may be unproven or they are expensive for a small potential benefit. THE STATUS of add-ons can change quite quickly with new information. Our Medical Directors have divided add-ons into three groups - possible benefit, low benefit or unproven, and evidence of no benefit. The HFEA in the UK have their own view on many add-ons, at https://ifqlive.blob.core.windows. net/umbracowebsite/1356/fertility-treatment-add-ons.pdf
Reasonable evidence for a benefit, or low cost for a possible benefit Your doctor may raise these options with you. • Artificial Oocyte Activation (AOA) AOA can increase the fertilisation rate of eggs. It is limited to couples with no or low fertilisation in a previous ICSI cycle. • Endometrial receptivity Assay (ERA) ERA looks at 250 genes that are active in a sample of endometrial tissue at the time implantation is expected. If gene expression does not match what is expected, then the day of embryo transfer can be adjusted. There is some evidence this is useful for people who have not become pregnant after the transfer of 2 or 3 embryos. • Embryo Glue Embryo Glue is a natural substance called hyaluron which is added to the culture medium at embryo transfer. There is reasonable evidence that it increases pregnancy rates, so we do use it routinely at no extra cost. Embryo Glue is standard at Fertility
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Associates but is an add-on at some other clinics. • Intrauterine infusion of hCG The infusion of a small amount of the hormone hCG shortly before embryo transfer has been found to increase the chance of a live birth in several studies. The infusion seemed to be more effective for transfer of fresh embryos than thawed embryos. hCG may influence the level of growth factors in the uterus and the immune response of the uterus around the time of implantation. • Luteinising hormone activity (LH) IVF drugs reduce the amount of LH, so extra LH may improve the response to IVF drugs. There is some evidence that extra LH activity may increase the number of eggs in certain groups of patients. • Aneuploidy screening (PGT-A) in older women PGT-A checks the number of chromosomes in an embryo. Embryos with a normal number of chromosomes are more likely to implant and less likely to lead to miscarriage. The benefit shows up in women aged 38 or older. It is covered in detail in the section ‘Choosing the best embryo’. • Sperm Chromatin Structure Assay (SCSA) SCSA measures DNA damage in sperm. Sperm DNA damage in general is associated with lower embryo quality and lower pregnancy rates. A high SCSA result suggests the man should pay more attention to lifestyle and diet before trying IVF again.
