![]() These interventions make up a small selection of the complete list of currently available add-ons, many of which are similarly rife with controversy. The procedures included in this review are time-lapse imaging of embryos, assisted hatching, EmbryoGlue, sperm DNA testing, egg activation with calcium ionophore, endometrial receptivity array, and physiological intracytoplasmic sperm injection (PICSI). Here we aim to provide an overview of the evidence, costs, and potential risks associated with several common IVF add-ons, and discuss future directions for managing add-ons in our field. These technologies have varying levels of evidence for their validity, and many providers disagree about the utility of offering them given that they often come at increased personal financial cost to the patient. While the basic steps of the IVF process are typically rather uniform, there are many “add-on” technologies that providers may offer to supplement standard practice in an effort to improve the odds of a cycle’s success. Patients who are undergoing IVF are highly motivated to achieve a successful pregnancy, and new technologies are constantly developed with the intent to improve treatment outcomes. ![]() Since its inception in the 1970s, in vitro fertilization (IVF) as a treatment for infertility has progressed from its earliest great achievement, the birth of Louise Brown, to a rapidly evolving field responsible for over 2.5 million IVF cycles globally each year. In the future, add-ons that show clear evidence of efficacy and justifiable cost should be incorporated into routine practice, while others that do not meet these criteria should be phased out entirely. We propose that all add-on procedures should provide true efficacy for the patient, and reproductive endocrinologists should inform patients of the costs and benefits of utilizing various technologies before they undergo treatment. While there is rather limited supporting evidence for nearly all IVF add-ons that we reviewed, there is strong demand from patients, physicians, and the biotechnology industry to continue further research and development in this arena. We discuss here a selection of commonly utilized IVF “add-ons” and discuss the existing evidence for their utility. However, not all technologies that are integrated into practice have convincing evidence of clinical effectiveness, and they often increase the financial burden of fertility care. Since the advent of ART, technology has continuously evolved to improve embryology and pregnancy outcomes.
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