IVF Add-On Treatments in India: Which Tests and Procedures Are Actually Necessary?

IVF (In Vitro Fertilisation) has helped many couples overcome fertility challenges and move closer to their dream of becoming parents. With advancements in reproductive medicine, fertility clinics now offer several additional tests, laboratory techniques and procedures that claim to improve IVF success rates.

These are commonly known as IVF add-on treatments.

In India, patients may come across options such as ERA testing, PGT-A, EmbryoGlue, assisted hatching, sperm DNA fragmentation testing and immune-related treatments. While some of these procedures can be helpful in selected medical situations, not all have been proven to improve the chances of having a healthy baby.

This often creates confusion for couples. They may wonder whether they should agree to every additional test recommended during IVF or whether a standard IVF treatment is enough.

The truth is that more tests and procedures do not automatically mean better IVF results. The right treatment depends on your medical history, fertility diagnosis, age, previous treatment outcomes and individual reproductive health.

Let’s understand which IVF add-ons may be useful and which ones require careful consideration.

Which IVF Add-On Treatments Are Actually Necessary?

The following table provides a simplified overview of commonly discussed IVF add-ons.

Test or procedure	Is it necessary for everyone?
AMH and AFC	Commonly useful for assessing ovarian reserve
Semen analysis	Standard male fertility investigation
PGT-A	Only for selected clinical circumstances
ERA testing	Not recommended for routine use
EmbryoGlue	Optional; benefits require discussion
Assisted hatching	Not recommended routinely
Sperm DNA fragmentation	Selected cases only
Immune testing and treatment	Not recommended routinely
Time-lapse monitoring	Optional laboratory technology

What Are IVF Add-On Treatments?

IVF add-ons are additional investigations, medications, laboratory techniques or procedures offered alongside a standard IVF treatment cycle.

Their purpose may be to:

• Improve embryo development or selection.
• Identify possible reasons for repeated IVF failure.
• Assess sperm or egg-related problems.
• Evaluate the uterine environment before embryo transfer.
• Reduce certain treatment-related risks.

Some add-ons are medically useful for specific patients. Others have limited scientific evidence, and their routine use is not recommended.

Before choosing an additional procedure, patients should understand its purpose, expected benefits, possible risks and additional cost.

1. Essential Tests Before Starting IVF

Before discussing advanced IVF add-ons, it is important to understand that certain investigations are necessary to plan a suitable fertility treatment.

These tests help the fertility specialist understand the underlying cause of infertility and select an appropriate treatment approach.

For women:

• AMH Test: Helps assess ovarian reserve and predict how the ovaries may respond to stimulation medicines.
• Antral Follicle Count (AFC): An ultrasound assessment that helps estimate the number of small follicles in the ovaries.
• Hormonal Tests: Depending on the patient’s history, tests such as FSH, LH, TSH and prolactin may be advised.
• Pelvic Ultrasound: Helps assess the uterus, ovaries, fibroids, cysts and other reproductive conditions.
• Uterine Assessment: Additional evaluation may be recommended if abnormalities inside the uterine cavity are suspected.
• Infection Screening: Appropriate pre-treatment screening may be required for the safety of the patient, partner and treatment process.

For men:

• Semen Analysis: Evaluates sperm count, movement (motility) and shape (morphology).
• Hormonal Testing: May be recommended when sperm parameters or clinical symptoms indicate a hormonal problem.
• Additional Male Fertility Evaluation: May be necessary in cases of severely abnormal semen reports or suspected male reproductive disorders.

Not every patient needs every investigation. A fertility specialist decides which tests are appropriate based on the couple’s medical history.

2. PGT-A Testing: Is Genetic Testing of Embryos Necessary?

Preimplantation Genetic Testing for Aneuploidy (PGT-A) is a laboratory technique used to examine the chromosome number in embryos created through IVF.

The purpose is to identify embryos with an abnormal number of chromosomes before embryo transfer.

When may it be considered?

• In selected patients with specific reproductive or genetic concerns.
• When there is a history of certain chromosome-related problems.
• In carefully evaluated cases where genetic information may influence treatment decisions.

However, PGT-A is not a guarantee of pregnancy or a healthy baby. It has not been established that routinely performing PGT-A improves the overall live birth rate for every IVF patient.

It also involves additional costs and embryo biopsy procedures.

Our advice: PGT-A should not automatically be added to every IVF cycle. Its potential benefits and limitations should be discussed according to the patient’s individual circumstances.

3. ERA Testing: Does Every Patient Need an Endometrial Receptivity Test?

ERA (Endometrial Receptivity Analysis) is a test that examines the expression of certain genes in the uterine lining to estimate the timing of its receptive period.

The test aims to identify a possible personalised window for embryo transfer.

It is sometimes suggested to patients who have experienced repeated unsuccessful embryo transfers.

However, a major concern is that adjusting embryo transfer timing based on ERA results has not consistently demonstrated improved live birth rates.

Current evidence does not support its routine use for all IVF patients.

A previous failed embryo transfer does not automatically mean that the uterine lining is the problem.

Our advice: ERA testing should not be treated as a compulsory step before embryo transfer. The reason for previous failures should be assessed carefully before considering additional investigations.

4. EmbryoGlue: Does It Really Improve IVF Success?

EmbryoGlue is a special embryo transfer medium containing a higher concentration of hyaluronic acid.

It is designed to provide an environment that may support the interaction between the embryo and the uterine lining during transfer.

Although some studies suggest possible benefits, the evidence is not strong enough to establish that it improves live birth outcomes for every IVF patient.

It is important to understand that the name EmbryoGlue does not mean that the embryo is physically glued to the uterus.

Our advice: Patients can discuss its potential benefits and limitations with their fertility specialist rather than assuming it is essential for successful implantation.

5. Assisted Hatching: Is It Required for Every Embryo?

An embryo is naturally surrounded by a protective outer covering called the zona pellucida.

During assisted hatching, a small opening is created in this outer covering using a specialised laboratory technique.

The procedure was developed to help embryos hatch before implantation.

However, scientific evidence has not established a consistent improvement in pregnancy or live birth rates with routine assisted hatching.

It also involves additional laboratory handling.

Our advice: Assisted hatching should not be considered a mandatory procedure for every IVF embryo. Its possible role should be discussed in light of individual circumstances and available evidence.

6. Sperm DNA Fragmentation Test: When Is It Useful?

A routine semen analysis evaluates sperm count, motility and morphology. However, it does not directly measure the integrity of sperm DNA.

A sperm DNA fragmentation test evaluates damage or breaks in the genetic material carried by sperm.

It may be considered in selected cases, such as certain male fertility concerns or unexplained reproductive problems, depending on the clinical assessment.

However, it is not a compulsory investigation for every man undergoing IVF.

A high DNA fragmentation result also does not automatically mean that IVF will fail.

Our advice: The test should be recommended when the result is likely to provide useful information and influence the treatment plan.

7. Immune Tests and Treatments: Are They Necessary for IVF?

Some fertility clinics offer immune-related investigations and treatments, including:

• Natural Killer (NK) cell testing.
• Intralipid infusions.
• Intravenous Immunoglobulin (IVIG).
• Steroid medications.
• Other immune-modulating treatments.

These treatments are sometimes suggested to address suspected immune-related implantation problems.

However, there is insufficient reliable evidence to support their routine use for improving IVF success rates. Some treatments may also carry risks and side effects.

An immune-related test result should not automatically be interpreted as the reason for infertility or failed implantation.

Our advice: Avoid unnecessary immune testing and treatment without a clear medical indication and a proper discussion of the supporting evidence.

8. Time-Lapse Embryo Monitoring: Is It Better Than Conventional Monitoring?

Time-lapse technology allows embryologists to observe embryo development through images captured at regular intervals inside specialised incubators.

It provides additional information about embryo development without repeatedly removing embryos for observation.

This technology can be useful for laboratory monitoring and documentation. However, there is no conclusive evidence that using time-lapse monitoring routinely improves the chances of having a baby compared with conventional embryo assessment.

It should be understood as a laboratory technology rather than a guaranteed IVF success booster.

How Can Patients Avoid Unnecessary IVF Expenses?

IVF treatment can already involve considerable emotional, physical and financial commitments. Additional procedures may increase the overall cost without necessarily improving the final outcome.

Before agreeing to an IVF add-on, consider asking your fertility specialist these questions:

1. Why is this particular test or procedure being recommended for me?
2. What problem are we trying to identify or address?
3. Is there scientific evidence that it improves the chances of having a baby?
4. Is it recommended for my specific medical condition or offered routinely?
5. Are there any possible risks or side effects?
6. What will be the additional cost?
7. What happens if I choose not to undergo this procedure?

A good fertility treatment plan should be based on medical necessity, scientific evidence and individual patient needs.

Why Personalised IVF Treatment Matters

Every couple has a different fertility journey. Some patients may need conventional IVF, while others may benefit from ICSI, genetic counselling, specialised male fertility investigations or additional uterine evaluation.

For example, a couple with severe male factor infertility may require ICSI, whereas another couple with normal sperm parameters may not need this additional laboratory procedure.

Similarly, a patient with a suspected uterine abnormality may require further evaluation, while another patient with a normal uterine assessment may not benefit from unnecessary invasive testing.

The objective should never be to add the maximum number of procedures. It should be to identify the actual fertility problem and choose the most appropriate treatment.

Final Thoughts: Choose Evidence-Based IVF, Not Just More IVF Add-Ons

Advancements in fertility treatment have introduced many new technologies and procedures. Some have an important role in selected patients, while others still require stronger scientific evidence.

Patients should remember that no single add-on can guarantee IVF success. Age, egg quality, sperm health, embryo development, uterine health and several other factors influence treatment outcomes.

At Dr. Bhavana Singla’s fertility practice in Moti Nagar, Delhi, the focus is on understanding each couple’s fertility concerns and discussing treatment options according to their individual medical requirements.

The right IVF treatment is not necessarily the one with the most additional procedures. It is the one that addresses your specific fertility needs through careful evaluation and evidence-based medical decisions.

If you are planning IVF or have experienced an unsuccessful IVF cycle, consult an experienced fertility specialist to understand which investigations and treatments are genuinely appropriate for you.