IVF Add-Ons: What the HFEA Traffic Lights Actually Mean

What an add-on is, and what it is not

The HFEA defines treatment add-ons as optional, non-essential treatments or tests offered in addition to proven fertility treatment such as IVF or IUI. The regulator publishes information on add-ons that meet a specific test: they are being offered to the general patient population in licensed UK clinics, there are published studies claiming they improve the chance of a baby or another rated outcome, but evidence of effectiveness in a clinical setting is lacking or absent.

That last clause is the whole point. An add-on is on the HFEA's list because the evidence does not support the claim being made for it, not because it is exotic or new. The regulator's own summary is worth quoting: for most patients, routine cycles of proven fertility treatment are effective without using any treatment add-ons.

What each colour means

The HFEA uses five ratings, decided by its Scientific and Clinical Advances Advisory Committee and reviewed when new evidence appears or at least every five years.

Note what green requires: not a promising study, but high quality evidence showing benefit. On the HFEA's current rated list for improving the chance of having a baby, the ratings run from grey down to red. Some add-ons carry separate ratings for other outcomes, such as reducing miscarriage or reducing the risk of ovarian hyperstimulation syndrome, and those are shown on each add-on's own page.

The current list, by colour

The HFEA's rated add-ons, as rated for improving the chance of having a baby for most fertility patients:

• Red: endometrial receptivity testing; intravenous immunoglobulin (IVIG); steroids or glucocorticoids as immunological treatment; platelet-rich plasma (PRP); pre-implantation genetic testing for aneuploidy (PGT-A).
• Black: physiological intracytoplasmic sperm injection (PICSI) for patients having ICSI for male factor infertility; time-lapse imaging and incubation.
• Yellow: elective freeze-all cycles; endometrial scratching; hyaluronate-enriched pre-transfer culture medium, sold under names such as EmbryoGlue.
• Grey: androgen supplementation; assisted hatching; intralipids as immunological treatment; intracytoplasmic morphologic sperm injection (IMSI); intrauterine culture.

Sperm DNA damage testing appears on the HFEA's page as additional information rather than as a rated add-on. NICE guideline NG257 is separately direct on the treatment side of that question: do not offer supplements, antioxidants or medical treatments to improve sperm DNA integrity, and do not offer surgical sperm retrieval as a way to improve outcomes where there is elevated fragmentation without azoospermia.

Red does not mean forbidden, and grey does not mean useless

The HFEA is careful here, and it is worth being careful too. A red safety rating highlights a potential concern; it does not automatically mean the add-on is unsafe or unsuitable for you, because your medical history changes the calculation. Equally, an add-on may be offered for a reason other than improving the chance of a baby — there can be a justifiable medical reason in particular circumstances, and some add-ons show benefit for specific groups or for outcomes other than live birth.

What the ratings do tell you is whether the general claim — this will improve your chances — is supported. If it is not, the burden shifts to your clinician to explain why it applies to you in particular.

How ratings are decided, and how the list changes

Ratings are set by the Scientific and Clinical Advances Advisory Committee, a subcommittee of the Authority, and are reviewed when new evidence emerges or at least every five years. The minutes of each decision and the specific evidence used are published alongside the description of each add-on, so the reasoning is available rather than assumed.

The list is not static. Platelet-rich plasma is a recent example: at its June 2025 meeting the committee concluded that intraovarian and intrauterine PRP treatments should be added to the rated list, because there is limited evidence supporting their use in improving the chance of a baby, little research into their effect on eggs, embryos or long-term fertility outcomes, and possible safety concerns. Regulation of PRP for quality and safety sits with the MHRA.

Artificial egg activation using calcium ionophore moved the other way. It was removed from the rated list in October 2023 because it should only be offered in specific circumstances, and professional guidance from ARCS and the British Fertility Society states it should not be used routinely with ICSI as its safety has not been established, and may be used where two previous routine ICSI cycles resulted in low or no fertilisation.

Who benefits from the sale

Add-ons are usually charged for, often at several hundred pounds each, on top of a cycle that already costs thousands. That is not a reason to assume bad faith, but it is a reason to ask the question directly. The HFEA and other professional and patient bodies agreed a consensus statement in October 2023 stating that treatments with no strong evidence of safety or effectiveness should only be offered in a research setting, and that patients should not be charged extra to take part in research, including clinical trials.

Your clinic should also provide the evidence of effectiveness for any treatment it offers you. If an add-on is suggested, the HFEA advises asking why it is being offered and whether it may benefit you specifically.

What to ask

• What is the HFEA rating for this add-on, and for which outcome?
• Why are you recommending it for me, rather than for patients in general?
• What does it cost, and what happens to my chances if I decline it?
• Is it being offered as part of a research study, and if so am I being charged?
• Would that money buy a further full cycle instead?

Declining every add-on is a normal, evidence-consistent choice. A clinic that treats it as a problem is telling you something useful.