By Dr. Francisco Arredondo | Founder and Medical Director, Pozitivf | May 2026
TL;DR: Many fertility clinics bundle expensive “add-ons” into IVF treatment plans: extra tests, extra lab procedures, extra technology fees. Leaders at the Society for Assisted Reproductive Technology (SART) and a new 2026 paper from Penn Fertility Care are saying the quiet part out loud. Most of these add-ons don’t improve your chances of a healthy baby, and some can quietly steal time and money from families who don’t have either to spare. Pozitivf Fertility has always built its care around evidence-based protocols. No upsells. No false hope. Just what the science says works.
- What IVF add-ons are, and why so many clinics offer them
- Five common add-ons your fertility clinic may recommend and what the research actually shows
- How add-ons quietly drive up the total cost of an IVF cycle
- Why Pozitivf Fertility doesn’t charge for treatments that don’t move the needle
- Questions to ask before agreeing to any IVF add-on
Patients Are Paying for Things That Don’t Work
I see it almost every week. A patient walks into my office holding an itemized quote from another fertility clinic. The base IVF cycle is listed at one price. Below it, a long list of what the clinic calls “recommended” add-ons: an ERA test, PRP, an immune protocol, extra medications, a genetic panel they may not need. By the time all of it is added up, the total has climbed by $5,000, sometimes $15,000 or more.
The question patients almost always ask me next: “Do I really need all of this?”
The honest answer, for most patients: no. Not if we’re being guided by evidence.
On a recent SART podcast recorded at the ASRM annual meeting here in San Antonio, the outgoing SART president, Dr. Micah Hill, put it as plainly as a fertility doctor can. By definition, an add-on means we don’t have evidence for it. If we had evidence, it would not be an add-on. It would be standard treatment.
That same month, two physicians at Penn Fertility Care, Dr. Anuja Dokras and Dr. Clarisa Gracia, published a paper in Fertility and Sterility warning the field not to let hype outrun evidence on yet another new add-on. They cite the 2026 ASRM Ethics Committee opinion that says one of the buzziest new tests on the market, polygenic embryo screening, is “a nascent and unproven technology that is not recommended for clinical use.”
These are not fringe voices. They are leaders at the major professional bodies in reproductive medicine. And what they are saying lines up with what we’ve been doing at Pozitivf since we opened our doors.
What Is an IVF “Add-On,” Exactly?
An IVF add-on is any extra treatment, test, or procedure layered on top of a standard IVF cycle with the promise of improving your chances of a live birth. Some sound clinical. Some sound cutting-edge. Most come with an extra fee.
A few add-ons are genuinely useful for specific patients. ICSI for severe male-factor infertility is a good example. But the category as a whole has grown into something else: a menu of upsells, often recommended without a clear medical reason, and usually without strong evidence that they help.
Why do so many clinics offer them? Part of it is hope. Patients want every possible edge, and clinics want to provide it. Part of it is business. Add-ons are high-margin. And part of it is inertia. Once an add-on becomes “standard” at a clinic, it can stay on the menu for years, even after the evidence says it shouldn’t.
Five Add-Ons You Might Be Offered, and What the Research Actually Shows
Here are five of the add-ons patients ask me about most often. The published literature and the leadership of our own professional societies tell the same story on all five.
1. The ERA Test (Endometrial Receptivity Array)
The ERA is pitched to patients as a way to find a personalized “window of implantation.” It usually requires a separate mock cycle and an endometrial biopsy, on top of a regular IVF cycle. As Dr. Micah Hill put it on the SART podcast, ERA was a “fascinating, wonderful idea, but in practice it didn’t really bear out.” It adds cost. It can add months of delay. And the data has not shown it improves the chance of a live birth for the average patient.
2. Assisted Hatching
Assisted hatching is a small incision made in the outer shell of the embryo before transfer. The intuition behind it sounds reasonable. But intuition is not evidence. The published data has not shown that assisted hatching improves outcomes for most patients. It is a procedure, with a cost, in search of a benefit.
3. Time-Lapse Embryo Imaging
Time-lapse imaging puts a camera inside the incubator and takes thousands of pictures of an embryo as it grows. The pitch is appealing. More data, better selection, better outcome. The studies, so far, have not shown that it actually helps clinics pick a better embryo to transfer. As Dr. Hill noted on the SART podcast, you can get the same benefit of leaving embryos undisturbed without paying for the technology. When clinics invest in expensive new equipment that isn’t proven, the question is who pays for it. Too often the answer is: the patient does, on the next cycle invoice.
4. PGT-A as a Default for Everyone
Preimplantation genetic testing for aneuploidy (PGT-A) checks an embryo for the right number of chromosomes. For some patients, especially with recurrent loss or specific clinical histories, that information matters. The problem is when it is recommended to every IVF patient by default. The latest ASRM guidance, as cited on the SART podcast, is that we still do not have definitive evidence that PGT-A improves the live birth rate per cycle for the average patient. It also adds thousands of dollars per cycle. PGT-A is a tool, not a default. A good clinic will explain when it actually helps you, and when it doesn’t.
5. PGT-P / Polygenic Embryo Screening
This is the newest add-on on the market. PGT-P claims to score embryos against polygenic risk for adult-onset conditions like heart disease, diabetes, or cancer. The 2026 ASRM Ethics Committee opinion is direct. PGT-P “remains a nascent and unproven technology that is not recommended for clinical use and should not be offered as a clinical service at this time except under research oversight.” The American College of Medical Genetics and Genomics agrees. The promise is genuine. The proof is not yet there. As Drs. Dokras and Gracia at Penn Fertility Care wrote this year in Fertility and Sterility, hype is running far ahead of evidence on this one.
What This Costs You: Time, Money, and Sometimes Both
Cost is not just dollars. It is dollars and time. An ERA test can push a transfer out by a couple of months. PGT-A on every cycle can add several thousand dollars. Time-lapse imaging shows up as a higher cycle fee. PGT-P, where it’s offered, layers another premium charge on top of all of it.
It is not unusual for a patient at a traditional clinic to be looking at thousands, sometimes tens of thousands, of dollars in add-on fees on top of the base IVF charge, for interventions that the leadership of our own professional societies says have not been shown to improve the chance of a healthy baby. That is real money. For most families, it is the difference between being able to afford a second cycle if the first one doesn’t work, or not.
Dr. Hill made the ethics of this point on the podcast in plain English. When clinics invest in expensive new technology before the evidence is in, that cost should sit with the clinic, not with the patient. “To spend money on more expensive incubators and then raise your IVF cycle fees and put that on the patient when you don’t know that it’s going to be helpful, to me, would not be ethical medicine.” That is not a competitor of mine talking. That is the outgoing president of the Society for Assisted Reproductive Technology.
The Pozitivf Way: Evidence, Not Extras
Pozitivf was built on a simple premise. Having a baby should not be a luxury. Fertility care should be efficient, transparent, and affordable, without cutting any corner on quality or safety.
That’s why we don’t bundle unproven add-ons into our treatment plans. We use the protocols the evidence supports, in the doses the evidence supports, with the technology the evidence supports. When something new comes out, we evaluate it against the research before it ever goes on a patient’s bill.
Patients sometimes ask me, “If Pozitivf is less expensive, what are you leaving out?” The answer: the things that don’t work. We are not a discounted version of a traditional clinic. We are a different model. Streamlined. Self-pay. Focused on the protocols that have the best evidence behind them. That combination is what keeps our pricing honest.
We also assign every patient a dedicated fertility advocate on day one, with bilingual support, so you are never navigating decisions alone. If an add-on is appropriate for your specific situation, we will tell you and explain why. If it isn’t, we will tell you that too.
What Actually Moves the Needle in IVF
If most add-ons don’t make a meaningful difference, what does? A few things. Embryo quality, which comes down to your biology and a skilled lab. Endometrial preparation done with care, not with gimmicks. Timing protocols backed by data. An experienced care team that knows when to intervene and when to leave well enough alone. These are the levers that matter. Everything else is noise.
Questions to Ask Before You Agree to Any IVF Add-On
On the SART podcast, Dr. Hill walked through the questions every patient should bring with them. They’re worth borrowing word for word.
- Does this add-on actually improve my chances of a baby? How good is the evidence?
- What are the risks, including financial risk and the risk of delay?
- How much will it cost me, including any follow-on cycles it might require?
- What are the alternatives if I don’t do it?
- How does this clinic specifically perform with this add-on, and what is your internal data?
A clinic that gives you direct, confident answers to those questions is a clinic that respects your intelligence. A clinic that gets evasive, or that only mentions a costly add-on if you bring it up first, is telling you something.
The Bottom Line
At the end of the day, what patients want from IVF is not a longer invoice. It is a baby. My job, and the job of the entire Pozitivf team, is to use what works, skip what doesn’t, and be honest with every patient about the difference.
If you’re weighing IVF options in Houston or San Antonio and want a second opinion on the add-ons you’ve been offered somewhere else, bring the quote. I will walk through it with you line by line.
Book a Free Consultation with Pozitivf Fertility
IVF Add-Ons: Frequently Asked Questions
- What are IVF add-ons?
IVF add-ons are extra tests, procedures, or technology fees layered onto a standard IVF cycle. Common examples include the ERA test, assisted hatching, time-lapse embryo imaging, routine PGT-A on every patient, and the newer polygenic embryo screening (PGT-P).
- Do IVF add-ons actually improve success rates?
For most patients, no. As the outgoing SART president explained on a recent SART podcast, by definition an add-on means we don’t have evidence for it. If we did, it would be standard treatment, not an add-on.
- What about polygenic embryo screening (PGT-P)?
The 2026 ASRM Ethics Committee opinion calls PGT-P a nascent and unproven technology that is not recommended for clinical use at this time. The American College of Medical Genetics and Genomics agrees.
- Why doesn’t Pozitivf Fertility charge for these add-ons?
Pozitivf uses evidence-based protocols. If an add-on doesn’t have strong research behind it, we don’t charge patients for it. Our goal is to help families build a baby, not a longer invoice.
- Is cheaper IVF the same as lower-quality IVF?
No. Pozitivf is a different model from a traditional fertility clinic, not a discounted one. We’re streamlined, self-pay, and focused on the protocols with the best evidence. That is why our pricing is transparent and lower, without sacrificing medical quality.
