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IVF/ICSI Additional Procedures

What Are IVF Add-Ons?

IVF treatment add-ons are additional procedures that are not part of the routine stimulation cycle. These are medications or supplements which can be added during the stimulation all during the process of transfer of embryos. These add-ons vary from using medications to procedures on embryos and the endometrium. The commonly used IVF add-ons are steroids, clexane, screening of embryos, endometrial tests, immunotherapy and immune testing, growth hormone and many other such additions.

Additional IVF & ICSI Procedures

There are a number of add-ons that can be used in conjunction with IVF, they are often credited as being able to increase IVF success rates, but some do not fulfil the requirements of adequate research. Others have reasonable evidence but have not been fully accepted as the mainstay of the IVF process.
The most talked-about IVF add-ons are:

  • assisted hatching
  • genetic screening of embryos
  • use of injectable progesterone
  • freeze all protocols (where all blastocysts are frozen)
  • endometrial receptivity assay

Embryo Freezing

Surplus embryos may be frozen after IVF treatment for use at a later date to create more siblings, or if the treatment cycle was unsuccessful.

Frozen embryos have a similar or better success rate than fresh embryos in our care for younger patients.

  • Frozen embryo replacement cycles show less asynchrony of the endometrium (lining of the womb).
  • Success rates increase from 10 to 15% or more compared to aggressive stimulation.
  • Ovarian hyperstimulation syndrome (with life-threatening risks) is almost completely prevented.
  • IVF cycles have a much higher success rate.

Embryos are frozen in the ‘freeze all’ protocol (this is where all good quality blastocysts are frozen) or when additional embryos are present. Embryo freezing is carried out by vitrification which is fast freezing. Embryos are usually frozen on day five when they reach the blastocyst stage.

Embryos that reach a blastocyst stage have been through accelerated growth and have between 100 to 150 cells. These embryos can thaw better and have a much better chance of survival. Embryos are also frozen on day three, though their survival rates are lower than those embryos frozen at the blastocyst stage.

Frozen embryos carry similar pregnancy rates as fresh embryos and in many clinics are the preferred option. There is around a 1 to 2% risk that embryos may not survive the freezing process and may not thaw.

Is It Better To Freeze Eggs Or Embryos?

Eggs and embryos can both be frozen.

Eggs are single cells that need to be frozen and then thawed to survive. Eggs that have undergone egg freezing have a lower survival rate and have to be converted to embryos before they can be implanted. Frozen eggs also will have a lower chance of pregnancy.

Embryos that are frozen at a blastocyst stage have between 100 -150 cells and survive the freezing process better. The success rate of frozen embryos is similar to fresh embryos and often is a chosen mechanism.

How Do Embryos Survive The Freezing Process?

Embryos are frozen at a very low temperature by vitrification. On thawing to trigger the process of growth is initiated again and embryos start to expand and begin growing again. A small number of embryos failed to survive and expand and will need to be discarded.

Blastocyst Culture

A blastocyst is a term given to an embryo that has been growing for 4-6 days. In nature, embryos implant at the blastocyst stage and thus the transfer of blastocyst embryos has an increased chance of implantation.

We aim to perform a blastocysts culture for all patients, though sometimes we may need to transfer or freeze embryos earlier if there are fewer embryos of less good quality

We feel that every effort should be made to improve the chances of pregnancy therefore there is no additional charge for blastocyst culture.

What Is The Blastocyst Culture Procedure?

Blastocyst culture is when embryos a grown-up to day five or day six when cells become between 100 to 150 cells and contain differentiated cells.

Assisted Hatching

Assisted hatching is believed to be associated with an increased pregnancy rate in selected patients. This technique involves the creation of a small hole in the embryo shell (zona) with a laser, or the use of a chemical process which thins and weakens the zona, just before the embryo is transferred into the womb.

It is useful for women whose embryos have been identified as having a zona that appears particularly thick, or is suspected of being harder than normal. This enables the embryo to hatch out and may help implantation. There is very little evidence that assisted hatching will improve pregnancy rates.

Assisted hatching is a procedure by which the outer surface which is the trophoectoderm ectoderm of the embryo is fractured. The aim of assisted hatching is that it allows the embryo to hatch more easily and aids implantation. Assisted hatching can be done mechanically with a needle or with a laser.

Is Assisted Hatching Necessary?

At Fertility Plus, we practice evidence-based medicine, there is very little evidence that assisted conception aids IVF implantation. There have been various studies and the evidence to support is very limited.

Does Assisted Hatching Make Implantation Faster?

There is very little evidence that assisted conception aids IVF implantation speed. There have been various studies and the evidence is very limited.

Does Assisted Hatching Improve IVF Implantation Rates?

There is very little evidence that assisted conception aids IVF implantation. There have been various studies and the evidence is very limited.

How Will I Know If I Need An Additional Procedure?

This will be discussed with your fertility specialist. There are certain add-ons which do not fulfil the requirements of adequate research. There are other add-ons which have reasonable evidence but have not yet been accepted as the mainstay of assisted conception. The common add-ons which are used extensively and where evidence is being collected are:

  • Genetic screening of embryos
  • Use of injectable progesterone
  • Freeze all protocols
  • Endometrial receptivity assay

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