IVF Add-Ons: Do ERA, PRP, and Embryo Glue Really Improve Success?
The Reality Behind Popular IVF "Enhancements"
As IVF patients seek ways to improve their chances, clinics increasingly offer expensive add-ons like endometrial receptivity analysis (ERA), platelet-rich plasma (PRP), and EmbryoGlue. But what does rigorous scientific evidence actually say about these interventions? We examine the data from peer-reviewed studies and clinical guidelines.
1. Endometrial Receptivity Analysis (ERA)
The ERA test assesses the optimal timing for embryo transfer by analyzing gene expression in the endometrial lining to determine its receptivity. While it aims to personalize embryo transfer timing, studies have shown mixed results regarding its efficacy. Igenomix gives a pretty good explanation here!
What It Claims to Do
Identifies a personalized "window of implantation" through endometrial biopsy
Purports to reduce implantation failure in recurrent implantation failure (RIF) patients
The Evidence
ASRM Committee Opinion (2022): "No conclusive evidence that ERA improves live birth rates in general IVF population"
Multicenter RCT (NEJM, 2021): No significant difference in live births between ERA-guided and standard timing (32.2% vs 31.3%)
Meta-analysis (Fertil Steril 2023): Pooled data from 8 studies showed no benefit for RIF patients (OR 1.12, 95% CI 0.89-1.41)
When It Might Help
Possible benefit for women with displaced WOI (about 15-20% of RIF cases)
May be considered after ≥3 unexplained implantation failures
2. Platelet-Rich Plasma (PRP) for Endometrium
PRP therapy involves injecting a concentration of a patient's own platelets to potentially rejuvenate ovarian function or improve endometrial thickness. Research on its effectiveness presents varied outcomes
What It Claims to Do
Uses concentrated growth factors from the patient's blood to "regenerate" the endometrium
Marketed for thin endometrium, poor receptivity, and recurrent loss
The Evidence
Cochrane Review (2023): Insufficient evidence to support routine use (only 4 small RCTs)
RCT (Human Reproduction, 2022): No improvement in implantation (28.1% PRP vs 26.7% control)
Best available data: May increase endometrial thickness by 0.5-1mm in thin lining cases
Priti Karadbhajne (2024) and Xinyuan Liu (2024) has found PRP to be safe and effective.
Reality Check
Not FDA-approved for endometrial use
Protocols vary wildly between clinics (centrifugation methods, activation agents)
No standardized definition of "success"
3. EmbryoGlue (High Concentration Hyaluronan)
EmbryoGlue is a hyaluronan-enriched transfer medium designed to enhance embryo implantation. Studies have shown varying results
What It Claims to Do
Culture medium with increased hyaluronan to enhance embryo-endometrium interaction
The Evidence
Cochrane Review (2022): Small increase in clinical pregnancy (RR 1.12), but no significant improvement in live births
Multicenter RCT (Fertil Steril 2021): 5% absolute increase in pregnancy (38% vs 33%), but high baseline rates
Cost-effectiveness analysis: $12,000 per additional live birth gained
Practical Considerations
It may be more beneficial for:
Frozen embryo transfers
Poor-quality embryos
Patients with previous implantation failure
Minimal risk (just a different culture medium)
Professional Society Positions
ASRM (2023): "No IVF add-ons should be offered as routine; experimental treatments require informed consent about unproven benefits"
ESHRE (2022): "Strongly recommends against commercial use of ERA in first/second IVF cycles"
FDA (2023): No approved PRP systems for endometrial treatment
Questions to Ask Your Clinic
"Can you share the peer-reviewed studies supporting this add-on for my specific situation?"
"What percentage of your patients see improved outcomes with this?"
"Is this treatment recommended in ASRM/ESHRE guidelines?"
"What are the exact costs and possible risks?"
It's important to note that while some studies suggest potential benefits of these add-ons, the evidence is often inconclusive or indicates no significant improvement in IVF outcomes. The Human Fertilisation and Embryology Authority (HFEA) emphasizes that many IVF add-ons lack robust evidence of effectiveness and may incur additional costs without proven benefits.
We’re sure that these add-ons could work to some degree, but their success is likely based on the individual. Some people react better to certain treatments so naturally, it will be similar for these add-ons! Is it worth a shot at having a baby? Definitely, but your wallet is going to take a small hit for each additional add-on!
“You didn’t hear it from me, but she’s a glue baby.”
