Clinic has offered us embryo glue, a scratch and time-lapse for round three. Is any of it worth paying for or am I buying hope?

Follow-up appointment last Thursday after our second failed transfer. Kind consultation, no answers as to why, which I am told is normal and which I am finding harder to sit with than I expected.

At the end of it we were given a list of optional extras for round three. Embryo glue, an endometrial scratch beforehand, time-lapse imaging in the incubator, and a set of immune blood tests that were described as "some people find them helpful". Total comes to a bit under a thousand for the first three and quite a lot more if we do the immune ones.

Here is my problem. I am the spreadsheet person in this house and I cannot find the number that tells me whether any of this buys us anything. When I asked how much it would improve our chances I got "it may help in some cases", which is not a number. My wife's view is that if we skip them and it fails again she will always wonder. My view is that a thousand pounds is a fifth of a whole extra cycle. Neither of us is obviously wrong and we have been going round in circles all week.

Has anyone actually paid for these and formed a view? And is there a way of finding out what the evidence says that is not just reading the clinic's own leaflet?

Yes, there is, and it is the single most useful thing anyone told me in four cycles: the regulator publishes a rating for each add-on based on the actual evidence, in plain English, on a public page. Go and read that before you read anything your clinic hands you. It is not a clinic marketing another clinic, and the ratings move as new trials come out.

I have paid for two of the four things on your list across my cycles. I do not know whether they did anything, and neither does anyone else, which is rather the point. The scratch I would not do again; it hurt more than I was led to expect and the evidence went the wrong way while I was still recommending it to people.

Your wife's argument is the one I made, and I want to defend it a bit, because "you are buying hope" is said dismissively and I do not think it should be.

I paid for an extra on my last cycle knowing perfectly well the evidence was thin. What I was buying was the ability to get to the end of the road without a "what if we had". That was worth real money to me and I would not call it irrational. What I would say now is that I should have decided about it weeks earlier, at the quote stage, sitting at my kitchen table, instead of in the room with a consultant being lovely at me. The decision I made in the room was the same one, but it cost me more anxiety to make.

Dhruv, the direct answer to "how much would this improve our chances" is that for most patients, most add-ons do not have good evidence that they increase the live birth rate, and that is why you were given a sentence rather than a number. There is not a number to give you. That is an honest answer rather than an evasive one, though I understand entirely why it did not feel like it.

gemma is right about where to look. In the UK the HFEA reviews the published evidence for each add-on and publishes a rating with a plain explanation of what is and is not known, and it is the least biased starting point you have. Take your list to that page one item at a time.

A few specifics, because your four are not equivalent. Time-lapse imaging is a genuinely useful tool for an embryology lab, since embryos can be watched without being disturbed; the open question is whether it changes which embryo is chosen in a way that changes the outcome, and the trials have not shown a clear live birth benefit. The endometrial scratch was widely offered on the strength of small early studies, and larger randomised trials since did not support it for most patients; it is also uncomfortable and not entirely without risk. Embryo glue is a transfer medium containing hyaluronate, and the evidence there is weaker than the confident name suggests. Immune testing and treatment is the one I would be most cautious about, because it is the most expensive, the treatments are actual drugs with actual side effects, and the case for routine use after two failed transfers is not established.

The three questions I would ask your clinic about each item, in order: what outcome does it improve, live birth or something further upstream? In whom, and what about our history makes you suggest it for us specifically rather than offering it to everyone? And what is the evidence, randomised trials or the clinic's own observed results? Our guide to IVF add-ons sets out the same questions in more detail.

One more thing, since you mentioned two transfers without an explanation. If there is a next step with more evidence behind it than any of these four, it is more likely to be a review of the protocol and of anything not yet investigated than an extra sold by the item. That is a conversation to have with your own team, who know your cycles.

Dr Priya Nair said:

what about our history makes you suggest it for us specifically rather than offering it to everyone

This is the question I did not know how to ask and it turns out to be the whole thing.

Read the regulator page last night, all four entries, took me about twenty minutes. Two of them I had genuinely misunderstood; I had assumed the time-lapse camera was some sort of selection algorithm that knew things. Emailed the clinic this morning with the three questions written out.

Coming in only to say the thing I wish someone had said to me in round two, when I paid for an extra in exactly this state of mind.

The comparison your spreadsheet brain is looking for is not "extra versus no extra". It is "extra versus the same money kept towards another attempt", because a cycle's chance is limited and the cumulative picture across attempts is usually the more realistic way to plan. That is the sum that settled it in our house, and it was a kitchen table conversation rather than a medical one. There is more on how the numbers stack up across cycles in IVF success rates.

And whatever you decide, please do not let it become the thing you interrogate afterwards. Both of you are trying to protect the other one from a future regret. That is not a spreadsheet problem.

Update. Clinic came back with a properly detailed answer, which I appreciated: they suggested the time-lapse because of how our embryos behaved on day four last time, could give no specific reason for the glue beyond that they offer it to everyone, and agreed the immune tests were not indicated for us. So we are doing one of the four.

Round three starts next month. Still no idea whether it will work. But we made this decision at our own table with a printout, and that feels different from the last two.