What tests improve IVF success?

This is an area where you should be cautious, because a number of widely sold "IVF add-ons" have weak or negative evidence behind them, and they are expensive. Genuinely useful investigations after failed cycles: Hysteroscopy — looks directly inside the uterine cavity and can find and treat polyps, adhesions or fibroids that scans may miss. Treating chronic endometritis — where inflammation of the lining is confirmed on biopsy, antibiotic treatment is reasonable. Correcting thyroid dysfunction and vitamin D deficiency — worth doing for general health and straightforward to address. Semen analysis review, including DNA fragmentation in selected cases. Where the evidence is weaker than the marketing suggests: The ERA test (endometrial receptivity analysis) is rated red by the UK regulator, the HFEA — meaning there is no good evidence it improves the chance of a baby. A large randomised trial found no benefit, and one study found live birth rates were lower in women who had ERA-guided transfer after a previous failure. It is expensive and involves a biopsy. PGT-A (genetic testing of embryos) is genuinely useful in specific situations, but it does not increase the chance of a baby for most patients — it can shorten the time to pregnancy by avoiding transfers unlikely to work, while also carrying a risk of discarding embryos that might have succeeded. Whether it helps you depends on your age and embryo numbers. A reasonable question to ask your clinic about any add-on: what is the evidence it increases live births, and what does the regulator rate it? If the answer is unclear, it is fair to decline.