EmbryoScope, EmbryoGlue & IVF Add-Ons: Which Solutions Are Actually Worth It?

Anyone undergoing in vitro fertilization (IVF) already knows that there’s nothing simple about the process. Between choosing the right provider and the multi-step protocols, you’re looking at a timeline of at least six months in most cases.

What many fertility patients may not know (at least not at the outset) is that, in addition to a “traditional” IVF protocol, they will likely be presented with a menu of “add-ons” during IVF. The goals of these add-ons are usually higher success rates or better embryo selection.

At the same time, these add-on options can cause significant overwhelm for fertility patients: How can they be sure embryo-focused tools like Vitrolife’s EmbryoGlue and EmbryoScope, as well as advanced diagnostic tests like EMMA and ALICE, are the right choices for their family?

That’s where Rescripted comes in. Below is our guide to the most common lab technologies and solutions you might encounter in an IVF add-on menu. We’ll help you understand what each of these tools does, how they work, and if they’re worth considering. Because when it comes to growing your family, you deserve to make informed decisions every step of the way.

What is an EmbryoScope?

Vitrolife’s innovative EmbryoScope is a time-lapse incubator that continuously monitors embryos, capturing images every few minutes without needing to move them. This system allows embryologists to review cell division timing, fragmentation, and abnormalities, enabling them to select the best embryos for transfer and freezing.

How EmbryoScope works in IVF

The way the EmbryoScope system works is that the incubators have a built-in microscope and camera, which take pictures of the embryos every 10 minutes. Embryologists, using advanced software, can then review time-lapse videos of the embryos throughout the full course of their development and select the ones they believe are most ideal for transfer and freezing.

The major difference between using the EmbryoScope system and a more traditional evaluation is that, with EmbryoScope, embryologists won’t need to remove the embryos from their optimal conditions (aka the incubator) to perform evaluations. In a traditional evaluation setting, embryos are only removed from the incubator once a day, because time outside the incubator can reduce their overall quality. This practice creates the risk of embryologists potentially missing key viability clues.

Is EmbryoScope worth it?

There is significant evidence of improved clinical outcomes regarding blastocyst development with EmbryoScope (blastocysts are early-stage embryos). According to a study published in the December 2022 issue of *Human Reproduction,* 55% of embryos developed to the blastocyst stage on Day 5 using EmbryoScope (compared to the 45% using a standard incubator). In addition, 59% of embryos generated specifically through IVF developed to the blastocyst stage on Day 5 using EmbryoScope, compared to the 48% that were developed using a standard incubator.

What this tells us is that EmbryoScope creates a more stable, closely monitored environment that gives embryos a better chance to develop well, and that's a meaningful step in the right direction. It's worth knowing, though, that current evidence from clinical trials, including the TILT trial and the SelecTIMO trial, hasn't yet shown a definitive improvement in overall pregnancy or live birth rates. Science is always evolving, and better embryo development is widely considered an important piece of the puzzle, but it's just one part of a much bigger picture. As with any decision in your fertility journey, the best thing you can do is talk openly with your care team about what the research means for your individual situation, so you can feel confident and informed every step of the way.

What is EmbryoGlue in IVF?

EmbryoGlue is another one of Vitrolife’s innovative offerings: A hyaluronan-enriched transfer medium (a solution, not a “glue”) used when transferring the embryo back into the uterus. Hyaluronan (also known as hyaluronic acid) is a naturally produced substance that binds to molecules on the uterine surface. Compared to a standard transfer medium, EmbryoGlue contains a high concentration of hyaluronan, which may minimize embryo drifting and increase the chances of implantation (when the embryo attaches to the uterine lining and thus establishes pregnancy).

Does EmbryoGlue work in IVF?

A 2020 Cochrane review of over 6,700 participants found that embryo transfer solutions containing high concentrations of hyaluronan “probably” increase the number of live births via IVF. The review also determined that high-concentration hyaluronan solutions “may slightly decrease” miscarriage rates.

Embryo transfer using media with high concentrations of hyaluronic acid probably increases the number of live births compared with using solutions with low concentrations or no hyaluronic acid (10 studies). If transfer media with low concentrations or no hyaluronic acid have a 33% chance of resulting in a live birth, solutions with high concentrations increase the chance of a live birth to between 37% and 44%. There would probably be 1 additional live birth for every 14 embryos transferred in a high-concentration hyaluronic acid solution.

It's worth painting the full picture here, though. The largest randomized controlled trial conducted in 2021 did not show an improved live birth rate when looking at a general, unselected population. Where the research does get more promising is for specific groups — studies have shown potential benefits for people with tubal factor infertility, recurrent implantation failure, and those considered to have a poorer prognosis. So while hyaluronic acid-enriched transfer media isn't a universal game-changer for everyone, it may be a particularly relevant conversation to have with your care team if you fall into one of those categories. As always, your fertility journey is uniquely yours, and understanding which interventions are most likely to make a difference for your specific situation is exactly the kind of informed, empowered decision-making you deserve to be part of.

If you’re an aspiring parent who has experienced recurrent implantation failure, poor embryo quality, or advanced maternal age, you may wish to consider EmbryoGlue.

EMMA and ALICE testing: The uterine side of the IVF add-ons conversation

While EmbryoScope and EmbryoGlue focus on embryo quality and transfer, some clinics also recommend certain add-ons that test your uterine lining. Even though these add-ons are decidedly different from embryo-focused options, investigating potential issues in your implantation environment should still be part of your ongoing “Is this worth it?” conversation.

There are two advanced diagnostic tests available that analyze the endometrial microbiome (the bacteria and other microorganisms that live within the uterus). Specifically, one checks for bacterial imbalances and the other chronic inflammation, both of which could affect your chances of becoming pregnant:

• EMMA (Endometrial Microbiome Metagenomic Analysis): This test assesses bacterial balance in the endometrium, or uterine lining.
• ALICE (Analysis of Infectious Chronic Endometritis): This test detects harmful bacteria that not only cause chronic endometritis, which is an inflammation of the endometrial lining, but could also prevent implantation.

Both of these tests are typically offered to aspiring parents following recurrent implantation failure or unexplained pregnancy loss. Because uterine microbiome testing is complex and evolving, we've created a comprehensive guide that covers costs, accuracy, who should consider testing, and how to interpret results.

Read our full EMMA and ALICE testing guide here.

When EMMA and ALICE might be recommended

EMMA and ALICE are not typically considered first-line testing for most IVF patients, but your fertility specialist may recommend EMMA and ALICE tests if you’ve experienced:

• Two or more failed transfers with good-quality embryos
• History of recurrent miscarriage
• Unexplained infertility with no clear embryo or structural issues
• Symptoms or history of chronic endometritis

What the research says about uterine microbiome testing

There is significant evidence suggesting uterine microbiome testing provides improved outcomes: A study published in the January 2022 issue of Microbiome found that “endometrial microbiota composition before embryo transfer is a useful biomarker to predict reproductive outcome, offering an opportunity to further improve diagnosis and treatment strategies.” Another study, published in the February 2025 issue of Reproductive Medicine and Biology, determined that “EMMA and ALICE-guided antimicrobial and probiotic treatments improved pregnancy outcomes, enabling the dysbiosis group to achieve pregnancy earlier than the normal group.” Researchers also concluded that “addressing uterine dysbiosis may reduce the time to pregnancy in patients with recurrent implantation failure and recurrent pregnancy loss.”

Other aspects of EMMA and ALICE testing to consider include varying clinic approaches, as well as the cost: Some clinics offer these tests routinely after one failed transfer, while others reserve them for specific cases. EMMA and ALICE testing can range from $300-$600+, and they are rarely covered by insurance.

Finally, EMMA and ALICE testing results may lead to antibiotic treatment or probiotic protocols, as examined in a 2025 study of 527 participants published in Reproductive Medicine and Biology. However, the study also determined that additional evaluations of the effectiveness of EMMA and ALICE testing are necessary.

Whether you're being offered embryo-focused tools or uterine testing, the key is understanding why your clinic is recommending them for your specific situation and what evidence supports that recommendation. So make sure to ask those questions!

How to decide which IVF add-ons are right for you

Now that you have evidence-based information for making your IVF add-ons decisions, how do you even start?

First, take a look at your fertility diagnosis and history, because your individual case is going to inform every step of your decision-making process.

Next, prepare a list of questions for your fertility specialist that are tailored to your specific needs. Start with broad questions like:

• Why are you recommending this?
• What does the evidence show for someone like me?
• Do you think these add-ons are worth it? Why?

Remember, these decisions concern your body, your health, and ultimately, your family. So you have a right to know why your doctor is making these recommendations. If your clinic is bundling several add-ons without explanation, that’s a red flag. You deserve to know why they’re doing this, and have a clear answer.

But if your clinic is offering you personalized recommendations based on your case, that’s a green flag. Don’t let that keep you from asking your questions, though!

Above all, given the financial, physical, and mental tolls IVF protocols can present, there is no better time for you to trust your instincts and advocate for transparency.

Deciding which IVF add-ons are worth it for you

As you research your IVF add-on options, keep in mind that while tools like EmbryoScope, EmbryoGlue, and EMMA/ALICE testing can help, they aren’t magic bullets. The most empowering thing you can do? Be an active participant in your own IVF care. That means engaging in informed consent and shared decision-making. In other words, remember that you are in partnership with your fertility care team. And that it is your responsibility, and your right, to ask as many questions as you want about your treatment plan.

Because the best IVF protocol is one you understand and feel good about.