Add-ons in medically assisted reproduction: from evidence to clinical practice.

The article focuses on the European Society for Human Reproduction and Embryology (ESHRE) good practice recommendations regarding add-ons in reproductive medicine, which encompass 42 interventions related to diagnosis, laboratory procedures, and clinical management in medically assisted reproduction (MAR). It highlights that only a few add-ons—such as hyaluronic acid addition to transfer media, artificial oocyte activation, and artificial sperm activation—are recommended or can be considered for specific patient groups, while the majority lack high-quality evidence supporting their routine use. The discussion addresses challenges in generating robust evidence, variations in clinical guidelines, ethical concerns about cost and patient information, and emphasizes the importance of transparent communication and evidence-based application of add-ons to optimize patient outcomes and avoid unnecessary or potentially harmful interventions.