Role of Assisted Hatching in In Vitro Fertilization

Infertility topics explained by Brian Acacio, M.D..   www.AcacioFertility.com 
Acacio Fertility Center, southern California.  (949)249-9200 begin_of_the_skype_highlighting (949)249-9200 end_of_the_skype_highlighting

Assisted Hatching involves the artificial thinning or breaching of the Zona Pellucida (ZP) and has been proposed as one technique to improve implantation and increase pregnancy rates following IVF. It was first reported in 1990. Since the early reports, many assisted reproductive technology (ART) programs have incorporated the use of assisted hatching in efforts to improve clinical outcomes.

Assisted hatching is generally performed on day 3 after fertilization using various methods. These methods include creating an opening in the zona by drilling with acid Tyrode’s solution, poking a hole with a glass microneedle, laser photoablation, or using a micromanipulator. Lethal damage to the embryo or individual blastomeres with reduction of embryo viability is a risk if not performed correctly. There is a slightly higher chance of monozygotic twins after this procedure.

The available published evidence does not support the routine or universal application of assisted hatching in all IVF cycles. Assisted hatching may be clinically useful in patients with a poor prognosis, including those with >2 failed IVF cycles and poor embryo quality and older women (>38 years of age). Importantly, delivery rates have not significantly improved, possibly because of small scale studies to date.

We believe that many clinics perform assisted hatching routinely for one reason and one reason only. Financial gain. We  perform assisted hatching when we feel it may benefit success and won’t do any harm. We use “cold” laser technology, as this is the most precise and least injurious method available.

Source: the American Society for Reproductive Medicine: A Committee Opinion (11/2008)