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Is Assisted Hatching Safe?

Is Assisted Hatching SafeWhat is assisted hatching (AH)?

Assisted hatching (AH) is a procedure used to thin or make a small opening in the zona pellucida (the egg shell surrounding an embryo). AH is supposed to increase the chances of implantation and subsequent pregnancy.

How is AH done?

It used to be done with an acidic Tyrode solution. Now, most fertility specialists use a laser for AH procedures. Lasers are more precise and accurate and can be used in a standardized manner.

When is AH performed?

AH is generally done in patients with thick zonae (often younger women), and in women that have previously failed embryo transfer. AH is also done in frozen cycles as the freezing can harden the zonae.

How common is the use of AH?

The use of AH is widespread and a recent survey in the US demonstrated that 44.8% of fresh IVF cycles (337,119 of 751,879) received AH.

What are the side effects?

Routine use of AH does NOT increase pregnancy rates. However, AH may be associated with an increase in twins (monozygotic).

Does AH increase the risk of birth defects?

This very important issue was addressed by Jwa et al. and co-workers from Japan (Fertil Steril 2015;104:71-78). The data analyzed was obtained from the Japanese ART registry assembled by the Japan Society of Obstetrics and Gynecology (JSOG) from all clinics on a mandatory reporting basis. They analyzed children born from IVF cycles where a single embryo was transferred after AH. The children were analyzed for major congenital anomalies. Here is what they found:

AH was performed in 35,488 cycles among 72,125 included cycles (49.2%). A total of 1,046 major congenital anomalies (1.4%) were identified (1.36% in AH group vs. 1.50% in non-AH group). Overall risks for major congenital anomalies were not significantly different between AH and non-AH groups adjusting for maternal age, calendar year, fetal sex, embryo stage at transfer, and status of cryopreservation. There were 1,009 cases of twins (1.5%) and 10 cases of triplets (0.015%) among all included cycles. No specific organ system demonstrated significant association between AH and non-AH groups. Subgroup analysis demonstrated no significant association between AH and non-AH groups in intracytoplasmic sperm injection cycles or in vitro fertilization in fresh cycles. Similar non-significant association was observed between early-cleavage or blastocyst stage at transfer in frozen-thawed cycles.

The authors therefore concluded that AH is NOT associated with an increase in major congenital abnormalities. About one-half cycles reaching birth received AH in Japan. These data are reassuring as they come from a large database with thousands of children being examined. A weakness of the study is the fact that data on the technique used for AH were not available.

At InVia Fertility Specialists, we offer a wide array of micromanipulation services in our embryology laboratory. These include intracytoplasmic sperm injection (ICSI), AH, and embryo biopsy for preimplantation screening or diagnosis.

To work with a qualified, board-certified fertility specialist, make an appointment at one of InVia four Chicago area fertilty clinics.

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