A comparison of the clinical effects of thinning and drilling on laser-assisted hatching

Abstract

To systematically investigate the effects of two methods used for laser-assisted hatching (LAH) on clinical outcomes after day 4 (D4) on frozen-embryo-transfer (FET) cycles. Data from 11471 infertile patients who underwent FET cycles between January 2014 and October 2018 was retrospectively analyzed. The 1410 patients who met the inclusion criteria were further categorized into two groups based on the hatching procedure used: the thinning laser-assisted hatching group (T-LAH, 716 patients), and the drilling laser-assisted hatching group (D-LAH, 694 patients). The baseline characteristics of the patients were consistent between the two groups. However, the rates of implantation and clinical pregnancy were significantly higher in the T-LAH group compared to the D-LAH group (32.73% vs. 29.09%, P < 0.01, and 50.98% vs. 43.95%, P < 0.01). The proportion of live birth was also higher in the T-LAH group, but the difference was insignificant (39.11% vs. 36.89%, P > 0.05). Moreover, there were no significant differences in rates of miscarriages, multiple pregnancies, ectopic pregnancies, preterm births, and congenital disabilities between the two groups. Nonetheless, significantly higher rates of implantation and pregnancy were reported in the T-LAH group compared to the D-LAH group among patients aged <35 years, patients with at least one previously failed cycle, and patients with an endometrial thickness of 8–10 mm. T-LAH is superior to D-LAH in improving clinical implantation and pregnancy outcomes in D4 FET, particularly in patients aged <35 years with at least one previously failed cycle or an endometrial thickness of 8–10 mm. The findings of this study provide theoretical support for clinical individualized diagnosis and treatment of patients with infertility.

Two laser-assisted hatching methods of embryos in ART: a systematic review and meta-analysis

“…1 depicted the complete filtering procedure. Nine studies totaling 4 RCT [ 16 , 28 – 30 ] and 5 non-RCT [ 12 , 23 , 24 , 26 , 27 ] were included. The particular information traits that were examined are listed in Table 1 .…”

“…On the other hand, the mechanical approach necessitates considerable expertise and consumes time, presenting challenges in implementation [ 11 ]. LAH is the most widely used AH method, and its various techniques also affect ART outcomes [ 12 ]. It serves as a preferred choice for separating embryos from the ZP due to its simplicity, rapid operation, precise laser application, and minimal disruption to embryos, among other benefits [ 13 ].…”

“…Despite the prevalence of both D-LAH and T-LAH in medical practice, determining the superior method remains contentious [ 22 ]. Existing studies present conflicting findings: some assert D-LAH's superiority, some favor T-LAH, while others report no substantial disparity [ 12 , 23 , 24 ].…”

“…After applying exclusion criteria using EndNote, 209 studies met the requirements for quantitative analysis. These studies were selected based on the reviewers' evaluation of the titles, abstracts, and full texts of the remaining 205 studies [ 12 , 16 , 23 , 24 , 26 – 30 ]. The literature search specifically focused on English papers, as depicted in Fig.…”

Site specificity of blastocyst hatching significantly influences pregnancy outcomes in mice

“…4, 23 Leonavicius et al found that reducing blastocyst pressure by inhibiting Na + /K + -ATPase activity decreased the probability of hatching, indicating the importance of mechanical forces during embryo hatching. Enzymatic process is also important in hatching, as mouse blastocysts hatch from TE cells that particularly express the trypsin-like proteinase strypsin, 24,25 for which ZP3 (a sperm-binding protein) is a potential substrate. 26,27 In addition, actin filaments are concentrated on TE cells near the hatching site and contribute to hatching.…”