Revisiting embryo assisted hatching approaches: a systematic review of the current protocols

Alteri, Alessandra; Viganò, Paola; Maizar, Ahmad Abu; Jovine, Luca; Giacomini, Elisa; Rubino, Patrizia

doi:10.1007/s10815-018-1118-4

Cited by 41 publications

(47 citation statements)

References 123 publications

(182 reference statements)

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“…Especially, laser-assisted hatching (LAH) is commonly used for in vitro fertilization of embryos to facilitate the hatching process, which has been shown to be faster and easier than other methods [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Effect of Laser-Assisted Hatching on the Clinical Outcomes of Human Vitrified-Thawed Embryo Transfer Cycles with Different Post-Thaw Culture Duration

Luo

Peng

Sun

et al. 2020

Preprint

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Background: Zona pellucida(ZP)hardening caused by prolonged in vitro culture and exacerbated by the freeze–thaw process making ZP hatching difficult; In theory, assisted hatching may facilitate the hatching process and have the potential to increase implantation and/or pregnancy rates in frozen embryo transfer (FET) cycles. However, a number of studies have shown controversial results on the clinical benefit of laser-assisted hatching (LAH) in FET cycles. This study firstly investigated the efficacy and safety of LAH using vitrified-thawed embryos with different post-thaw culture duration in FET cycles.Methods: Data from the center’s IVF database were retrospectively analyzed, only embryos thawed for the first FET cycle of each ovarian pick-up were eligible for this study, and only cycles in which at least one embryo was available for transfer were included in the present study. Finally, a total of 1225 infertile couples who underwent 1225 FET cycles between July 2013 and March 2015 were analyzed in this study. According to the duration of post-thaw culture in FET cycles, these patients were allocated to three subgroups: the short culture (4-5 h) group (LAH, n=205; control, n=201), overnight culture (20-24 h) group (LAH, n=197; control, n=203), and blastocyst culture (44-48 h) group (LAH, n=210; control, n=209), respectively.Results: In the short culture(4-5 h) subgroup, no statistically significant differences were found related to the implantation, clinical pregnancy and live birth rates between the two groups (28.0% versus 27.8%, 38.0% versus 36.8%, and 30.7% versus 30.3%, respectively, P＞0.05). When the perinatal outcomes of two groups were compared, there was no significant difference in the gestational weeks (37.96±2.23 versus 37.59±2.35, P＞0.05), birth weight (2.70±0.56 versus 2.82±0.62, P＞0.05), as well as the preterm birth (15.4% versus 17.6%, P＞0.05), ectopic pregnancy (2.6% versus 1.4%, P＞0.05), and miscarriage rates (16.7% versus 16.2%, P＞0.05).In the overnight culture(20-24 h) subgroup, no statistically significant differences were found regarding the implantation, clinical pregnancy and live birth rates (29.5% versus 29.1%, 40.1%versus 37.4%, 33.0%versus 30.5%, respectively, P＞0.05).As to the perinatal outcomes, there was no significant difference in the gestational weeks (36.86±2.28 versus 35.69±2.95, P＞0.05), birth weight (2.73±0.76 versus2.62±0.52, P＞0.05), as well as the preterm birth (15.2% versus 17.1%, P＞0.05), ectopic pregnancy (3.8% versus 2.6%, P＞0.05), and miscarriage rates (13.9% versus 15.8%, P＞0.05).In the blastocyst culture(44-48 h) subgroup, the two groups did not differ significantly in the implantation, clinical pregnancy and live birth rates (56.3% versus 59.3%, 68.6% versus 66.5%, and 55.7% versus56.5%, respectively, P＞0.05).Furthermore, there were also no significant difference in the gestational weeks (38.68±2.76 versus 36.95±2.59, P＞0.05), birth weight (2.78±0.74 versus 2.72±0.59, P＞0.05), as well as the preterm birth (8.3% versus 11.5%, P＞0.05), ectopic pregnancy (2.8% versus 2.2%, P＞0.05), and miscarriage rates (16.0% versus 12.9%, P＞0.05).Conclusions: Our results suggested that LAH does not improve the clinical outcomes in FET cycles, irrespective of the duration of post-thaw culture. Though the risk of perinatal period did not increase, it is still necessary to conduct further investigations to validate the safety of LAH.

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Section: Introductionmentioning

confidence: 99%

Effect of Laser-Assisted Hatching on the Clinical Outcomes of Human Vitrified-Thawed Embryo Transfer Cycles with Different Post-Thaw Culture Duration

Luo

Peng

Sun

et al. 2020

Preprint

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“…Procedures include manipulations of the ZP such as (1) making holes, slots or thinning of different sizes; (2) drilling, cutting, digesting or melting the zona mechanically, chemically or with a laser beam (3) on fresh or frozen/thawed embryos (iv) at different developmental stages (v) in different groups of patients. 21 Therefore, it is likely that the general conclusions drawn from the evaluation of the overall effectiveness may withhold some confounding factors. 21 …”

Section: Introductionmentioning

confidence: 99%

“… 21 Therefore, it is likely that the general conclusions drawn from the evaluation of the overall effectiveness may withhold some confounding factors. 21 …”

Section: Introductionmentioning

confidence: 99%

ALADDIN study: does assisted hatching of vitrified/warmed blastocysts improve live birth rate? Protocol for a multicentric randomised controlled trial

et al. 2020

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IntroductionRecent data suggest a higher clinical pregnancy rate performing assisted hatching (AH) on previously cryopreserved embryos but fail to demonstrate significant effects on live birth rate. However, current evidence is based on studies with a small sample size and may hide a type II error. Moreover, poor attention has been given to the specific effect of AH on frozen/thawed blastocysts. To shed light on this topic, we developed the present protocol for a randomised trial to investigate the benefits of the laser-mediated partial removal of the zona pellucida in vitrified/warmed blastocysts.Methods and analysisThe pArtiaL zonA pelluciDa removal by assisteD hatchINg of blastocysts (ALADDIN) study is a multicentric prospective comparative study with a parallel randomised controlled design aiming to investigate whether AH performed on warmed blastocysts before embryo transfer can improve live birth rate. Women allocated to the control group will undergo embryo transfer of blastocysts not previously subjected to AH. Two infertility units will be involved in the study. Enrolment of patients will last 18 months with quarterly monitoring and the entire study is foreseen to be closed in 36 months. Secondary outcomes include: proportion of transferred blastocysts/thawed blastocyst, morphological features of blastocysts before embryo transfer, implantation, biochemical pregnancy, clinical pregnancy (ultrasound visible gestational sac), miscarriage, multiple pregnancy, preterm birth (<37 weeks of gestation), obstetrical and neonatal complications and congenital anomaly rates.Ethics and disseminationThis protocol received a favourable ethical opinion from the Ethical Committee of IRCCS San Raffaele Scientific Institute and the Ethical Committee Area 2 Milan. Each participant will provide written consent to participate and remain encoded during the study. The trial results will be published in peer-reviewed journals and presented at conferences.Trial registration numberNCT03623659.

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“…performed in the IVF laboratory after freezing-thawing may assist the natural hatching process in vivo and therefore may have the potential to facilitate embryonic implantation. In recent years, AH was widely used in frozen embryo transfer (FET) cycles [4,[8][9][10]. A systematic review and meta-analysis of the medical literature showed that AH is associated with a signi cantly increased clinical pregnancy rate for women undergoing frozen-thawed embryo transfer [11,12].…”

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confidence: 99%

Laser-assisted Hatching Improves Live Birth Rate of Vitrified-warmed Blastocyst Transfer Cycles: a Case Control Study

Zhao

et al. 2021

Preprint

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Background Assisted hatching is a widely accepted technique in assisted reproductive technology, however, it’s efficiency remains controversial and lack of data on safety. The aim of this study was to assess whether laser-assisted hatching improves clinical pregnancy results of vitrified-warmed blastocyst transfer cycles.Methods This was a retrospective cohort study of 4143 vitrified-warmed blastocyst transfer cycles from October 2014 to December 2015 at a single, university-based hospital. Cases involving blastocysts that survived after warming were divided into the assisted hatching (AH) group (n=1975) and non-AH group (n=2168). In the AH group, laser AH was performed for the warmed blastocysts before transfer. In the non-AH group, the warmed blastocysts were transferred without AH. The primary outcome was live birth rate after survived vitrified-warmed blastocyst transfers.Results No significant differences in age, endometrial preparation regimen, number of embryos transferred, or blastocyst developmental stage were found between the two groups (P>0.05). The biochemical pregnancy (67.0% vs. 63.6%; P=0.023; odds ratio [OR], 1.177; 95% confidence interval [CI], 1.032–1.344), clinical pregnancy (59.2% vs. 56.0%; P=0.041; OR, 1.163; 95% CI, 1.024–1.321), live birth (48.6% vs. 45.4%; P=0.041; OR, 1.160; 95% CI, 1.022–1.316), and implantation (52.1% vs. 49.3%; P=0.039) rates of the AH group were significantly higher than those of the non-AH group. The early miscarriage (17.1% vs. 17.8%; P=0.674), monozygotic twin (1.5% vs. 0.90%; P=0.214), and birth defect (3.1% vs. 3.6%; P=0.571) rates were similar in both groups. Conclusions In vitrified-warmed blastocyst transfer cycles, laser AH is associated with high clinical pregnancy and live birth rates. The benefits of AH outweigh its drawbacks, which include prolonged in vitro procedure, thermal damage, and higher workload in the in vitro fertilization laboratory.Trial registration: retrospectively registered

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Revisiting embryo assisted hatching approaches: a systematic review of the current protocols

Cited by 41 publications

References 123 publications

Effect of Laser-Assisted Hatching on the Clinical Outcomes of Human Vitrified-Thawed Embryo Transfer Cycles with Different Post-Thaw Culture Duration

Effect of Laser-Assisted Hatching on the Clinical Outcomes of Human Vitrified-Thawed Embryo Transfer Cycles with Different Post-Thaw Culture Duration

ALADDIN study: does assisted hatching of vitrified/warmed blastocysts improve live birth rate? Protocol for a multicentric randomised controlled trial

Laser-assisted Hatching Improves Live Birth Rate of Vitrified-warmed Blastocyst Transfer Cycles: a Case Control Study

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