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Liu Y, Jones C, Coward K. The Current Practice of Assisted Hatching for Embryos in Fertility Centres: a General Survey. Reprod Sci 2022; 29:2664-2673. [PMID: 35411451 PMCID: PMC9444829 DOI: 10.1007/s43032-022-00931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
At present, there is no standardised protocol for assisted hatching (AH) and the field is beset with contradictory data. We hypothesised that such contradiction may be related to inconsistencies in clinical practice. This study aimed to investigate the application, preferences, and variations of AH in current clinical practice prior to embryo transfer (AHpET) and biopsy (AHpBP). An online voluntary survey, consisted of 25 questions regarding different aspects of AH, was circulated amongst different fertility centres via newsletters between October 2019 and March 2020. One-hundred twenty-nine different fertility centres participated in the survey. AHpBP was widely used (90.6% [48/53]) amongst these centres, especially for trophectoderm biopsy (92.2% [47/51]). In contrast, only 64.6% (73/113) of centres administrated AHpET; the application of AHpET was even lower in UK-based centres (36.6% [15/41]). Although laser pulses have become the predominant technique for AH, significant variation existed in the precise strategy. Zona pellucida (ZP) drilling was the main method for AHpBP, whilst both ZP drilling and ZP thinning were applied equally for AHpET. Furthermore, the ZP manipulation varied widely with regards to the size of the ZP opening and the extension of ZP thinning. This is the first representative survey relating to the current practice of AH. Laser-assisted AH is used extensively, especially for AHpBP. However, there is significant disparity in clinical practice across different centres. Future research should aim to create a standardised protocol for AH to help reduce the evident variation in clinical practice and investigate the true value of AH.
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Affiliation(s)
- Yaqiong Liu
- Nuffield Department of Women's and Reproductive Health, Women's Centre, University of Oxford, John Radcliffe Hospital, Level 3, Headington, Oxford, OX3 9DU, UK
- Present address: Centre for Gene Therapy and Regenerative Medicine, King's College London, Guy's Hospital, 28th Floor, Tower Wing, London, SE1 1UL, UK
| | - Celine Jones
- Nuffield Department of Women's and Reproductive Health, Women's Centre, University of Oxford, John Radcliffe Hospital, Level 3, Headington, Oxford, OX3 9DU, UK
| | - Kevin Coward
- Nuffield Department of Women's and Reproductive Health, Women's Centre, University of Oxford, John Radcliffe Hospital, Level 3, Headington, Oxford, OX3 9DU, UK.
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Hazır S, Kaplanoğlu İ, Özdemir AA, Aldemir O, Özelci R, Kahyaoğlu İ, Dilbaz S. Comparison of the impact of laser-assisted hatching on fresh cleavage and blastocyst embryo transfer and association with pregnancy outcomes. Turk J Obstet Gynecol 2022; 19:130-137. [PMID: 35770480 PMCID: PMC9249366 DOI: 10.4274/tjod.galenos.2022.36690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Assisted hatching (AH) techniques can improve live birth (LB) and clinical pregnancy (CP) rates. Since there are limited data regarding this subject, we investigated the impact of laser-assisted hatching (LAH) on fresh embryo transfer (ET) and association with pregnancy outcomes in unselected patient population. Materials and Methods: This retrospective study included the fresh ETs performed at our center between April 2010 and April 2019. Among 3.782 fresh ETs, 3.286 underwent LAH (n=1.583 at cleavage stage and n=1.703 at blastocyst stage) while 496 underwent non-assisted hatching (NAH) (n=213 at cleavage stage and n=283 at blastocyst stage). The ETs were performed at the blastocyst or cleavage stages, and single or double embryos were transferred. LB rate was the primary outcome, while secondary outcomes were the pregnancy test, monozygotic twinning (MZT), and CP rates. Results: The LAH and NAH groups showed similar LB, pregnancy test, CP, and MZT rates at cleavage and blastocyst stages. On the other hand, LAH significantly affected LB rates at the blastocyst stage (20.6% at blastocyst stage vs. 16% at the cleavage stage, p=0.001). Conclusion: In conclusion, LAH does not improve reproductive outcomes of fresh blastocyst-stage and cleavage-stage ETs. However, LAH significant impacts LB rates in the blastocyst stage than the cleavage stage.
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3
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Yin C, Li LJ, Ma S, Zhao H, Xu L, Li C, Zhao H, Li Q, Xu K, Li M. Efficiency and safety of laser-assisted hatching on vitrified-warmed blastocyst transfer cycles: a prospective control trial. Lasers Med Sci 2021; 37:1931-1942. [PMID: 34802083 DOI: 10.1007/s10103-021-03453-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
To clarify the efficiency and safety of laser-assisted hatching (LAH) application on vitrified-warmed blastocyst transfer (VBT) cycles, we designed the non-randomized concurrent control trial included 4039 VBT cycles in the Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, during the even days from November 2014 to December 2015. The VBT cycles were divided into LAH group (n = 1932) and non-LAH group (n = 2107) according to the date of blastocyst thawing. Laser-partial zona pellucida dissection was performed on all blastocysts thawed on that day every 4 days, and those blastocysts were assigned to the LAH group. There were a higher biochemical pregnancy rate (66.87% vs 63.69%; P = 0.034; rate ratio for LAH vs non-LAH group [RR], 1.050; 95% confidence interval [CI], 1.004-1.098) and an increased live birth rate (48.81% vs 45.51%; P = 0.036; RR, 1.072; 95% CI, 1.005-1.145) with comparable ectopic pregnancy, twin or multiple pregnancies, spontaneous abortion and birth defect rates of the LAH group than those of the non-LAH group. Subgroup analysis showed that live birth rate, birth defect rate, and other pregnancy outcomes were comparable for patients younger than 35 years when blastocyst transfer, patients with endometrium thickness less than 0.9 cm during ovulation or the initiation of progesterone treatment, ICSI blastocysts, AC or BC blastocysts according to Gardner morphological criteria and day 5 blastocysts of the LAH group than it of non-LAH group. LAH could be performed selectively on vitrified-warmed blastocysts before transfer for better pregnancy outcomes. Trial registration number: ChiCTR2000032975. Date of registration: May 17, 2020. Retrospectively registered.
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Affiliation(s)
- Changjian Yin
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Lian-Jie Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Shuiying Ma
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Hui Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Lihong Xu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.,Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Cheng Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Haibin Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Qing Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Kai Xu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Mei Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Shandong, 250012, Jinan, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China. .,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China. .,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China. .,The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250014, China. .,Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, No. 157, Jingliu Road, Shizhong District, Shandong, 250001, Jinan, China.
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Ilina IV, Khramova YV, Ivanova AD, Filatov MA, Silaeva YY, Deykin AV, Sitnikov DS. Controlled hatching at the prescribed site using femtosecond laser for zona pellucida drilling at the early blastocyst stage. J Assist Reprod Genet 2021; 38:517-529. [PMID: 33205358 PMCID: PMC7884559 DOI: 10.1007/s10815-020-01998-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To study whether the application of femtosecond laser pulses for zona pellucida (ZP) drilling of blastocysts at the embryonic or abembryonic poles can promote hatching to start immediately through the hole formed and ensure high hatching rates and embryo viability. METHODS Mouse blastocyst (E3.5) ZP were microdissected with femtosecond laser pulses (514-nm wavelength, 280-fs pulse duration, 2.5-kHz repetition rate) close to the trophoblast or inner cell mass (ICM). The sizes of the holes formed were in the range of 4.5-8.5 μm. Additional longitudinal incisions (5-7-μm long) on either side of the hole were created to determine whether hatching had started at the correct position. Embryos post-laser-assisted ZP drilling and intact embryos were cultured under standard conditions for 2 days; embryo quality was assessed twice daily. The hatching rates and in vitro and in vivo implantation rates (only for embryos with ZP dissected close to the ICM) were estimated. RESULTS Femtosecond laser-assisted ZP drilling at the early blastocyst stage facilitated embryo hatching to start at the artificial opening with probability approaching 100%. Despite the artificial opening's small size, no embryo trapping during hatching was observed. Both experimental groups had higher hatching rates than the control groups (93.3-94.7% vs. 83.3-85.7%, respectively). The in vitro implantation rate was comparable with that of the control group (92.3% vs. 95.4%). No statistically significant differences were obtained in the in vivo implantation rates between the experimental and control groups. CONCLUSIONS Blastocyst-stage femtosecond laser microsurgery of ZP is fast and delicate and enables the hatching process to be initiated in a controlled manner through a relatively small opening, with no embryo trapping.
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Affiliation(s)
- Inna V Ilina
- Joint Institute for High Temperatures of the Russian Academy of Sciences, Izhorskaya st. 13 Bd.2, Moscow, Russian Federation, 125412.
| | - Yulia V Khramova
- Faculty of Biology, Lomonosov Moscow State University, Leninskie Gory, 12-1, Moscow, Russian Federation, 119234
| | - Anna D Ivanova
- Faculty of Biology, Lomonosov Moscow State University, Leninskie Gory, 12-1, Moscow, Russian Federation, 119234
| | - Maxim A Filatov
- Faculty of Biology, Lomonosov Moscow State University, Leninskie Gory, 12-1, Moscow, Russian Federation, 119234
| | - Yuliya Yu Silaeva
- Core Facility Centre, Institute of Gene Biology, Russian Academy of Sciences, Vavilova st. 34/5, Moscow, Russian Federation, 119334
| | - Alexey V Deykin
- Core Facility Centre, Institute of Gene Biology, Russian Academy of Sciences, Vavilova st. 34/5, Moscow, Russian Federation, 119334
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Institute of Gene Biology, Russian Academy of Sciences, Vavilova st. 34/5, Moscow, Russian Federation, 119334
| | - Dmitry S Sitnikov
- Joint Institute for High Temperatures of the Russian Academy of Sciences, Izhorskaya st. 13 Bd.2, Moscow, Russian Federation, 125412
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5
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García-Jiménez M, Rink K, Mestres E, Vanrell I, Calderón G, Costa-Borges N. Evaluation of the impact of laser-assisted hatching techniques on the hatching process of mouse blastocysts using time-lapse microscopy. F&S SCIENCE 2021; 2:43-49. [PMID: 35559763 DOI: 10.1016/j.xfss.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study the effect of zona opening (ZO) and 2 zona thinning (ZT) techniques on the hatching process of mouse embryos using a last-generation laser system and time-lapse microscopy (TLM). DESIGN Prospective randomized study. SETTING Private research center. ANIMALS A total of 267 F1 hybrid (B6/CBA) mice embryos were included. INTERVENTION(S) Morulae were randomly selected and the zona pellucida (ZP) manipulated using a laser system according to 4 experimental groups: control (ZP intact, n = 59), ZO (25 μm hole, n = 70), ZT25 (25% perimeter thinned, n = 71), and ZT35 (35% perimeter thinned, n = 67). Embryo development was monitored by TLM until day 6. MAIN OUTCOME MEASURE(S) Time to first breach the ZP, hatching time, time to complete hatching, multiple breaching, multiple hatching, loss of cells, hole size, and embryo quality were analyzed. RESULT(S) No significant differences in the proportion of completely hatched embryos were found among groups. However, the time (average hours ± SD) to complete hatching was significantly delayed in the control group compared with all laser-treated groups: 118.3 ± 9.5 hours in the ZT25 group, 116.6 ± 8.7 hours in the ZT35 group, and 120.4 ± 9.9 hours in the ZO group. The applied laser techniques did not interfere with the quality of the blastocysts at day 5/6 of culture. CONCLUSION(S) ZO, ZT25, and ZT35 embryos hatched significantly earlier than the zona intact group without increasing the multiple hatching rates, suggesting an improvement of the hatching process. This study found that the pattern of the hatching process after ZT and ZO differs.
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Affiliation(s)
| | - Klaus Rink
- Embryotools R&D Centre Barcelona, Parc Científic de Barcelona, Barcelona, Spain
| | - Enric Mestres
- Embryotools R&D Centre Barcelona, Parc Científic de Barcelona, Barcelona, Spain
| | - Ivette Vanrell
- Embryotools R&D Centre Barcelona, Parc Científic de Barcelona, Barcelona, Spain
| | - Gloria Calderón
- Embryotools R&D Centre Barcelona, Parc Científic de Barcelona, Barcelona, Spain
| | - Nuno Costa-Borges
- Embryotools R&D Centre Barcelona, Parc Científic de Barcelona, Barcelona, Spain.
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Femtosecond laser is effective tool for zona pellucida engraving and tagging of preimplantation mammalian embryos. J Assist Reprod Genet 2019; 36:1251-1261. [PMID: 31147866 DOI: 10.1007/s10815-019-01424-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/14/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Our purpose was to study whether application of femtosecond laser pulses for alphanumeric code marking in the volume of zona pellucida (ZP) could be effective and reliable approach for direct tagging of preimplantation embryos. METHODS Femtosecond laser pulses (wavelength of 514 nm, pulse duration of 280 fs, repetition rate of 2.5 kHz, pulse energy of 20 nJ) were applied for precise alphanumeric code engraving on the ZP of mouse embryos at the zygote stage for individual embryo marking and their accurate identification. Embryo quality assessment every 24 h post laser-assisted marking as well as immunofluorescence staining (for ICM/TE cell number ratio calculation) were performed. RESULTS Initial experiments have started with embryo marking in a single equatorial plane. The codes engraved could be clearly recognized until the thinning of the ZP prior to hatching. Since embryo may change its orientation during the ART cycle, multi-plane code engraving seems to be more practical for simplifying the process of code searching and embryo identification. We have marked the ZP in three planes, and no decrease in developmental rates as well as no morphological changes of embryos post laser-assisted engraving have been observed as compared to control group embryos. CONCLUSIONS Our results demonstrate the suitability of femtosecond laser as a novel tool for noninvasive embryo tagging, enabling embryo identification from day 0.5 post coitum to at least early blastocyst stage. Thus, the versatility and the potential use of femtosecond lasers in the field of developmental biology and assisted reproduction have been shown.
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Davidson LM, Liu Y, Griffiths T, Jones C, Coward K. Laser technology in the ART laboratory: a narrative review. Reprod Biomed Online 2019; 38:725-739. [DOI: 10.1016/j.rbmo.2018.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/01/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022]
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Lee JW, Cha JH, Shin SH, Kim YJ, Lee SK, Park CK, Pak KA, Yoon JS, Park SY. Effects of laser-assisted thinning versus opening on clinical outcomes according to maternal age in patients with repeated implantation failure. Lasers Med Sci 2019; 34:1889-1895. [PMID: 31044362 DOI: 10.1007/s10103-019-02787-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
Laser-assisted thinning (LAT) and laser-assisted opening (LAO) are performed as part of human in vitro fertilization (IVF) to increase the implantation rate in patients with a poor prognosis and in cases of repeated implantation failure. However, an insufficient number of studies have directly compared LAT and LAO using the same methods. Therefore, we compared the effects of LAT and LAO on clinical outcomes according to maternal age in patients with repeated implantation failure. This retrospective study was performed in 509 IVF cycles (458 patients). The cycles were divided based on maternal age and the method used (< 38 years LAT, n = 119 vs. LAO, n = 179 and ≥ 38 years LAT, n = 72 vs. LAO, n = 139). Cleavage-stage embryos before transfer were either thinned or opened using a 1.46-μm noncontact diode laser. We compared the implantation rates and pregnancy outcomes of cycles between LAT and LAO according to maternal age. The characteristics of patients did not differ significantly among the groups (p > 0.05), with the exception of mixed factor infertility, which was more common in the LAT group than in the LAO group among patients < 38 years of age (10.1% vs. 2.8%, p = 0.008). The LAT and LAO groups showed similar rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, abortion, implantation, singleton pregnancy, and twin pregnancy (p > 0.05). In conclusion, LAT and LAO had similar clinical outcomes. Therefore, we did not find any evidence that LAT is superior to LAO. In fact, the patients ≥ 38 years of age who underwent LAO tended to have a lower abortion rate. Further study is necessary to confirm these results in a larger population.
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Affiliation(s)
- Jung-Woo Lee
- Agaon Fertility Clinic, Seoul, 08391, South Korea.,College of Animal Life Science, Kangwon National University, Chuncheon, 24341, South Korea
| | - Jeong-Ho Cha
- Agaon Fertility Clinic, Seoul, 08391, South Korea.
| | - Sun-Hee Shin
- Agaon Fertility Clinic, Seoul, 08391, South Korea.,College of Animal Life Science, Kangwon National University, Chuncheon, 24341, South Korea
| | | | - Seul-Ki Lee
- Agaon Fertility Clinic, Seoul, 08391, South Korea
| | - Choon-Keun Park
- College of Animal Life Science, Kangwon National University, Chuncheon, 24341, South Korea
| | - Kyung-Ah Pak
- Agaon Fertility Clinic, Seoul, 08391, South Korea
| | - Ji-Sung Yoon
- Agaon Fertility Clinic, Seoul, 08391, South Korea
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Lu X, Liu Y, Cao X, Liu SY, Dong X. Laser-assisted hatching and clinical outcomes in frozen-thawed cleavage-embryo transfers of patients with previous repeated failure. Lasers Med Sci 2019; 34:1137-1145. [DOI: 10.1007/s10103-018-02702-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022]
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10
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Tannus S, Cohen Y, Henderson S, Son WY, Tulandi T. The Effect of Assisted Hatching on Live Birth Rate Following Fresh Embryo Transfer in Advanced Maternal Age. Reprod Sci 2018; 26:806-811. [PMID: 30213229 DOI: 10.1177/1933719118799192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted hatching (AH) was introduced 3 decades ago as an adjunct method to in vitro fertilization (IVF) and embryo transfer (ET) to improve embryo implantation rate. Limited data are available on the effect of AH on live birth rate (LBR) in advanced maternal age. The objective of this study is to investigate the effect of AH on LBR in women aged 40 years and older. MATERIALS AND METHODS A retrospective study conducted at a single academic reproductive center. Women aged ≥40 years, who were undergoing their first IVF cycle were included. Laser-assisted hatching was the method used for AH and single or double embryos were transferred. Embryo transfer was performed at the cleavage or blastocyst stage. Separate analysis was performed on each ET stage. Live birth rate was the primary outcome. RESULTS A total of 892 patients were included. Of these, 681 women underwent cleavage ET and 211 underwent blastocyst ET. The clinical pregnancy rate in the entire group was 15.3% and the LBR was 10.2%. Baseline and cycle parameters between the AH group and the control group were comparable. Assisted hatching in the cleavage stage was associated with lower clinical pregnancy rate (odds ratio [OR], 0.52; confidence interval [CI], 0.31-0.86; P = .012) and lower LBR (OR, 0.36; CI, 0.19-0.68; P = .001). Assisted hatching did not have any effect on outcomes in blastocyst ET. CONCLUSION Assisted hatching does not improve the reproductive outcomes in advanced maternal age. Performing routine AH for the sole indication of advanced maternal age is not clinically justified.
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Affiliation(s)
- Samer Tannus
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1.
| | - Yoni Cohen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
| | - Sara Henderson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
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11
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Alteri A, Viganò P, Maizar AA, Jovine L, Giacomini E, Rubino P. Revisiting embryo assisted hatching approaches: a systematic review of the current protocols. J Assist Reprod Genet 2018; 35:367-391. [PMID: 29350315 PMCID: PMC5904073 DOI: 10.1007/s10815-018-1118-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
Zona pellucida (ZP) manipulation, termed "assisted hatching" (AH), has been introduced in order to favor embryo hatching and ultimately improve assisted reproductive technology success but with poor proofs of safety and biological plausibility. We herein provide a systematic review of clinical outcomes following the application of different methods of ZP manipulation on fresh or frozen/thawed embryos at different developmental stages in different groups of patients. Out of the 69 papers that compared the clinical outcomes deriving from hatched versus non-hatched embryos, only 11 considered blastocysts while the rest referred to cleavage stage embryos. The ZP thinning of fresh embryos either by chemical or laser approach was shown to provide very limited benefit in terms of clinical outcomes. Better results were observed with procedures implying a higher degree of zona manipulation, including zona removal. Studies comparing the mechanical or chemical procedures to those laser-mediated consistently reported a superiority of the latter ones over the former. Literature is consistent for a benefit of ZP breaching in thawed blastocysts. This review provides the current knowledge on the AH procedure in order to improve its efficacy in the appropriate context. Embryologists might benefit from the approaches presented herein in order to improve Assisted Reproduction Technologies (ART) outcomes.
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Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Ahmad Abu Maizar
- California Fertility Partners, 11818 Wilshire Blvd, Los Angeles, CA, 90025, USA
| | - Luca Jovine
- Department of Biosciences and Nutrition & Center for Innovative Medicine, Karolinska Institutet, Hälsovägen 7, SE-141 83, Huddinge, Sweden
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Patrizia Rubino
- HRC Fertility, 333 South Arroyo Parkway, Pasadena, CA, 91105, USA
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Halvaei I, Ghazali S, Nottola SA, Khalili MA. Cleavage-stage embryo micromanipulation in the clinical setting. Syst Biol Reprod Med 2018; 64:157-168. [PMID: 29297236 DOI: 10.1080/19396368.2017.1422197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Embryo micromanipulation was developed after introduction of microinjection to overcome infertility. Embryo micromanipulation may be performed at any embryo stage from pronuclear to blastocyst. The technique started out as basic and turned out to be increasingly more complex. Embryo micromanipulation at the cleavage-stage includes a wide range of techniques, from opening the zona pellucida in order to improve the chance of implantation, to removing detrimental components from the embryo to enhance embryo development or blastomeres for preimplantation genetic diagnosis and embryo splitting. Evaluating the impact(s) of different micromanipulation techniques on epigenetics of the embryo and considering quality control during these techniques are important issues in this regard. This review aims to discuss the micromanipulation of cleavage-stage embryos in clinical assisted reproductive technology (ART). ABBREVIATIONS ART: assisted reproductive technology; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; PGD: preimplantation genetic diagnosis; PZD: partial zona dissection; ZP: zona pellucida; SUZI: subzonal insemination; PVS: perivitelline space; AH: assisted hatching; LAH: laserassisted hatching; ZT: zona thinning; UV: ultraviolet; IR: infrared; PCR: polymerase chain reaction; FISH: fluorescent in situ hybridization; NGS: next generation sequencing; QC: quality control; QA: quality assurance.
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Affiliation(s)
- Iman Halvaei
- a Department of Anatomical Sciences, Faculty of Medical Sciences , Tarbiat Modares University , Tehran , Iran
| | - Shahin Ghazali
- b Department of Midwifery, Islamic Azad University, Sanandaj Branch , Sanandaj , Iran
| | - Stefania A Nottola
- c Department of Anatomy, Histology, Forensic Medicine and Orthopaedics , La Sapienza University of Rome , Rome , Italy
| | - Mohammad Ali Khalili
- d Research and Clinical Center for Infertility , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
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Uppangala S, D'Souza F, Pudakalakatti S, Atreya HS, Raval K, Kalthur G, Adiga SK. Laser assisted zona hatching does not lead to immediate impairment in human embryo quality and metabolism. Syst Biol Reprod Med 2016; 62:396-403. [PMID: 27598006 DOI: 10.1080/19396368.2016.1217952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Laser assisted zona hatching (LAH) is a routinely used therapeutic intervention in assisted reproductive technology for patients with poor prognosis. However, results are not conclusive in demonstrating the benefits of zona hatching in improving the pregnancy rate. Recent observations on LAH induced genetic instability in animal embryos prompted us to look into the effects of laser assisted zona hatching on the human preimplantation embryo quality and metabolic uptake using high resolution nuclear magnetic resonance (NMR) technology. This experimental prospective study included fifty embryos from twenty-five patients undergoing intra cytoplasmic sperm injection. Embryo quality assessment followed by profiling of spent media for the non-invasive evaluation of metabolites was performed using NMR spectroscopy 24 hours after laser treatment and compared with that of non-treated sibling embryos. Both cell number and embryo quality on day 3 of development did not vary significantly between the two groups at 24 hours post laser treatment interval. Time lapse monitoring of the embryos for 24 hours did not reveal blastomere fragmentation adjacent to the point of laser treatment. Similarly, principal component analysis of metabolites did not demonstrate any variation across the groups. These results suggest that laser assisted zona hatching does not affect human preimplantation embryo morphology and metabolism at least until 24 hours post laser assisted zona hatching. However, studies are required to elucidate laser induced metabolic and developmental changes at extended time periods. ABBREVIATIONS AH: assisted hatching; ART: assisted reproductive technology; DNA: deoxy-ribo nucleic acid; LAH: laser assisted hatching; MHz: megahertz; NMR: nuclear magnetic resonance; PCA: principal component analysis; PGD: preimplantation genetic diagnosis; TLM: time lapse monitoring.
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Affiliation(s)
- Shubhashree Uppangala
- a Division of Clinical Embryology , Kasturba Medical College, Manipal University , Manipal , India
| | - Fiona D'Souza
- a Division of Clinical Embryology , Kasturba Medical College, Manipal University , Manipal , India
| | - Shivanand Pudakalakatti
- b NMR Research Centre, Indian Institute of Science , Bangalore , India.,c Solid State and Structural Chemistry Unit , Indian Institute of Science , Bangalore , India
| | - Hanudatta S Atreya
- b NMR Research Centre, Indian Institute of Science , Bangalore , India.,c Solid State and Structural Chemistry Unit , Indian Institute of Science , Bangalore , India
| | - Keyur Raval
- d National Institute of Technology Karnataka (NITK) , Surathkal , India
| | - Guruprasad Kalthur
- a Division of Clinical Embryology , Kasturba Medical College, Manipal University , Manipal , India
| | - Satish Kumar Adiga
- a Division of Clinical Embryology , Kasturba Medical College, Manipal University , Manipal , India
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Wang EH, Wang AC, Wang BS, Li B. Outcomes of vitrified-warmed cleavage-stage embryo hatching after in vitro laser-assisted zona pellucida thinning in patients. Biomed Rep 2016; 5:376-382. [PMID: 27602216 DOI: 10.3892/br.2016.716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/08/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to determine whether the size of the zona pellucida (ZP) thinning area by laser-assisted hatching affected the potential development of vitrified-warmed embryos. A total of 196 vitrified-warmed cleavage-stage embryos (from 49 patients, four sister embryos per patient) were used in the study, i.e., four sister embryos from each patient were randomly assigned to four groups: a control group of embryos that were not zona-manipulated (zona intact, group A); one experimental group of embryos in which a quarter of the zona pellucida was thinned using laser-assisted ZP thinning (group B); a second experimental group of embryos in which half of ZP was thinned (group C); and a third group in which two-thirds of the ZP was thinned (group D). Subsequent blastocyst development was assessed. Microscopy was performed to study the hatching process of the embryos after zona thinning. The blastocyst formation rates were 71.43% in group A, 67.35% in group B, 65.31% in group C, and 51.02% in group D (groups B-D vs. group A, P=0.661, P=0.515, P=0.038, respectively). The rates of complete hatching were 30.61% in group A, 38.78% in group B, 61.22% in group C, and 48.98% in group D (groups B-D vs. group A, P=0.396, P=0.002, P=0.063, respectively). For a subgroup of patients, there was a significant difference in the complete hatching in all the groups for women aged <35 years (P=0.011), and there was a significant difference in the complete hatching in all the groups for secondary infertility women (P=0.022). There was no significant difference in the blastocyst formation rates in the different groups of women aged ≥35 years (P=0.340). In addition, there was no significant difference in the complete hatching in the different groups among women aged ≥35 years (P=0.492). The results of the present study showed that in vitrified-warmed embryo transfers at the cleavage-stage, and the two-thirds zona pellucida thinning group demonstrated a significantly decreased blastocyst formation rate compared with the control group, while the half zona pellucida thinning group demonstrated a significantly increased complete hatching rate compared with the control group, which may have a high value in clinical application.
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Affiliation(s)
- En-Hua Wang
- Department of Genetic Teaching and Research Section, Shandong Medical College, Linyi, Shandong 276000, P.R. China
| | - An-Cong Wang
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China; Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Bao-Song Wang
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Bin Li
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
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Lee YS, Park MJ, Park SH, Koo JS, Moon HS, Joo BS. Effect of laser-assisted multi-point zona thinning on development and hatching of cleavage embryos in mice. Clin Exp Reprod Med 2015; 42:51-7. [PMID: 26161333 PMCID: PMC4496431 DOI: 10.5653/cerm.2015.42.2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to examine the effect of laser-assisted zona thinning (LAZT) at one or four-points on the blastocyst formation and hatching process in mice with respect to female age. METHODS Eight-cell or morula embryos collected from superovulated C57BL female mice with different ages (6-11 and 28-31 weeks) were treated with LAZT at one-point (LAZT1) or four-points (LAZT4). The zona pellucida was thinned to more than 70% of its initial thickness by making two holes of 15-20 µm. RESULTS In the young mice, LAZT resulted in a significant increase in early hatching and hatching rates compared to the control group (p<0.05). However, in the old mice, LAZT significantly increased blastocyst formation as well as early hatching and hatching compared to the controls (p<0.05). These effects were more remarkable in LAZT4 than in LAZT1 and in aged mice than in young ones. CONCLUSION These results show that multi-point LAZT leads to a significant improvement of blastocyst formation and hatching in mice compared to controls.
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Affiliation(s)
- Young Seok Lee
- Department of Pediatric Cardiology, Dong-A University Hospital, Busan, Korea
| | - Min Jung Park
- Research Center for Anti-Aging Technology Development, Pusan National University, Busan, Korea
| | - Sea Hee Park
- Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Korea
| | - Ja Seong Koo
- Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Korea
| | - Hwa Sook Moon
- Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Korea
| | - Bo Sun Joo
- Research Center for Anti-Aging Technology Development, Pusan National University, Busan, Korea
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Lu HF, Peng FS, Chen SU, Chiu BC, Yeh SH, Hsiao SM. The outcomes of intracytoplasmic sperm injection and laser assisted hatching in women undergoing in vitro fertilization are affected by the cause of infertility. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:33-40. [PMID: 25918590 PMCID: PMC4410035 DOI: 10.22074/ijfs.2015.4206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/28/2014] [Indexed: 11/12/2022]
Abstract
Background We sought to determine the association between factors that affected clini-
cal pregnancy and live birth rates in patients who underwent in vitro fertilization (IVF)
and received intracytoplasmic sperm injection (ICSI) and/or laser assisted hatching
(LAH), or neither. Materials and Methods In this retrospective cohort study, the records of women
who underwent IVF with or without ICSI and/or LAH at the Far Eastern Memorial
Hospital, Taipei, Taiwan between January 2007 and December 2010 were reviewed.
We divided patients into four groups: 1. those that did not receive ICSI or LAH,
2. those that received ICSI only, 3. those that received LAH only and 4. those that
received both ICSI and LAH. Univariate and multivariate analyses were performed
to determine factors associated with clinical pregnancy rate and live birth rate in
each group. Results A total of 375 women were included in the analysis. Oocyte number (OR=1.07)
affected the live birth rate in patients that did not receive either ICSI or LAH. Mater-
nal age (OR=0.89) and embryo transfer (ET) number (OR=1.59) affected the rate in
those that received ICSI only. Female infertility factors other than tubal affected the rate
(OR=5.92) in patients that received both ICSI and LAH. No factors were found to affect
the live birth rate in patients that received LAH only. Conclusion Oocyte number, maternal age and ET number and female infertility fac-
tors other than tubal affected the live birth rate in patients that did not receive ICSI
or LAH, those that received ICSI only, and those that received both ICSI and LAH,
respectively. No factors affected the live birth rate in patients that received LAH only.
These data might assist in advising patients on the appropriateness of ICSI and LAH
after failed IVF.
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Affiliation(s)
- Hsin-Fen Lu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Fu-Shiang Peng
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bao-Chu Chiu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Szu-Hsing Yeh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
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Zhou H, Zao W, Zhang W, Shi J, Shi W. No adverse effects were identified on the perinatal outcomes after laser-assisted hatching treatment. Reprod Biomed Online 2014; 29:692-8. [PMID: 25444502 DOI: 10.1016/j.rbmo.2014.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the safety of laser-assisted hatching (LAH) by comparing obstetric and neonatal outcomes between assisted hatching and control groups in cryopreserved embryo transfer cycles. A retrospective cohort analysis was carried out. A total of 699 women with 392 infants delivered were included. Laser- assisted hatching was carried out on D-3 thawed and warmed embryos before transfer in 480 cryopreserved embryos transfer cycles. Obstetric outcomes, neonatal outcomes, and congenital birth defects were recorded. A total of 815 cryopreserved embryo transfer cycles (480 in LAH group and 335 in control group) in 699 patients were analysed. Statistically significantly higher implantation (31.85% versus 16.95%), clinical pregnancy (53.96% versus 33.43%) and live delivery (44.58% versus 23.88%) rates were observed in the LAH group (all P < 0.001). For either singleton or multiple gestations, no statistically significant differences were found in mean gestational age, mean birth weight and mean Apgar score. Four major malformations occurred in the assisted hatching group and three malformations (one major and two minor) in the control group. This study did not identify any harmful effect of LAH on neonates, which suggested that LAH may be a safe treatment in cryopreserved embryo transfer cycles.
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Affiliation(s)
- Hanying Zhou
- Assisted Reproduction Center, Maternal & Child Health Care Hospital of Shaanxi Province, Xi'an Houzai Gate 73#, Xi'an 710003, China
| | - Wanqiu Zao
- Respiratory Internal Medicine, Shaanxi Provincial People's Hospital, YouYiXilu 236#, Xi'an 710068, China
| | - Wei Zhang
- Assisted Reproduction Center, Maternal & Child Health Care Hospital of Shaanxi Province, Xi'an Houzai Gate 73#, Xi'an 710003, China
| | - Juanzi Shi
- Assisted Reproduction Center, Maternal & Child Health Care Hospital of Shaanxi Province, Xi'an Houzai Gate 73#, Xi'an 710003, China.
| | - Wenhao Shi
- Assisted Reproduction Center, Maternal & Child Health Care Hospital of Shaanxi Province, Xi'an Houzai Gate 73#, Xi'an 710003, China
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Honguntikar SD, Uppangala S, Salian SR, Kalthur G, Kumar P, Adiga SK. Laser-assisted hatching of cleavage-stage embryos impairs developmental potential and increases DNA damage in blastocysts. Lasers Med Sci 2014; 30:95-101. [DOI: 10.1007/s10103-014-1625-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
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Park SB, Kim HJ, Choi YB, Ahn KH, Lee KH, Yang JB, Yu CS, Seo BB. The effect of various assisted hatching techniques on the mouse early embryo development. Clin Exp Reprod Med 2014; 41:68-74. [PMID: 25045630 PMCID: PMC4102692 DOI: 10.5653/cerm.2014.41.2.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/03/2014] [Accepted: 04/14/2014] [Indexed: 11/17/2022] Open
Abstract
Objective In search of an ideal method of assisted hatching (AH), we compared the effects of conventional micropipette-AH and laser-AH on the blastocyst formation rate (BFR) and blastocyst cell numbers. Methods Four- to five-week-old ICR female mice were paired with male mice after superovulation using Pregnant mare's serum gonadotropin (PMSG) and hCG. The two-cell embryos were flushed from the oviducts of female mice. The retrieved two-cell embryos underwent one of five AH procedures: single mechanical assisted hatching (sMAH); cross mechanical assisted hatching (cMAH); single laser assisted hatching (sLAH); quarter laser assisted hatching (qLAH); and quarter laser zona thinning assisted hatching (qLZT-AH). After 72 hours incubation, double immunofluorescence staining was performed. Results Following a 72 hours incubation, a higher hatching BFR was observed in the control, sMAH, cMAH, and sLAH groups, compared to those in the qLAH and qLZT-AH groups (p<0.05). The hatched BFR was significantly higher in the qLAH and qLZT-AH groups than in the others (p<0.05 for each group). The inner cell mass (ICM) was higher in the control and sMAH group (p<0.05). The trophectoderm cell number was higher in the cMAH and qLAH groups (p<0.05). Conclusion Our results showed that the hatched BFR was higher in groups exposed the the qLAH and qLZT-AH methods compared to groups exposed to other AH methods. In the qLAH group, although the total cell number was significantly higher than in controls, the ICM ratio was significantly lower in than controls.
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Affiliation(s)
| | - Hye Jin Kim
- Department of Obstetrics and Gynecology, Chungnam National Hospital, Daejeon, Korea
| | | | - Kwang Hwa Ahn
- Fertility Clinic, Mirae Ladies Hospital, Daejeon, Korea
| | - Kee Hwan Lee
- Department of Obstetrics and Gynecology, Chungnam National Hospital, Daejeon, Korea
| | - Jung Bo Yang
- Department of Obstetrics and Gynecology, Chungnam National Hospital, Daejeon, Korea
| | - Chang Seok Yu
- Department of Animal Resources, Daegu University, Gyeongsan, Korea
| | - Byoung Boo Seo
- Department of Animal Resources, Daegu University, Gyeongsan, Korea
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Figueira RDCS, Braga DPDAF, Setti AS, Iaconelli A, Borges E. Relevance of assisted hatching in an oocyte donation programme using egg cryobanking: a prospective randomised study. Eur J Obstet Gynecol Reprod Biol 2012; 164:48-51. [PMID: 22672993 DOI: 10.1016/j.ejogrb.2012.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/11/2012] [Accepted: 05/04/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this prospective randomised study was to evaluate if there is an improvement in clinical outcomes when assisted hatching (AH) is performed in embryos derived from vitrified/warmed oocytes in an ovum donation programme using egg cryobanking. STUDY DESIGN Sixty oocyte recipients in a donation programme using egg cryobanking were randomly allocated to the assisted hatched (AH, n=30) or control group (n=30). The pregnancy and implantation rates were compared between the groups. RESULTS A total of 288 vitrified oocytes were warmed for the 60 recipients. Of the 288 vitrified oocytes, 94.8% survived. All surviving oocytes were sperm injected, and 83.5% underwent fertilisation. There were 172 good-quality embryos selected for transfer. The total pregnancy rate was 40%. The pregnancy rate did not differ between the AH and control groups (43.3% and 33.3%, respectively, p=0.1967), but AH resulted in a higher implantation rate (31.6% vs. 18.4%, p=0.0206). CONCLUSION Our study demonstrates the effectiveness of AH in embryos derived from warmed oocytes. Our results also suggest that oocyte cryopreservation can be considered as a tool for providing highly successful outcomes in an egg donor programme.
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Affiliation(s)
- Rita de Cássia S Figueira
- Fertility - Assisted Fertilization Centre, Av. Brigadeiro Luis, 4545. São Paulo, SP 01401 002, Brazil
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Martins WP, Rocha IA, Ferriani RA, Nastri CO. Assisted hatching of human embryos: a systematic review and meta-analysis of randomized controlled trials. Hum Reprod Update 2011; 17:438-453. [DOI: 10.1093/humupd/dmr012] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Laser assisted zona hatching: What is the evidence to justify its use? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2011.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hammadeh ME, Fischer-Hammadeh C, Ali KR. Assisted hatching in assisted reproduction: a state of the art. J Assist Reprod Genet 2011; 28:119-28. [PMID: 21042844 PMCID: PMC3059528 DOI: 10.1007/s10815-010-9495-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 10/11/2010] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization estimates that one in six couples experience some delay in conception and an increasing number require treatment by the assisted conception (AC) procedures of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).The implantation rate of embryos resulting from in vitro fertilization cycles is generally less than 20%. The exposure of oocytes and embryos to the artificial conditions of in vitro culture may have negative effects on the embryo's ability to undergo normal hatching, resulting in low rates of implantation following IVF and embryo transfer. Human embryos resulting from superovulation develop more slowly in vitro compared to embryos in vivo, manifest a relatively high degree of cytogenetic abnormalities and undergo cellular fragmentation. Artificially disrupting the zona pellucida is known as assisted hatching (AH) and there is some evidence that embryos that have undergone zona manipulation for assisted hatching tend to implant one day earlier than unhatched embryos. A variety of techniques have since been employed to assist embryo hatching, including partial mechanical zona dissection, zona drilling and zona thinning, making use of acid tyrodes, proteinases, piezon vibrator manipulators and lasers. This review will consider the impact of IVF conditions on zona pellucida physiology, zona hardening, different techniques of assisted hatching, who may benefit from assisted hatching and potential hazards.
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Affiliation(s)
- Mohamad Eid Hammadeh
- Obstetrics and Gynaecology Department, Assisted Reproduction Technology Unit, University of Saarland, Homburg/Saar, Germany.
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Laser assisted zona thinning technique has no beneficial effect on the ART outcomes of two different maternal age groups. J Assist Reprod Genet 2010; 27:457-61. [PMID: 20467801 DOI: 10.1007/s10815-010-9431-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Laser assisted zona thinning is a technique used for facilitating embryo's hatching process and is commonly used for the embryos of poor prognosis patients with advanced maternal age, repeated implantation failures, poor embryo quality or thick zona pellucida. The aim of this study was to investigate the effect of zona thinning on both good or poor prognosis patients of two different age groups. METHODS We investigated two different age groups (group 1: <35 years and group 2: ≥35 years ) and compared the effect of assisted zona thinning (groups 1A and 2A) versus not-thinned controls (groups 1B and 2B) in both groups. RESULTS The clinical pregnancy rates were 57% and 56% in groups 1A and 1B (p = 0.86), 43% and 38% in groups 2A and 2B (p = 0.59) respectively. CONCLUSIONS Our results suggest that laser assisted zona thinning of day 3 embryos has no beneficial effect on clinical pregnancy and implantation outcomes.
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Hiraoka K, Hiraoka K, Horiuchi T, Kusuda T, Okano S, Kinutani M, Kinutani K. Impact of the size of zona pellucida thinning area on vitrified-warmed cleavage-stage embryo transfers: a prospective, randomized study. J Assist Reprod Genet 2009; 26:515-21. [PMID: 19830543 DOI: 10.1007/s10815-009-9350-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 10/01/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to determine if the size of zona pellucida thinning area by laser assisted hatching could affect the rates of pregnancy and implantation for vitrified-warmed embryo transfers at the cleavage-stage. METHODS A total of 120 vitrified-warmed cleavage-stage embryo transfers were randomly assigned to either quarter or half of zona pellucida thinning group. RESULTS The rates of clinical pregnancy (46.7 versus 25.0%) and implantation (32.0 versus 16.2%) were significantly greater in the half thinning group than in the quarter thinning group (P = 0.0218 and P = 0.0090, respectively). CONCLUSIONS The results of this investigation show that, in vitrified-warmed embryo transfers at the cleavage-stage, the size of zona pellucida thinning area by laser assisted hatching impacts the rate of clinical pregnancy and implantation and that half of zona pellucida thinning significantly increases both of these results compared with quarter of zona pellucida thinning.
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Affiliation(s)
- Kenichiro Hiraoka
- Kinutani Women's Clinic, 8-23-4F, Hondori, Naka-ku, Hiroshima 730-0035, Japan.
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Blessmann-Roset J, Rives N, Clavier B, Milazzo JP, Mazurier S, Mousset-Siméon N, Macé B. [Laser assisted hatching: Rouen University Hospital outcomes]. ACTA ACUST UNITED AC 2009; 37:313-20. [PMID: 19346148 DOI: 10.1016/j.gyobfe.2009.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 01/08/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite technical progress in In Vitro Fertilisation (IVF) procedure, embryo implantation rate remains low. Assisted hatching has been proposed to facilitate natural embryo hatching and implantation. PATIENTS AND METHODS Our study has evaluated whether laser assisted hatching improves implantation, pregnancy and live birth rates in different cases. We studied retrospectively 143 IVF cycles concerning more than 38 years old women, 166 IVF cycles after two previous implantation failures and 180 frozen-thawed embryo transfers. RESULTS Population characteristics were comparable in hatched and control groups. Implantation, pregnancy and live birth rates in women more than 38 years old were comparable with or without assisted hatching. Concerning repeated implantation failures, even if implantation, pregnancy and live birth rates were higher in assisted hatching group (FIV or ICSI), the differences were not significant. After frozen-thawed embryo transfers, implantation rate was significantly better with assisted hatching (19.14% vs 8.84% [p=0.02]). DISCUSSION AND CONCLUSION Assisted hatching improves embryo implantation rate after frozen-thawed embryo transfer.
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Affiliation(s)
- J Blessmann-Roset
- EA 4308 spermatogenèse et qualité du gamète male, laboratoire de biologie de la reproduction, CECOS, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
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The role of assisted hatching in in vitro fertilization: a review of the literature. A Committee opinion. Fertil Steril 2008; 90:S196-8. [PMID: 19007629 DOI: 10.1016/j.fertnstert.2008.08.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 12/02/2005] [Accepted: 12/02/2005] [Indexed: 11/28/2022]
Abstract
This Committee Opinion reviews the published literature regarding appropriate usage of assisted hatching as a part of in vitro fertilization.
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Hiraoka K, Fuchiwaki M, Hiraoka K, Horiuchi T, Murakami T, Kinutani M, Kinutani K. Effect of the size of zona pellucida opening by laser assisted hatching on clinical outcome of frozen cleaved embryos that were cultured to blastocyst after thawing in women with multiple implantation failures of embryo transfer: a retrospective study. J Assist Reprod Genet 2008; 25:129-35. [PMID: 18365308 DOI: 10.1007/s10815-008-9214-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 03/03/2008] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the effect of the size of zona pellucida opening by laser assisted hatching for frozen cleaved embryo that were thawed after both fresh and frozen cleaved embryo transfer cycles failed and were cultured to blastocyst after thawing in patients with multiple implantation failures. MATERIALS AND METHODS Of 101 consecutive procedures (October 2003 to June 2006), 30 patients declined to perform assisted hatching and were selected as control group, 40 patients had 40 microm opening of the zona (October 2003 to January 2005), 31 patients had 50% of the zona opening (February 2005 to June 2006). RESULTS The pregnancy, implantation and delivery rates were significantly higher in 50% opening group (74%, 52% and 65%) compared to control group (17%, 10% and 13%; P < 0.01) and 40 microm opening group (43%, 27% and 38%; P < 0.04). CONCLUSIONS The size of the zona pellucida opening may affect the outcome of frozen cleaved embryo transfer.
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Affiliation(s)
- Kenichiro Hiraoka
- Kinutani Women's Clinic, 8-23-4F, Hondori, Naka-ku, Hiroshima 730-0035, Japan.
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Feng HL, Hershlag A, Scholl GM, Cohen MA. A retroprospective study comparing three different assisted hatching techniques. Fertil Steril 2008; 91:1323-5. [PMID: 18394610 DOI: 10.1016/j.fertnstert.2008.02.133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/19/2008] [Accepted: 02/19/2008] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the effect of four different assisted hatching techniques on pregnancy rates in women with prior IVF failure in fresh IVF cycles. The results suggested that assisted hatching utilizing laser, chemical, or microsurgical techniques increases both implantation and pregnancy rates.
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Affiliation(s)
- Huai L Feng
- Center for Human Reproduction, North Shore University Hospital, NYU School of Medicine, Manhasset, New York 11030, USA.
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Valojerdi MR, Eftekhari-Yazdi P, Karimian L, Ashtiani SK. Effect of laser zona pellucida opening on clinical outcome of assisted reproduction technology in patients with advanced female age, recurrent implantation failure, or frozen-thawed embryos. Fertil Steril 2007; 90:84-91. [PMID: 17889864 DOI: 10.1016/j.fertnstert.2007.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 06/04/2007] [Accepted: 06/04/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether laser-assisted hatching can improve clinical outcome of assisted reproductive techniques in patients with advanced female age, with recurrent implantation failure, or who are using frozen-thawed embryos. DESIGN A prospective randomized study. SETTING The infertility and IVF unit at a research facility in Iran. PATIENT(S) Four hundred ten patients with advanced female age (> or =37 y), 796 patients with recurrent implantation failure (for > or =2 cycles), and 180 patients with frozen-thawed embryos. INTERVENTION(S) Patients were divided equally into test and control groups. On the day of embryo transfer, the zona pellucida of the selected embryos in the test group were opened about 40 mum by using an infrared optical laser system, whereas in the control group they were all intact. MAIN OUTCOME MEASURE(S) Clinical pregnancy rates and implantation rates. RESULT(S) In the patients with advanced female age or recurrent implantation failure, the clinical pregnancy and implantation rates were similar for the test and control groups. However, in the patients with frozen-thawed embryos, the rates were statistically significantly higher in the test group as compared with those of the control group (31.2% and 12.8% vs. 11.1% and 4.2%, respectively). CONCLUSION(S) The laser-assisted hatching improved the pregnancy and implantation rates in patients with frozen-thawed embryos but had no effect in patients with advanced female age or recurrent implantation failure.
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Ng EHY, Lau EYL, Yeung WSB, Cheung TM, Tang OS, Ho PC. Randomized double-blind comparison of laser zona pellucida thinning and breaching in frozen-thawed embryo transfer at the cleavage stage. Fertil Steril 2007; 89:1147-1153. [PMID: 17662284 DOI: 10.1016/j.fertnstert.2007.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 05/09/2007] [Accepted: 05/09/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the implantation and ongoing pregnancy rates of frozen-thawed embryo transfer (FET) using laser thinning with those of laser breaching of the zona pellucida (ZP). DESIGN Double-blind randomized study. SETTING A tertiary assisted reproduction unit. PATIENT(S) Infertile patients undergoing FET cycles. INTERVENTION(S) In the thinning group, more than a quarter of the ZP's outer half-diameter was removed by using a 1,480-nm noncontact laser, whereas a hole about 30 microm in size was created in the ZP in the breaching group. MAIN OUTCOME MEASURE(S) Implantation and ongoing pregnancy rates. RESULT(S) On the day of the FET, 180 patients were randomly divided into the thinning and breaching groups according to a computer-generated randomization list that was placed in sealed envelopes. The two groups were comparable in terms of demographic characteristics, ovarian response of the stimulated cycle, and quality of fresh and frozen-thawed embryos. The implantation and ongoing pregnancy rates of the thinning group were significantly higher than the corresponding rates of the breaching group but were similar to those of patients without ZP thinning or breaching. CONCLUSION(S) Laser ZP thinning is associated with significantly higher implantation and ongoing pregnancy rates in FET cycles compared with the case of laser ZP breaching.
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Affiliation(s)
- Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Estella Yee Lan Lau
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Tak Ming Cheung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Oi Shan Tang
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Grace J, Bolton V, Braude P, Khalaf Y. Assisted hatching is more effective when embryo quality was optimal in previous failed IVF/ICSI cycles. J OBSTET GYNAECOL 2007; 27:56-60. [PMID: 17365461 DOI: 10.1080/01443610601056335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Assisted hatching (AH) was developed as a possible solution to repeated implantation failure. The aim of this analysis was to examine the relationship between the morphology of embryos in a previous cycle on outcome in a subsequent cycle with AH. A total of 175 AH cycles performed after previous failed ART without hatching were divided into group A with optimal and group B with suboptimal embryos transferred previously. The groups were similar in terms of demographic and cycle characteristics. In group A, there was a significant improvement (p<0.001) in implantation (28.8 vs 5.1%), clinical pregnancy (41.9 vs 12.1%) and live birth rate (38.5 vs 8.6%) compared with group B. The data suggest that the prognosis for treatment is better if AH is performed after failure despite optimal embryos compared with failure associated with suboptimal embryos and embryo quality is the most significant factor affecting outcome.
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Affiliation(s)
- J Grace
- Assisted Conception Unit, King's College London, School of Medicine, Guy's and St Thomas' Hospital, London, UK.
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The role of assisted hatching in in vitro fertilization: a review of the literature. A Committee opinion. Fertil Steril 2007; 86:S124-6. [PMID: 17055807 DOI: 10.1016/j.fertnstert.2006.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 12/02/2005] [Accepted: 12/02/2005] [Indexed: 10/24/2022]
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Sagoskin AW, Levy MJ, Tucker MJ, Richter KS, Widra EA. Laser assisted hatching in good prognosis patients undergoing in vitro fertilization-embryo transfer: a randomized controlled trial. Fertil Steril 2006; 87:283-7. [PMID: 17094975 DOI: 10.1016/j.fertnstert.2006.07.1498] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 07/05/2006] [Accepted: 07/05/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether assisted hatching improves clinical outcomes of embryo transfers to good prognosis patients, defined as patients < or =39 years with normal follicle-stimulating hormone (FSH) and E(2) levels, no more than one previous unsuccessful cycle of in vitro fertilization (IVF)-embryo transfer, and good embryo quality. DESIGN Prospective randomized controlled trial. SETTING Private assisted reproductive technology (ART) center. PATIENT(S) One hundred ninety-nine good prognosis patients undergoing IVF-embryo transfer. INTERVENTION(S) In vitro fertilization followed by embryo transfer on day 3 after oocyte retrieval with or without assisted hatching using a 1,480-nm wavelength infrared laser. MAIN OUTCOME MEASURE(S) Clinical intrauterine pregnancy, spontaneous pregnancy loss, and live birth. RESULT(S) Rates of clinical intrauterine pregnancy with fetal cardiac activity (53% vs. 54% per cycle), spontaneous pregnancy loss (13% vs. 16% per pregnancy), and live birth (47% vs. 46% per cycle) were very similar between treatment cycles with laser-assisted hatching and control cycles in which embryos were transferred without assisted hatching. There were no significant differences between treatment and control groups in any measured clinical outcome parameters. CONCLUSION(S) Assisted hatching does not improve clinical outcomes among good prognosis patients.
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Affiliation(s)
- Arthur W Sagoskin
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland 20850, USA
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Laser versus mechanical assisted hatching: a prospective study of clinical outcomes. Fertil Steril 2006; 86:1596-600. [PMID: 17055494 DOI: 10.1016/j.fertnstert.2006.05.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 05/05/2006] [Accepted: 05/05/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare clinical outcomes after laser or mechanical techniques of assisted hatching (AH) in women of advanced age undergoing IVF or intracytoplasmic sperm injection (ICSI). DESIGN Prospective randomized study. SETTING Center for Human Reproduction, Genesis Clinic, Athens, Greece. PATIENTS Three hundred and sixteen consenting women of advanced age (> or =39 years) with primary infertility undergoing IVF/ICSI programs and having available embryos for transfer on day 3. Patients were randomized into laser or mechanical AH of their transferred embryos. INTERVENTIONS Controlled ovarian hyperstimulation, oocyte retrieval, IVF/ICSI, laser or mechanical AH, and embryo-transfer. MAIN OUTCOME MEASURES Implantation rate, clinical pregnancy rate, and viable pregnancy rate. RESULTS The implantation rate was significantly higher in the laser AH group. Clinical and viable pregnancy rates were higher (but not significantly) in the laser AH group. CONCLUSIONS Laser AH of embryos may result in better clinical outcomes when compared to the mechanical technique in women of advanced age undergoing IVF or ICSI.
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Abstract
Preimplantation genetic aneuploidy screening performed by polar body biopsy has become a frequently used method, especially as in several countries only preconceptional genetic diagnosis is allowed. To penetrate the zona pellucida, mechanical, chemical and laser-assisted techniques have been introduced. In this paper, the advantages, disadvantages, efficacy and safety of these techniques are elucidated.
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Affiliation(s)
- A Dawson
- Department of Gynaecology and Obstetrics, IVF Unit, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck, Germany
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Yano K, Kubo T, Ôhashi I, Yano C. Assisted hatching using a 1.48-µm diode laser: Evaluation of zona opening and zona thinning techniques in human embryos. Reprod Med Biol 2006; 5:221-226. [PMID: 29699251 DOI: 10.1111/j.1447-0578.2006.00145.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: We assessed the effectiveness of assisted hatching using a 1.48-µm diode laser in human embryos, comparing zona opening and zona thinning techniques. Methods: A total of 56 day 3 embryos were assigned randomly to a zona opening group, a zona thinning group, or a control group. We then carried out assisted hatching using the OCTAX Laser Shot system (MTG Medical Technology, Altdorf, Germany) in the first two groups. In the zona opening group, the inner membrane of the zona pellucida was broken to create a full-thickness opening. In the zona thinning group, the inner membrane of the zona pellucida was not breached. After the laser procedure, embryos were cultured to the hatched blastocyst stage. Results: Blastocyst development rates did not differ significantly between the three groups. In the zona opening group, blastocysts were significantly more likely to hatch than those in the control group (P ≤ 0.05) and no arrested hatching of blastocysts was observed. Conclusions: Assisted hatching using a 1.48-µm diode laser in the zona opening technique increases the likelihood of blastocyst hatching in human embryos and does not adversely effect subsequent embryo development. (Reprod Med Biol 2006; 5: 221-226).
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Affiliation(s)
- Kohji Yano
- IVF Center, Yano Maternity Clinic, Ehime, Japan
| | | | | | - Chieko Yano
- IVF Center, Yano Maternity Clinic, Ehime, Japan
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Dias S, McNamee R, Vail A. Evidence of improving quality of reporting of randomized controlled trials in subfertility. Hum Reprod 2006; 21:2617-27. [PMID: 16793995 DOI: 10.1093/humrep/del236] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The quality of randomized controlled trials (RCTs) in subfertility and their suitability for inclusion in meta-analyses have been assessed in the past and found to be insufficient. Our aim was to assess whether this quality has improved over time, particularly since the publication of the Consolidated Standards of Reporting Trials (CONSORT) statement, and to assess what proportion of trials could be included in the meta-analyses of pregnancy outcomes such as those included in Cochrane Reviews. METHODS A selection of subfertility trials published in 1990, 1996 and 2002 was collected from the Cochrane Menstrual Disorder and Subfertility Group (MDSG) database. Only trials published in English as full journal articles, claiming to be randomized and reporting on pregnancy outcomes, were included. RESULTS One hundred and sixty-four trials met our inclusion criteria. Twenty-four (15%) were found not to be randomized, despite claims, and only 10 trials (6%) provided adequate details on the methods of randomization and allocation concealment. Of these, only three had sufficient details extractable to allow for an intention-to-treat analysis of the outcome 'live birth'. CONCLUSIONS Although an improvement in some subfertility-specific issues was observed, the quality of reporting of RCTs still needs to improve to make them suitable for inclusion in meta-analyses such as those in the Cochrane Library.
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Affiliation(s)
- Sofia Dias
- Biostatistics Group, University of Manchester, Manchester, UK.
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Frydman N, Madoux S, Hesters L, Duvernoy C, Feyereisen E, Le Du A, Tachdjian G, Frydman R, Fanchin R. A randomized double-blind controlled study on the efficacy of laser zona pellucida thinning on live birth rates in cases of advanced female age. Hum Reprod 2006; 21:2131-5. [PMID: 16644913 DOI: 10.1093/humrep/del124] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is conceivable that defective embryo hatching plays a part in the mechanisms involved in the decrease of embryo implantation rates with advancing age. In an effort to test this hypothesis, we tested the effectiveness of assisted hatching (AH) in women > or =37 years of age. METHODS We prospectively studied 103 IVF-embryo transfer patients undergoing 103 embryo transfers. All of them were > or =37 years of age and had <3 previous IVF-embryo transfer attempts. Laser-AH of transferred embryos was either performed (AH group, n = 49) or not (control group, n = 54) according to randomized and double-blind methodology. Primary outcome was live birth rate. RESULTS Population characteristics were comparable in AH and control groups as well as the mean number of embryos transferred (2.7 +/- 0.6 versus 2.7 +/- 0.6) and the prevalence of top quality embryos transferred (65 versus 59%, respectively). We failed to find any statistically significant difference between AH and control groups with regard to implantation (16.1 versus 16.7%, respectively) and live birth rates (22.4 versus 29.6%, respectively). CONCLUSION The present study indicates that AH does not improve IVF-embryo transfer outcome in women aged > or =37 years.
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Affiliation(s)
- N Frydman
- Department of Genetic and Reproduction, Hospital Antoine Béclère, Clamart, France.
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The role of assisted hatching in in vitro fertilization: a review of the literature. A Committee opinion. Fertil Steril 2006; 85:544-6. [PMID: 16598861 DOI: 10.1016/j.fertnstert.2005.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Hershlag A, Feng HL. Effect of prefreeze assisted hatching on postthaw survival of mouse embryos. Fertil Steril 2005; 84:1752-4. [PMID: 16359983 DOI: 10.1016/j.fertnstert.2005.05.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 05/24/2005] [Accepted: 05/24/2005] [Indexed: 11/17/2022]
Abstract
Embryos that underwent assisted hatching before freezing had a statistically significant higher survival rate and blastocyst formation rate compared with controls. Therefore, breaching the integrity of the zona pellucida and directly exposing the embryos to cryoprotectants not only does not result in damaging the embryos but might also afford them an advantage as they go through the freeze-thaw cycle.
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Affiliation(s)
- Avner Hershlag
- Department of Obstetrics and Gynecology, Center for Human Reproduction, North Shore University Hospital, New York University School of Medicine, Manhasset, New York, USA.
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Nadir Ciray H, Bener F, Karagenç L, Ulug U, Bahçeci M. Impact of assisted hatching on ART outcome in women with endometriosis. Hum Reprod 2005; 20:2546-9. [PMID: 15905297 DOI: 10.1093/humrep/dei064] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Assisted hatching can improve the implantation rate in cycles with poor outcome. The impact of assisted hatching in embryos from women with endometriosis is not known. Therefore, the hypothesis that the implantation potential of embryos obtained from women with endometriosis can be improved with assisted hatching was tested. METHODS In a prospective randomized study, transfer embryos obtained from 60 women with endometriosis were hatched using a laser system and compared to embryos obtained from patients with the same diagnosis which were left intact (n = 30). RESULTS The characteristics of cycles were similar between groups. The pregnancy (40% zona intact, 28.3% assisted hatching), and implantation rates (19.4% zona intact, 17.8% assisted hatching) did not differ in endometriosis cycles regardless of assisted hatching. CONCLUSION Assisted hatching does not improve outcome in women with endometriosis undergoing assisted reproduction.
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Affiliation(s)
- H Nadir Ciray
- Bahceci Women Health Care Centre and German Hospital at Istanbul, Istanbul, Turkey
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Ebner T, Moser M, Tews G. Possible applications of a non-contact 1.48 μm wavelength diode laser in assisted reproduction technologies. Hum Reprod Update 2005; 11:425-35. [PMID: 15817523 DOI: 10.1093/humupd/dmi009] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recently, one laser system has been introduced in IVF fulfilling all safety requirements, while achieving a high standard of reproducibility in terms of ablation diameter. This 1.48 microm wavelength indium-gallium-arsenic-phosphorus (InGaAsP) semiconductor laser offers a variety of laser applications to the embryologist. On the one hand, zona pellucida of oocytes or embryos can be manipulated in order to facilitate ICSI or biopsy and assist hatching, and on the other, spermatozoa may be paralysed or immobilized prior to usage. To conclude, the 1.48 microm diode laser provides a promising tool for the microdissection of subcellular targets. The diode laser stands out due to the rapidity, the simplicity and the safety of the procedure which is supported by healthy offspring after laser application.
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Affiliation(s)
- T Ebner
- Women's General Hospital, IVF-Unit, Lederergasse 47, A-4020 Linz, Austria.
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Ng EHY, Naveed F, Lau EYL, Yeung WSB, Chan CCW, Tang OS, Ho PC. A randomized double-blind controlled study of the efficacy of laser-assisted hatching on implantation and pregnancy rates of frozen–thawed embryo transfer at the cleavage stage. Hum Reprod 2005; 20:979-85. [PMID: 15665025 DOI: 10.1093/humrep/deh724] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Assisted hatching (AH) in fresh embryo transfer (ET) cycles increases the implantation and pregnancy rates, especially in women with a poor prognosis, repeated implantation failures and in older women. Little information exists in the literature regarding the role of AH in frozen-thawed embryo transfer (FET) cycles. METHODS Embryos were cryopreserved at the cleavage stage. On the day of FET, 160 patients were randomized according to a computer-generated randomization list in sealed envelopes into the AH group and the control group. The patients and the clinicians were blinded to the group assigned. In the AH group, the outer half of the zona pellucida over a quarter of the diameter of zona was removed using a 1480 nm non-contact laser. RESULTS The two groups were comparable in terms of demographic characteristics, ovarian response of the stimulated cycle and quality of fresh and frozen-thawed embryos. No differences in implantation, pregnancy and multiple pregnancy rates were found between the two groups. There was a non-significant trend of a higher implantation rate in the AH group when the zona thickness was > or = 16 mm. CONCLUSION Laser AH did not improve the implantation rate of FET cycles and should not be performed routinely in all frozen-thawed embryos at the cleavage stage.
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Affiliation(s)
- Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
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Chatzimeletiou K, Morrison EE, Panagiotidis Y, Prapas N, Prapas Y, Rutherford AJ, Grudzinskas G, Handyside AH. Comparison of effects of zona drilling by non-contact infrared laser or acid Tyrode's on the development of human biopsied embryos as revealed by blastomere viability, cytoskeletal analysis and molecular cytogenetics. Reprod Biomed Online 2005; 11:697-710. [PMID: 16417734 DOI: 10.1016/s1472-6483(10)61688-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Use of a non-contact infrared laser (IRL) or acid Tyrode's for zona drilling before embryo biopsy was compared by assessing blastomere viability using various fluorescent markers or culture of the single biopsied blastomere, and, by cytoskeletal and molecular cytogenetic analysis of the biopsied embryos following culture to the blastocyst stage. There was no significant difference in the proportion of biopsied embryos that showed no damage in both the biopsied blastomere and in the remaining embryo (acid Tyrode's: 75% versus IRL: 68%), or in the proportion of single biopsied blastomeres that divided in culture (P > 0.05). However, single biopsied blastomeres from laser drilled embryos showed a greater tendency to form miniblastocysts. The proportion of laser or acid Tyrode's biopsied embryos that reached the blastocyst stage by day 6 was similar, although evident earlier (day 5) in the laser biopsied embryos. Spindle abnormalities at the blastocyst stage included tripolar and tetrapolar spindles, but their incidence was not significantly different from controls. In addition, no significant difference was observed in the incidence of chromosomal abnormalities and mosaicism between the two groups. It is concluded that using an IRL at a safe working distance does not cause adverse immediate or longer term effects on the development of human biopsied embryos, although damage can occur if drilling within this distance is unavoidable. Acid Tyrode's drilling can also cause damage, and tended to retard blastocyst development.
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Pelletier C, Keefe DL, Trimarchi JR. Noninvasive polarized light microscopy quantitatively distinguishes the multilaminar structure of the zona pellucida of living human eggs and embryos. Fertil Steril 2004; 81 Suppl 1:850-6. [PMID: 15019819 DOI: 10.1016/j.fertnstert.2003.09.033] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Revised: 09/19/2003] [Accepted: 09/19/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize the architecture of the zona pellucida in living human eggs and embryos, noninvasively with the PolScope, a digital polarizing light microscope. DESIGN The PolScope was used to examine zonae pellucida of living human eggs and embryos. SETTING Academic IVF clinic. PATIENT(S) Patients undergoing fresh, nondonor infertility treatment who underwent egg aspiration, fertilization by intracytoplasmic sperm injection or traditional IVF, and cleavage-stage embryo transfer (day 3). INTERVENTION(S) The PolScope imaged the zona of eggs before intracytoplasmic sperm injection and in cleavage-stage embryos before transfer. MAIN OUTCOME MEASURE(S) Thickness and retardance of three zona layers were measured from eight quadrants. Mean and variance in thickness and retardance were calculated for individual eggs and embryos, between eggs and embryos of a cohort, and across the sample patient population. RESULT(S) Cleavage-stage (day 3) embryos have thinner zonae (15.2 +/- 2.9 microm) than both immature (20.4 +/- 2.4 microm) and mature (19.5 +/- 2.2 microm) eggs. The zona of embryos is thinner, primarily owing to thinning of the outer layer. The thicker the zona layer, the greater its retardance. Considerable variation exists in the thickness and retardance of zona layers around individual eggs and embryos and between members of a cohort. The zona of eggs and embryos from different patients differ in thickness, retardance, and variation. CONCLUSION(S) Thickness and organization of zonae pellucida of human eggs and embryos varies considerably and can be quantitatively imaged with the PolScope.
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Affiliation(s)
- Cory Pelletier
- Division of Reproductive Medicine and Infertility, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Brown University Medical School, 1 Blackstone Place, Providence, RI 02905, USA
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Frydman N. [Assisted hatching: procedure and effectiveness]. ACTA ACUST UNITED AC 2004; 33:S25-8. [PMID: 14968041 DOI: 10.1016/s0368-2315(04)96400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Assisted hatching (AH) has been proposed to improve the implantation rate in patients with poor prognosis for pregnancy. This systematic review of randomized controlled trials addresses primary outcomes of clinical pregnancy and embryo implantation. Several different methods for AH have been introduced over the years but comparative studies are lacking. AH using laser technology is probably the best technique. Assisted hatching increases the pregnancy and implantation rates significantly in patients with a poor prognosis undergoing IVF or ICSI, particularly in older women. More randomized trials are required to confirm any positive effects on the take-home-baby rate and to compare the different techniques.
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Affiliation(s)
- N Frydman
- Laboratoire de Biologie de la Reproduction, Hôpital Antoine-Béclère, Clamart, France
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Sallam HN, Sadek SS, Agameya AF. Assisted hatching--a meta-analysis of randomized controlled trials. J Assist Reprod Genet 2003; 20:332-42. [PMID: 12948097 PMCID: PMC3455281 DOI: 10.1023/a:1024865725713] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To conduct a meta-analysis of randomized controlled trials (RCTs) on assisted hatching. METHODS One hundred sixty-five studies were retrieved from the literature, but only 13 of them fitted our selection criteria. The meta-analysis was conducted using the RevMan software with the Peto-modified Mantel-Haenszel method. RESULTS Assisted hatching increases the pregnancy [OR (+/-95% CI) = 2.51 (1.91-3.29)], implantation [OR (+/-95% CI) = 2.38 (1.87-3.03)], and ongoing pregnancy rates [OR (+/-95% CI) = 2.65 (1.85-3.79)] significantly in poor prognosis patients undergoing IVF or ICSI. For patients with repeated IVF failures, the OR (+/-95% CI) were 2.84 (1.99-4.06) for pregnancy, 2.53 (1.85-3.47) for implantation, and 3.51 (2.12-5.82) for ongoing pregnancy rates, in favor of assisted hatching. CONCLUSIONS Assisted hatching increases the pregnancy, implantation, and ongoing pregnancy rates significantly in patients with a poor prognosis undergoing IVF or ICSI, particularly those with repeated failures.
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Affiliation(s)
- Hassan N Sallam
- Department of Obstetrics and Gynecology, the University of Alexandria, Alexandria, Egypt.
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