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Chen K, Gao M, Wu Y, Hu Z, Tang L, Li M, Tian M, Cui H, Huang Y, Han Y, Li L, Li Y, Li Y, Wu Z, Tang Z, Zhang R, Wu Y, Zhang Y, Guo Y, Zhang H, Xiang L, Yan J. Two laser-assisted hatching methods of embryos in ART: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:300. [PMID: 38649878 PMCID: PMC11034172 DOI: 10.1186/s12884-024-06380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Laser-assisted hatching (LAH) stands as the predominant technique for removing the zona pellucida (ZP) in embryos, primarily consisting of two methods: drilling laser-assisted hatching (D-LAH) and thinning laser-assisted hatching (T-LAH). Presently, both methods have limitations, and their comparative efficacy for embryo implantation and clinical pregnancy remains uncertain. AIM Evaluate the impact of D-LAH and T-LAH on clinical pregnancy rates within assisted reproductive technology (ART). METHODS We systematically searched electronic databases including PubMed, Web of Science, and Cochrane Library until July 20, 2022. This study encompassed observational studies and randomized controlled trials (RCTs). A 95% confidence interval (CI) was utilized for assessing the risk ratio (RR) of pregnancy outcomes. The level of heterogeneity was measured using I2 statistics, considering a value exceeding 50% as indicative of substantial heterogeneity. RESULTS The meta-analysis scrutinized 9 studies involving 2405 clinical pregnancies from D-LAH and 2239 from T-LAH. Findings suggested no considerable variation in the clinical pregnancy rates between the two techniques (RR = 0.93, 95% CI: 0.79-1.10, I2 = 71%, P = 0.41). Subgroup analyses also revealed no substantial differences. However, D-LAH exhibited a notably higher occurrence of singleton pregnancies compared to T-LAH (RR = 2.28, 95% CI: 1.08-4.82, I2 = 89%, P = 0.03). There were no noteworthy distinctions observed in other secondary outcomes encompassing implantation rate, multiple pregnancies, ongoing pregnancy, miscarriage, premature birth, and live birth. CONCLUSION Both the primary findings and subgroup analyses showed no marked variance in clinical pregnancy rates between D-LAH and T-LAH. Therefore, patients with varying conditions should select their preferred LAH technique after assessing their individual situation. However, due to the restricted number of studies involved, accurately gauging the influence of these laser techniques on clinical outcomes is challenging, necessitating further RCTs and high-quality studies to enhance the success rate of ART. TRIAL REGISTRATION PROSPERO: CRD42022347066.
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Affiliation(s)
- Kexin Chen
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Mengying Gao
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Yao Wu
- The First People's Hospital of Qujing, Qujing, Yunnan, China
| | - Zhixin Hu
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Lu Tang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Minyao Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Mei Tian
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Hao Cui
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Yanrong Huang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Youzhen Han
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Lei Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Yonggang Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Yunxiu Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Ze Wu
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Zouying Tang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Ronghui Zhang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Yuerong Wu
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China
| | - Yizhi Zhang
- Kunming Maternity and Child Care Hospital, Kunming, Yunnan, China
| | - Yan Guo
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China
| | - Hongqing Zhang
- Kunming Maternity and Child Care Hospital, Kunming, Yunnan, China.
| | - Lifeng Xiang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China.
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China.
| | - Jiacong Yan
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, First People's Hospital of Yunnan Province, Kunming, China.
- KUST-YPFPH Reproductive Medicine Joint Research Center, Kunming, Yunnan, China.
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Baatarsuren M, Jamiyansuren J, Ganbaatar C, Sengebaljir D, Erdenekhuyag B, Enkhbaatar S, Baljinnyam L, Radnaa E, Dorjpurev A, Ganbat G, Boris T, Khangarid A. Clinical and neonatal outcomes of complete zona pellucida removal by laser-assisted hatching after single vitrified-warmed blastocyst transfer. Lasers Med Sci 2024; 39:51. [PMID: 38285329 DOI: 10.1007/s10103-024-04002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Laser-assisted hatching (LAH) is a widely used and unavoidable technique in assisted reproductive technology after frozen embryo transfer (FET). We aimed to investigate the safety and efficacy of completely ZP (zona pellucida) removed by an assisted laser group compared to an intact group after FET. This retrospective study involved 320 SVBT single vitrified-warmed blastocyst transfers of 213 patients who underwent clomiphene citrate (CC) based minimal stimulation protocol. This study compared 160 SVBT with ZP that were completely removed using laser-assisted (laser beams of 10-15, a wavelength of 1.48 μm, and duration of 1.8-2.2 ms) to 160 cases of intact SVBT. Fisher's exact test, chi-squared test, and logistic regression are used for statistical analysis. The women's age, cause of infertility, BMI, transferred embryo day, insemination methods, and blastocyst grade were not significantly different between two groups. The implantation rate (66.2% vs. 51.2%, P < 0.01), the clinical pregnancy rate (CPR, 52.5% vs. 39.3%, P = 0.01), and the live birth rate (LBR, 43.7% vs. 29.3%, P < 0.01) were significantly higher in the completely ZP removed than the intact group. In logistic regression analysis, the laser-assisted hatching group showed about 2 times higher implantation rate and CPR and LBR than the control group. But miscarriage, gestational weeks, gender, birth weight, and twin births were insignificant between two groups. Our study suggests ZP free embryo transfer by assisted laser is more effective and safer than intact embryo transfer.
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Affiliation(s)
| | - Jambaldorj Jamiyansuren
- Ojinmed IVF Center, Ulaanbaatar, Mongolia
- Department of Molecular Biology and Genetics, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Biochemistry, School of Medicine, International University of Health and Welfare, Narita, Japan
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Xu W, Yu Y, Li S. Dual laser-assisted hatching: an effective technique to salvage low-grade cleavage-stage embryos and harvest day 7 blastocysts. Lasers Med Sci 2023; 38:226. [PMID: 37776389 PMCID: PMC10543824 DOI: 10.1007/s10103-023-03898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023]
Abstract
To investigate whether repeating laser-assisted hatching (LAH) procedure on day 6 low-grade cleavage-stage embryos (LGCEs) helps blastulation. A total of 579 cycles with LGCEs from 2019 to 2022 was retrospectively reviewed. In 323 cycles, single LAH producing small holes (10 μm) was performed on LGCEs on day 4 (D4-LAH). In 256 cycles with persistent LGCEs despite D4-LAH, a repeat LAH procedure was performed on day 6 (Dual-LAH) with a bigger hole (30 μm). We compared day 7 blastocyst formation rate, usable blastocyst rate, and good grade blastocyst rate from these day 6 LGCEs between the two groups. Compared to the D4-LAH group, the Dual-LAH group had both higher day 7 blastocyst formation rate (9.4% vs. 3.0%, p < 0.001) and higher day 7 usable blastocyst rates (7.4% vs. 2.1%, p < 0.001). For persistent LGCEs despite single LAH, performing a repeat LAH on day 6 increased day 7 blastocyst formation rate.
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Affiliation(s)
- Weihai Xu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, People's Republic of China
| | - Yiqi Yu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, People's Republic of China
| | - Shishi Li
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, People's Republic of China.
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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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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] [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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Zhang L, Zhou YE, Wu YJ, Wu LM, Li SS, Zhang L, Jin Z, Shu CY, Xu WH, Shu J. Thinning or Opening: A Randomized Sibling-Embryo Pilot Trial on the Efficacy of Two Laser-Assisted Hatching Modes During the Extended Culture of Highly Fragmented Cleavage Embryos. Front Endocrinol (Lausanne) 2022; 13:927834. [PMID: 35832433 PMCID: PMC9271933 DOI: 10.3389/fendo.2022.927834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
A randomized sibling-embryo pilot trial investigated whether two ways of laser-assisted hatching result in different blastulation and clinical outcomes after extended in vitro culture process of highly fragmented day-3 cleavage embryos. From 92 couples, a total of 315 highly fragmented day-3 embryos (the fragmentation >25%) were recruited and randomized into laser-assisted zona thinning (LAT, n=157) and opening (LAO, n=158) groups, and then underwent a blastocyst culture in vitro. The main endpoint measurements including blastocyst formation and grading as well as the clinical pregnancy after blastocyst transfer were obtained during the treatment procedure of in vitro fertilization and embryo transfer, and then analyzed with generalized estimating equation (GEE) and/or time-to blastocyst analysis models. A total of 166 day-3 embryos developed into blastocyst stage (52.70%), of which 97 were viable blastocysts (30.79%), and 42 top-quality ones (13.33%). LAT did not have any inferior or superior to LAO in the endpoints of either total, viable, top-quality or hatched blastocyst formation, with the ORs (95%CI) from GEE model as 0.89 (0.55-1.45), 0.71 (0.42-1.21), 1.12 (0.56-2.25) and 0.68 (0.42-1.12) respectively for LAT treatment. And the time-to-blastocyst analysis showed a similar result. Additionally, no difference in clinical outcomes after blastocyst transfer was found between the two groups. The author concluded that when applying the LAHs during the extended culture of highly fragmented embryos, both LAT and LAO can generate a promising clinical outcome, and the LAT operation be equivalent to the LAO. Future well-designed, multiple-center, larger-sample investigations are required to ascertain above conclusion.
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Affiliation(s)
- Ling Zhang
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yi-Er Zhou
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yue-Jin Wu
- Institute of Food Science and Engineering, Hangzhou Medical College, Hangzhou, China
| | - Li-Mei Wu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shi-Shi Li
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Lin Zhang
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Zhen Jin
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Chong-Yi Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wei-Hai Xu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jing Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
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