While some clinics use assisted hatching routinely, the American Society of Reproductive Medicine (ASRM) does not recommend routine use. The reasoning behind this assertion is that assisted hatching hasn’t been shown to improve live birth rates. Plus, as with any reproductive technology, there are additional costs and risks associated with using assisted hatching. If your doctor has recommended assisted hatching, here’s what you need to know.
How Embryos Hatch
To understand assisted hatching, it helps to understand the natural hatching of an embryo. Before you get an embryo, you start with an oocyte or egg. The oocyte has a protein shell surrounding it known as the zona pellucida. The zona pellucida has many roles in embryo development, and these functions change as the embryo grows. Before the egg becomes an embryo, the zona pellucida fuses with sperm cells. This fusion is the start of the fertilization process. Once a single sperm cell penetrates the shell and fertilizes the egg, the zona pellucida hardens. This hardening prevents more sperm cells from entering the now-fertilized zygote. The hardened shell also helps prevent the embryo from implanting prematurely in the fallopian tubes, which would cause an ectopic pregnancy. It also keeps the many blastocyst cells together. As the zygote travels down the fallopian tube and develops into the blastocyst stage, the zona pellucida expands and begins to thin and deteriorate. Around day four of development, the zona pellucida cracks open and the blastocyst/embryo emerges, leaving behind the thin protein shell. This stage represents the embryo hatching process. Within a few days of hatching, the blastocyst implants itself into the endometrium. Without hatching, the blastocyst can’t implant itself into the uterine wall and a pregnancy would fail to happen.
What Is Assisted Hatching?
During IVF treatment, fertilization takes place in the lab. But as any couple that has gone through an IVF treatment knows, having a fertilized embryo doesn’t guarantee a pregnancy. The transferred embryo has to implant itself into the endometrium and “stick” for pregnancy to occur. There are several theories on why this occurs, and one of those theories is that the embryo doesn’t hatch properly. This lack of hatching may occur because the embryo intrinsically has an unusually hard shell, or because something in the lab environment—such as the cultures used to keep the embryo alive or the cryopreservation (freezing) chemicals—has artificially interrupted the hatching process. Assisted hatching is meant to get over whatever hurdles are preventing hatching. It’s also hoped that it will improve the odds of implantation success and ultimately lead to a pregnancy.
Methods Used
You may assume that assisted hatching always involves making a small “break” or tear in the zona pellucida. But that’s not actually so. There are a few methods available, and every embryo lab approaches this differently. There are pros and cons to every way, and the skill of the technician matters. Be sure you gather as much information as possible so that you can make an informed decision.
Mechanical hatching: With this technique, the embryologist keeps the embryo steady with the help of a pipette, while using a micro-needle to puncture through the zona pellucida, go just underneath the shell for a bit, and then come out the other end. (Imagine drawing a very thin line just alongside the embryo.) Then, the area between the two punctures is gently rubbed until a small tear occurs. It’s difficult to control the size of the opening with this method.Mechanical expansion of the shell: With this technique, the zona pellucida is not broken open. Instead, hydrostatic pressure is introduced just under the shell, to cause it to expand. The idea for this method comes from the natural expansion of the outer shell during the hatching process.Chemical hatching: This technique involves using a chemical known as Tyrode’s solution. Tiny amounts of acid are applied to the zona pellucida until the shell is breached. Then, the embryo is quickly cleaned to avoid unnecessary acid exposure.Drilling: With drilling, vibratory movements are used to create a conical opening. This technique uses something known as Piezo technology.Laser-assisted hatching: Using a specialized laser to breach the zona pellucida is another possibility. Laser-assisted hatching allows much more control of the size of the hole created, more so than mechanical hatching with a needle (as described above).
Of all the methods, laser-assisted hatching may be the safest and most effective. However, not every embryology lab is equipped to perform this specific technology. Chemical hatching is more commonly used. With all of these methods, the skill and experience level of the embryologist can make a big difference.
Risks
Any manipulation or interference with an embryo is going to involve some risk. One possible risk with assisted hatching is that the embryo will become lethally damaged. This damage could occur before embryo transfer or after. In either case, pregnancy would not result. Somewhat ironically, another risk of assisted hatching is the embryo’s natural hatching process will be thrown off and the embryo will fail to fully hatch from the zona pellucida. Monozygotic twins are identical twins, who come from one egg and one sperm. Twinning is already increased during conventional IVF treatment, and research has found that assisted hatching my further increase that risk. While all multiple pregnancies carry risk, monozygotic twin pregnancies come with even higher risks for the mother and babies. Still, the risk of twinning is low, occurring less than 1% of the time. You may be wondering if assisted hatching increases the risk of birth defects. A large retrospective study of almost 65,000 assisted reproduction births found that the risk of congenital anomalies was “marginally associated” with assisted hatching, but that the increased risk could have been due to other factors.
Effectiveness
The big question is, of course, is it worth it? Does assisted hatching help you take home a baby? The answer is a bit complicated. A Cochrane review on assisted hatching—that considered 31 studies, totaling 1,992 pregnancies, and 5,728 women—found that assisted hatching just slightly improved clinical pregnancy rates. However, live birth rates did not improve. Unfortunately, most of the research on assisted hatching has only reported clinical pregnancy rates, and not live birth rates. Those studies that did look at live birth rates didn’t find an advantage. Consequently, more research needs to be done. Another study found that when assisted hatching was done on “good quality” embryos, pregnancy rates went down. The results varied depending on age group when assisted hatching was done on fair- to poor-quality embryos. These results would imply that assisted hatching not only won’t help those with a good prognosis, but it may harm their chances of success.
Who Benefits From Assisted Hatching?
There is evidence that assisted hatching may improve clinical pregnancy rates with patients who:
Have experienced two or more failed IVF cyclesHave poor embryo qualityAre older than age 38
It was believed that assisted hatching might be worth trying with frozen embryo transfer cycles, but this may not be the case. In fact, one study found that assisted hatching in a frozen embryo cycle may slightly decrease the odds of a live birth.
Cost
Despite the recommendations of the ASRM, who advise against the routine use of assisted hatching, some clinics still offer it to every patient. In these clinics, the cost for assisted hatching may already be “included” in the overall IVF fee. For clinics who charge for assisted hatching, the cost can range from $200 to $700, on average. There are also a few clinics that offer the technology for “free,” if they think it may be beneficial.
A Word From Verywell
When discussing IVF treatment, it can be tempting to accept or want to use every possible technological “add-on” offered. It may seem like more help should always lead to a better chance of success. But more doesn’t always mean better. Because there is not enough evidence to show that assisted hatching improves live birth rates, the ASRM recommends against the routine use of the technology. If your clinic does use assisted hatching with every patient, talk to your doctor about why they think this is best for you. As always, talk to your doctor about your personal situation.
