Assisted Hatching in Couples with Advanced Maternal Age: A Systematic Review and Meta-analysis

Abstract

This systematic review aimed to evaluate the efficacy and safety of assisted hatching (AH) performed in couples with advanced maternal age. We searched for randomized controlled trials (RCTs) in electronic databases, including MEDLINE, EMBASE and CENTRAL (from inception to January 2018); in addition, we hand-searched the reference lists of included studies and similar reviews. We included RCTs comparing AH versus no treatment (control). The meta-analysis was performed by RevMan 5.3 software. The search retrieved 943 records and 8 RCTs were included, comprising 870 cycles (n=440 for AH, and n=430 for control). There was no significant difference in the rates of live birth (RR 0.88, 95% CI 0.65 to 1.18, 3 RCTs, n=427, I²=0%), clinical pregnancy (RR 1.00, 95% CI 0.83 to 1.19, 8 RCTs, n=870, I²=22%), implantation (RR 1.07, 95% CI 0.83 to 1.39, 4 RCTs, n=1359, I²=0%), miscarriage (RR 1.13, 95% CI 0.66 to 1.94, 2 RCTs, n=116, I²=0%) and multiple pregnancy (RR 0.89, 95% CI 0.31 to 2.52, 1 RCT, n=97, I²=not applicable) between the treatment group and control group. No reasonable conclusions could be drawn regarding reproductive outcomes after AH in patients with advanced maternal age due to the small sample pooled in meta-analyses. Studies of high methodological quality and with adequate power are necessary to further investigate the value of AH in assisted conception of those patients.

Keywords

assisted hatching / advanced maternal age / in vitro fertilization / frozen-thawed embryo transfer

References

[1] CohenJ, EisnerC, KortH, et al.. Impairment of the hatching process following IVF in the human and improvement of implantation by assisting hatching using micromanipulation. HumReprod, 1990, 5(1): 7-13

[2] FengHL, HershlagA, SchollGM, et al.. A retroprospective study comparing three different assisted hatching techniques. Fertil Steril, 2009, 91(4): 1323-1325

[3] AlteriA, ViganoP, MaizarAA, et al.. Revisiting embryo assisted hatching approaches: a systematic review of the current protocols. J Assist Reprod Genet, 2018, 35(3): 367-391

[4] FrydmanN, MadouxS, HestersL, et al.. Arandomized double-blind controlled study on the efficacy of laser zona pellucida thinning on live birth rates in cases of advanced female age. HumReprod, 2006, 21(8): 2131-2135

[5] LiD, YangDL, AnJ, et al.. Effect of assisted hatching on pregnancy outcomes: a systematic review and meta-analysis of randomized controlled trials. Sci Rep, 2016, 6: 31228

[6] BalabanB, UrmanB, AlatasC, et al.. A comparison of four different techniques of assisted hatching. Hum Reprod, 2002, 17(5): 1239-1243

[7] Practice Committee of the American Society for Reproductive Medicine; Practice Committee of the Society for Assisted Reproductive Technology. Role of assisted hatching in in vitro fertilization: a guideline. Fertil Steril, 2014,102(2):348-351

[8] MagliMC, GianaroliL, FerrarettiAP, et al.. Rescue of implantation potential in embryos with poor prognosis by assisted zona hatching. Hum Reprod, 1998, 13(5): 1331-1335

[9] ValojerdiMR, Eftekhari-YazdiP, KarimianL, et al.. 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, 2008, 90(1): 84-91

[10] KanyoK, ZekeJ, KristonR, et al.. The impact of laserassisted hatching on the outcome of frozen human embryo transfer cycles. Zygote, 2016, 24(5): 742-747

[11] ShiW, HongweiT, ZhangW, et al.. A prospective randomized controlled study of laser-assisted hatching on the outcome of first fresh IVF-ET cycle in advanced age women. Reprod Sci, 2016, 23(10): 1397-1401

[12] MartinsWP, RochaIA, FerrianiRA, et al.. Assisted hatching of human embryos: a systematic review and meta-analysis of randomized controlled trials. Hum Reprod Update, 2011, 17(4): 438-453

[13] CarneySK, DasS, BlakeD, et al.. Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperminjection (ICSI)). Cochrane Database Syst Rev, 2012, 12: CD001894

[14] ZengM, SuS, LiL. The effect of laser-assisted hatching on pregnancy outcomes of cryopreservedthawed embryo transfer: a meta-analysis of randomized controlled trials. Lasers Med Sci, 2017, 33(3): 655-666

[15] HigginsJPT, AltaianDGSterne, et al.. HigginsJPT, GreenS, et al.. Chapter 8: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions, 2011

[16] ElnahasT, TawabN, AzmyO, et al.. Prospective randomized trial on the use of laser assisted hatching for transfer of frozen/thawed embryos in human intracytoplasmic sperm injection. Middle East Fertil Soc J, 2017, 22(4): 309-312

[17] GeHS, ZhouW, ZhangW, et al.. Impact of assisted hatching on fresh and frozen-thawed embryo transfer cycles: a prospective, randomized study. Reprod Biomed Online, 2008, 16(4): 589-596

[18] KutluP, AtvarO, VanliogluOF. 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(8): 457-461

[19] LanzendorfSE, NehchiriF, MayerJF, et al.. A prospective, randomized, double-blind study for the evaluation of assisted hatching in patients with advanced maternal age. Hum Reprod, 1998, 13(2): 409-413

[20] PetersenCG, MauriAL, BaruffiRL, et al.. Zona thinning with a noncontact diode laser in ICSI embryos from women of advanced age. J Assist Reprod Genet, 2002, 19(11): 512-516

[21] Harbin Consensus Conference Workshop Group. Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement. Fertil Steril, 2014,102(4):952-959