A European multicentre prospective randomized study to assess the use of assisted hatching with a diode laser and the benefit of an immunosuppressive/antibiotic treatment in different patient populations.
BACKGROUND
Assisted hatching (AH) techniques, designed for facilitating the embryo escape out of the zona pellucida (ZP) have been used in IVF centres since 1992. The initial indications for AH were patient's age, ZP thickness, high basal FSH and repeated IVF failures. Several retrospective and prospective studies assessing AH in these indications have given disparate results. Our aims were to evaluate the benefits of AH and immunosuppressive/antibiotic treatment (IA) in patients with either a poor prognosis of success, previous implantation failures or transfers of cryopreserved embryos.


METHODS
Four IVF centres allocated 426 patients, randomized for AH and IA, into four groups of AH indications between 1997 and 1999. AH was performed with a diode laser. ZP thickness, opening size and embryo score were recorded. Outcome measures were implantation and delivery rates.


RESULTS
Patients coming for a first or third transfer of cryopreserved embryos and poor prognosis patients admitted for a first trial did not benefit from AH. Even patients with repeated implantation failures of fresh embryos did not gain significantly from AH.


CONCLUSIONS
Among AH indications, absence of implantation after several transfers of good quality embryos remains the strongest patient selection criterion. Prescription of an immunosuppressive/antibiotic treatment is essential.
Reproductive Medicine Unit, Department of Gynaecology and Obstetrics, CHUV, CH-1011 Lausanne, Switzerland.
M-P
MP
Primi
A
A
Senn
M
M
Montag
H
H
Van der Ven
J
J
Mandelbaum
A
A
Veiga
P
P
Barri
M
M
Germond
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053685:Laser Therapy; D008499:Medical Records; D018579:Patient Selection; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D019233:Retreatment; D017211:Treatment Failure; D015044:Zona Pellucida / Q000528:radiation effects*
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents