title: Transfer of spontaneously hatching or hatched blastocyst yields better pregnancy rates than expanded blastocyst transfer.
abstract: BACKGROUND
  Blastocyst stage embryo transfer (ET) has become routine practice in recent years. However, probably due to limitations of assisted hatching techniques, expanded blastocyst transfer (EBT) is still the preferred mode. Inexplicably, not much consideration has been given to spontaneously hatching/hatched blastocyst transfer (SHBT).
  
  
  OBJECTIVE
  This study aimed to investigate developmental potential of spontaneously hatching/hatched blastocyst against EBT in in vitro fertilization (IVF) cycles.
  
  
  METHODS
  Prospective study of 146 women undergoing their first IVF- ET cycle.
  
  
  METHODS
  On the basis of blastocyst status, women were classified into SHBT and EBT groups. Intracytoplasmic sperm injection cycles were excluded to remove male factor bias. Implantation rate (IR), clinical pregnancy rate, and live birth rate were the main outcome measures.
  
  
  METHODS
  Graph-pad Prism 5 statistical package.
  
  
  RESULTS
  SHBT group showed significantly higher blastocyst formation rate (53.3 ± 17.5 vs. 43.1 ± 14.5%, P = 0.0098), top-quality blastocysts (71.8 vs. 53.7%, P = 0.0436), IR (43.6 vs. 27.9%, P = 0.0408), pregnancy rate (59.4 vs. 45.1%, P = 0.0173), and live birth rate (36.8 vs. 22.8%, P = 0.003) compared to EBT group. Multiple pregnancy rates remained comparable between the two groups. Implantation correlated strongly with top-quality blastocysts (Pearson, r = 0.4441) in SHBT group, while the correlation was nonsignificant in EBT group.
  
  
  CONCLUSIONS
  Extending culture of expanded blastocysts by a few hours to allow transfer of spontaneously hatching/hatched blastocysts gives higher implantation and pregnancy rates with no added risk of multiple gestations. Spontaneously hatching/hatched blastocysts have a better potential to implant and develop into a positive pregnancy.
authors.affiliation: Department of Embryology, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India ; Department of Endocrinology, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
authors.forename: Natachandra M
authors.initials: NM
authors.lastname: Chimote
authors.affiliation: Department of Embryology, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
authors.forename: Nishad N
authors.initials: NN
authors.lastname: Chimote
authors.affiliation: Department of Biochemistry Research Laboratory, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
authors.forename: Nirmalendu M
authors.initials: NM
authors.lastname: Nath
authors.affiliation: Department of Embryology, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India ; Department of Biochemistry Research Laboratory, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
authors.forename: Bindu N
authors.initials: BN
authors.lastname: Mehta
keywords: Blastocyst transfer; expanded blastocyst; extended culture; implantation; in vitro fertilization; pregnancy outcome; spontaneously hatching/hatched blastocyst