title: Assisted hatching: trends and pregnancy outcomes, United States, 2000-2010.
abstract: OBJECTIVE
  To assess trends and outcomes of assisted hatching among assisted reproductive technology (ART) cycles.
  
  
  METHODS
  Retrospective cohort analysis using National ART Surveillance System (NASS) data.
  
  
  METHODS
  U.S. fertility centers reporting to NASS.
  
  
  METHODS
  Fresh autologous noncanceled ART cycles conducted from 2000-2010.
  
  
  METHODS
  None.
  
  
  METHODS
  Implantation, clinical pregnancy, live-birth, miscarriage, multiple gestation.
  
  
  RESULTS
  Assisted hatching use statistically significantly increased in absolute number (from 25,724 to 35,518 cycles), percentages of day-3 (from 50.7% to 56.3%) and day-5 transfers (from 15.9% to 22.8%), and percentage of transfers among women ≥38 years (from 17.8% to 21.8%) or women with ≥2 prior ART cycles and no live birth(s) (from 4.3% to 7.4%). Both day-3 and day-5 cycles involving assisted hatching were associated with lower odds of implantation (adjusted odds ratios [aOR] 0.7 and 0.6, respectively), clinical pregnancy (aOR 0.8 and 0.7, respectively), live birth (aOR 0.8 and 0.7, respectively), and increased odds of miscarriage (aOR 1.4 and 1.4, respectively), as compared with cycles without assisted hatching. Assisted hatching was associated with lower odds of multiple gestation in day-5 cycles (aOR 0.8). In cycles for women with a "poor prognosis," the association of assisted hatching with pregnancy outcomes was not statistically significant.
  
  
  CONCLUSIONS
  Assisted hatching use had an increasing trend but was not associated with improved pregnancy outcomes, even in poor-prognosis patients. Prospective studies are needed to identify the patients who may benefit from assisted hatching.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia. Electronic address: dkissin@cdc.gov.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Kawwass
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: Monsour
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Session
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D046149:Embryo Culture Techniques / Q000706:statistics & numerical data; D004624:Embryo Transfer / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data* / Q000639:trends*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Assisted hatching; assisted reproductive technology (ART); in vitro fertilization (IVF); live birth rate; pregnancy outcome