comparison between Cleavage Stage versus Blastocyst Stage Embryo Transfer in an Egyptian Cohort Undergoing in vitro Fertilization: A possible Role for Laser Assisted Hatching

Abstract

BackgroundExtended in vitro embryo culture and blastocyst transfer have emerged as essential components of the advanced reproductive technology armamentarium, permitting selection of more advanced embryos considered best suited for transfer.Aim of studyThe aim of this study was to compare between cleavage stage and blastocyst stage embryo transfer in patients undergoing intracytoplasmic sperm injection, and to assess the role of assisted hatching technique in patients undergoing blastocyst transfer.Patients and methodsThis study was carried out on two groups. Group I: 110 patients who underwent 120 cycles of intracytoplasmic sperm injection with day 2–3 embryo transfer—for unexplained infertility or male factor within the previous 3 years. Their data obtained retrospectively from medical records. Group II: 46 age matched infertile female patients undergoing 51 intracytoplasmic sperm injection cycles for similar causes. Patients in Group II were further subdivided into 2 equal subgroups; Group IIa (23 patients), which had laser assisted hatching and Group IIb (23 patients), which did not have assisted hatching. All patients had an infertility workup including basal hormonal profile, pelvic ultrasound, hysterosalpingogram and/or laparoscope and semen analysis of the patient’s partner. All patients underwent controlled ovarian hyperstimulation: Using long protocol of ovulation induction. Laser assisted hatching was done for blastocysts of 23 patients.ResultsComparison between both groups as regards the reproductive outcome showed a significant difference in pregnancy and implantation rates, both being higher in group II (P < 0.05) Comparison between both subgroups as regards the reproductive outcome showed a highly significant difference in pregnancy and implantation rates, both being higher in Group IIa (P < 0.01). There was also a significantly higher rate of multiple pregnancies among Group IIa (P < 0.05).ConclusionBlastocyst transfer is a successful and improved alternative for patients with multiple failed in vitro fertilization attempts, associated with a significant increase in pregnancy and implantation rates. Furthermore, laser assisted hatching increases implantation and clinical pregnancy rates.

Reduced Ectopic Pregnancy Rate on Day 5 Embryo Transfer Compared with Day 3: A Meta-Analysis

“…Sensitivity analysis with 8 studies of low bias risk by allocation concealment and a NOS score at nine did not substantially influence our findings [RR,0.65; 95% CI 0.56–0.76,79885 pregnancies in 8 studies; I 2 = 10%][ 9 , 12 , 24 , 29 , 30 , 32 , 33 , 36 ](data not shown). Sensitivity analysis excluding studies of day2/3 or day 5/6 ET [ 34 , 35 ] obtained similar results [RR, 0.65; 95% CI,0.52–0.82; 142893 pregnancies in 21 studies, I 2 = 68%](data not shown). Omitting single study in turn did not significantly alter the initial association of EP rate between D3-ET and D5-ET( S2 Fig ).…”

“…Characters of the 23 eligible studies were listed in Fig 2 , of which two were conference reports [ 21 , 22 ], seven were RCTs[ 23 – 29 ], and sixteen were retrospective studies[twelve cohort [ 8 , 10 – 14 , 21 , 30 – 33 ] and 4 case-control studies[ 9 , 22 , 34 , 35 ]] ( Fig 2 ). Thirty-three studies were conducted in combined IVF/ICSI cycles[ 8 , 11 , 13 , 23 – 28 , 31 , 33 , 34 ],9 studies were in IVF [ 9 , 10 , 12 , 14 , 21 , 22 , 29 , 30 , 32 ]and one study were only in ICSI cycles[ 35 ]. All studies compared the EP rate between day 3 versus day 5 except two[ 34 , 35 ], which compared day2/3 versus day 5/6.Embryos transferred on day2/3 were grouped to D3-ET group and embryos transferred on day5/6 were grouped to D5-ET group.…”

“…Thirty-three studies were conducted in combined IVF/ICSI cycles[ 8 , 11 , 13 , 23 – 28 , 31 , 33 , 34 ],9 studies were in IVF [ 9 , 10 , 12 , 14 , 21 , 22 , 29 , 30 , 32 ]and one study were only in ICSI cycles[ 35 ]. All studies compared the EP rate between day 3 versus day 5 except two[ 34 , 35 ], which compared day2/3 versus day 5/6.Embryos transferred on day2/3 were grouped to D3-ET group and embryos transferred on day5/6 were grouped to D5-ET group. All studies except two [ 9 , 13 ]stated the number of embryo transfer in their studies.…”

Effect of Total versus Partial Assisted Hatching on the Clinical Pregnancy Rates in Assisted Reproduction Technology

“…Another study showed higher implantation rate in group with blastocyst stage embryo transfer and partial assisted hatching in this group resulted in favorable outcome (20). However, there is still no clear evidence indicating the role of AH on the outcome of cases without known poor prognosis with their first fresh cycles (21).…”