Placental histology following assisted hatching in fresh transfer cycles.

PURPOSE: To assess placental histological findings following assisted hatching in fresh transfer in vitro fertilization cycles. METHODS: Evaluation of a historic cohort of live singleton deliveries after fresh embryo transfer (ET) at a single university medical center between 2009 and 2017. We compared perinatal outcomes and placental histology in cases where assisted hatching was performed prior to ET (AH group) and cases with no AH (no AH group). RESULTS: Overall, 166 deliveries following AH were compared to 494 deliveries with no AH. Patients' demographics were similar between the groups. Median antral follicle count was significantly lower in the AH group, median 11 (range 1-50) vs. 16 (range 1-80), p < 0.001, and the primary indication for infertility treatment significantly more often diminished ovarian reserve (p < 0.001). Cycle characteristics in the AH group included a higher gonadotropin dose employed, and a lower rate of single and blastocyte transfer. Pregnancies following AH were associated with less low-lying placentas, 0.6% vs. 6.2%, p = 0.001, and comparable for other perinatal outcomes. After adjusting for confounders, the rate of bilobated placentas was higher following AH, aOR 7.10, 95% CI 1.50-33.51. The rate of perivillous depositions was higher with AH, aOR, 95% CI 3.18, 1.46-6.93, and the rate of chorangiosis lower in this group, aOR, 95% CI 0.32, 0.11-0.93. The overall rate of vascular lesions was similar between the groups. CONCLUSION: Pregnancies following AH are notable for a lower rate of placenta previa, yet a higher rate of bilobated placentas and perivillous depositions and less chorangiosis, warranting further investigation.

Clinical Efficacy of Assisted Hatching with Partial Zona Dissection in Intrauterine Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To investigate the clinical efficacy of assisted hatching (AH) with partial zona dissection (PZD) in intrauterine embryo transfer in the patients who failed more than 2 times with standard IVF-ET protocol (Group R), were more than 37 years old (Group A), or had high basal serum FSH levels more than 15 mIU/ml (Group F). METHODS: From January, 1998 to June, 2002, 156 cycles of AH with partial zona dissection were performed in 117 infertile patients in Department of Obstetrics and Gynecology, Seoul National University Hospital. The outcomes of AH were analyzed according to pregnancy rate. RESULTS: The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was 8.3 +/- 5.2 in 104 cycles of 75 patients who failed more than 2 times with standard IVF-ET protocol (Group I: Groups R, R+A, R+F, and R+A+F), 7.7 +/- 5.0 in 82 cycles of 67 patients who were more than 37 years old (Group II: Groups A, R+A, A+F, and R+A+F), and 7.2 +/- 4.9 in 38 cycles of 30 patients who had high basal serum FSH levels more than 15 mIU/ml (Group III: Groups F, R+F, A+F, and R+A+F). The number of embryos transferred after AH was 4.1 +/- 1.5 in Group I, 3.7 +/- 1.3 in Group II, and 4.0 +/- 1.7 in Group III. The mean cumulative embryo score (CES) was 81.9 +/- 46.5 in Group I, 75.9 +/- 43.0 in Group II, and 75.7 +/- 40.2 in Group III. There were no significant differences in the numbers of oocytes retrieved, embryos transferred and CES among 3 groups. The overall clinical pregnancy rate was 22.4% (35/156) per cycle and 29.9% (35/117) per patient. The clinical pregnancy rate per cycle and per patient was 18.3% (19/104) and 25.3% (19/75) in Group I, 15.9% (13/82) and 19.4% (13/67) in Group II, and 31.6% (12/38) and 40.0% (12/30) in Group III, and there was a significant difference between Group II and Group III. CONCLUSION: AH of human embryos with PZD might be promising for the improvement of pregnancy rates, especially in the patients with the past history of repeated failure, old age, or high basal serum FSH level.

Impreovement in Endometrial Implantation of Humman Embryos with Assisted Hatching Using Micromanipulation in Intrauterine Embryo Transfer / 대한산부인과학회잡지

Although the fertilization rate exceeds to 80~90% with much progress in vitro fertilizaton and embyo transfer(IVF-ET) program, the prgnancy rate rmains at 20~30%, and the endometrial implantaion rate per embryo transferred at 10~15%. Recently, many attempts have been made to improve embrynic implantion after IVF-ET including serveral procedures of assisted hatching(AH) using micromanipulation, and pregnacies and births have been obtained after AH. This clinical study was performed to develop and estabilish AH as an effective procedure to improve embryonic implantioan in IVF-ET patients who had previous repeated failure of standard IVF-ET more than 2 times(Group R), were more than 37 years old(Group A), or had high basal serun FSH levels more than 15 mIU/ml(Group F). From January, 1995 to Februry, 1996, 132 cycles of AH using partial zona dissection(PZD) were performed in 104 infertile patients, and the outcomes of AH were analyzed according to pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation(COH) was 9.9+/-7.1 in 71 cycles of 54 patients who had previous repeated failure more than two times(Group I: Group R,R+A,R+F, and R+A+F), 8.4+/-5.9 in 62 cycles of 46 patients whose age was more than 37 years old(Group II : Groups A, R+A, A+F, and R+A+F), and 8.7+/-6.5 in 49 cycles of 47 patients who had high basal serum FSH levels more than 15 mIU/ml(Group III:Groups F,R+F, A+F, and R+A+F). The number of embroys transferred after AH was 4.7 +/-1.8 in Group I, 4.2 +/-1.9 in Group II, and 4.2+/-2.0 in Froup III. The mean cumulative embryo score(CES) was 56.8+/-30.0 in Group I, 52.6+/-30.6 in Group II, and 52.6+/-29.9 in Group III. There were no significant differences in the numbers of oocytes rerieved and embryos transferred, and CES among 3 groups. The overall clinical pregnancy rate was 14.4%(19/132) per cycle and 18.3%(19/104) per patient. THe clinical pregnancy rate per cycle and per patient was 12.7%(9/71) and 16.7%(9/54) in Group I, 4.8% (3/62) and 6.5%(3/46) in Group II, and 26.5%(13/49) and 27.7%(13/47) in Group III, and there was a significant difference between Group II and Group III. In conclusion, AH of human embryos using micromanipulation might be promising for IVF-ET patients, especially with the past history of repeated failure, old age, and high basal serum FSH level and AH will provide a range of novel techiques which may dramatically improve the implanatation and pregnancy rates in IVF-ET program and contribute much to effective management of infertile couples.