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Hum. Reprod. Advance Access originally published online on July 29, 2004
Human Reproduction 2004 19(10):2325-2333; doi:10.1093/humrep/deh430
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Human Reproduction vol. 19 no. 10 © European Society of Human Reproduction and Embryology 2004; all rights reserved

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

M.-P. Primi1, A. Senn1, M. Montag2, H. Van der Ven2, J. Mandelbaum3, A. Veiga4, P. Barri4 and M. Germond1,5

1 Reproductive Medicine Unit, Department of Gynaecology and Obstetrics, CHUV, CH-1011 Lausanne, Switzerland, 2 Department of Gynaecology and Reproductive Medicine, University of Bonn, D-53105 Bonn, Germany, 3 IVF and Reproductive Biology Laboratory, Necker Hospital, F-75015 Paris, France and 4 Dexeus Institute, E-08017 Barcelona, Spain

5 To whom correspondence should be addressed at: Unité de Médecine de la Reproduction, Maternité, CHUV, CH-1011 Lausanne, Switzerland. Email: marc.germond{at}chuv.hospvd.ch

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.

Key words: diode laser/hatching/immunosuppression/pregnancy rate/randomized trial


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