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Human Reproduction, Vol. 18, No. 9, 1828-1835, September 2003
© 2003 European Society of Human Reproduction and Embryology

The impact of assisted hatching on live birth rates and outcomes of assisted conception: a systematic review

Edmond Edi-Osagie1, Lee Hooper2 and Mourad W. Seif1,3

1 Academic Unit of Obstetrics, Gynaecology and Reproductive Healthcare, St Mary’s Hospital, Manchester and 2 Health Service Research Unit, Central Manchester Healthcare Trust and MANDEC, University Dental Hospital, Manchester, UK

3 To whom correspondence should be addressed at: Academic Unit of Obstetrics, Gynaecology and Reproductive Healthcare, St Mary’s Hospital, Manchester, M13 OJH, UK. e-mail: mwseif{at}man.ac.uk

BACKGROUND: During the past decade in the UK, only one in six cycles of assisted conception has resulted successfully in a live birth. Assisted hatching (AH) has been proposed to improve outcome. This systematic review of randomized controlled trials addresses primary outcomes of live birth, clinical pregnancy and embryo implantation. METHODS: Trials on post-fertilization disruption of the zona pellucida were identified from the Cochrane Controlled Trials Register, MEDLINE, EMBASE and published bibliographies. Outcomes were analysed using random effects meta-analysis, sensitivity analysis, sub-grouping and meta-regression. RESULTS: Of 23 included trials recruiting 2572 women, only six reported live birth data. AH had no significant effect on live birth (OR 1.21, 95% CI 0.82–1.78). There was a significant benefit of AH on clinical pregnancy (OR 1.63, 95% CI 1.27–2.09), especially in the sub-group of women with previous failure of assisted conception (OR 2.33, 95% CI 1.63–3.34). Meta-regression suggested that AH might be more useful in older women. Implantation data were not considered valid for statistical analysis. The methodological quality of included trials was sub-optimal. CONCLUSIONS: AH probably enhances clinical pregnancy, especially in women with previous failure of assisted conception treatment and in older women; however, trials were of poor quality and so may be biased. Better quality trials reporting live birth are required to confirm any positive effects on the ‘take-home-baby rate’.

Key words: assisted hatching/IVF/meta-analysis/randomized controlled trials/systematic review


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