Assisted Hatching

ChristinaV2015

Hello all!

Wondering if anyone has any experience with Assisted hatching. I'm have an FET with 3 day snowflakes and my nurse added assisted hatching to my protocol. I wasn't completely comfortable with signing off on it because it's never been brought up before and when I asked her why she said they do it on all the FET? Well then why was there a check box for "no"?

Any who, I'm not loving my nurse this cycle but just wondering if anyone has had any experience or success using it.

Thanks so much and happy new year!

AandDM2014

Hey @ChristinaV2015! I used assisted hatching in my previous fresh and my current FET cycle (no luck yet, going in for FET beta soon). All it is is a chemical that goes on to the embryo(s) to help wear away the outer layer that is formed when sperm met egg. It has to do that anyway to implant, and doing the AH just helps make sure it gets done. It doesn't harm the embryo in any way, and may help with implanting.

Sorry to hear about your nurse

Best of luck! 

KLake42

I only recently found out that ICSI and assisted hatching are both standard with frozen donor sperm, something I'd wished they'd told me earlier (like, when they first went over what those options were). 

I understand that they don't want to overwhelm us with information, but I've yet to see someone here complaining that they got too much info at once. 

oxinfree

Such a shame you ladies didn't get all the info. I do have to say my first doc in Canada was really good about telling us all the options regarding icsi/assisted hatching etc. It WAS overwhelming though, and added to a lot of stress trying to make decisions. ultimately we did ICSI (as my DH has low morph) but did not do assisted hatching after my research. I had a FET and did NOT do it, so it is not standard practice to have it done, and IS optional. I often wondered if I should have chosen to do it. I remember there being risks or something negative that originally deterred me, but don't remember what and all my current research states there is no risk, so why wouldn't we do it each time? I'm very curious about the topic.

Some info:

Why is assisted hatching ordered? The most common indications for AH are maternal age (over 37 years of age), elevated FSH levels which can negatively impact egg quality, thick zona pellucida (the original indication), slow embryo progression, lots of fragmentation (fragments can sometimes be removed during the hatching procedure) , previous failed IVF cycles and cryopreserved embryos which may have hardened zonas from the freezing solutions used and the freezing process itself.

Other reasons for ordering assisted hatching is patient preference (e.g. they were successful several years ago using AH and want to do everything the same) and (cynically) there is a procedure code for hatching so labs can charge separately for it.

Is it always needed? No. Hatching was a much more useful technique in the bad old days of cell culture when we could only grow embryos for three days in culture and the medias were not optimized for embryo growth. There is evidence to suggest that zona hardening and failure to thin may have been an unintended consequence of these early culture methods. These concerns and the observations of persistently thick zonas in culture is what prompted Dr. Cohen to want to breach the zona for the embryo since it might not bbe able to breach a hardened zona through simple expansion. There is no evidence that the newer culture systems that support embryo growth to the blastocyst stage result in thick zonas. We routinely see embryos growing to relatively huge sizes with zonas strained to almost invisible thinness just prior to spontaneous hatching in vitro. Frankly, a bigger problem today may be that embryos hatch before we get them into the catheter and back into Mom.

Assisted hatching of thawed cryopreserved embryos may still be beneficial for implantation according to some studies. Cryopreservation by some methods may cause zona hardening and assisted hatching could theoretically bypass hatching difficulties for these embryo. Most programs would rather hatch “just in case” rather than having to try to explain to the patient why her frozen embryo transfer didn’t work, but her friend who had AH, did get pregnant.

- See more at: https://fertilitylabinsider.com/2012/03/q-from-u-assisted-hatching/#sthash.IuXuY52J.dpuf

Piperella

I'm not having AH because I will be doing a FET of 5/6day blasts. He said if we had 3 day, they would have done assisted hatching, though. He said 5/6 day blasts with AH increases the chance of identical twins. We had ICSI done as well.

susykat77

***MC mentioned***

Sorry about your nurse. Great info above. I had AH done on a 5dt (actually all 4 had AH and 2 were transferred and 2 frozen). The cycle I got a BFP was from a FET - unfortunately I had a MMC.

suchaglencoco

***bfp, m/c mentioned***

We did a fresh cycle a year and a half ago with 2, 5 day embryos. No ah was done and one took, then split. Unfortunately, it ended in a miscarriage at 7 weeks.
We did our fet last April with 2, 5 day embryos and they did ah on them. Our re explained it all too us as well as our nurse and the specialist who was handling the embryos and the ah. We never questioned it because it would give us the best chance of one implanting. A couple of weeks later, we got our bfp and at our first u/s, we found out both had implanted and we were ecstatic.
Today, our twin snowflakes are one month old! So for us, it was extremely successful!
Good luck on your cycles, ladies. I know it's hard but try and stay positive and I hope you get your well deserved bfp soon!

athompson0308

Our Drs does assisted hatching as standard for everyone. It worked for me. Good luck!

oxinfree

Anyone who's done assisted hatching know of any concerns/risks associated with it other than increase chance of identical twins? If not, I really don't see why it wouldnt be standard practice across the board... I guess there's always risk of damaging the embryo right? I've tried researching but continue to come up empty...
@athompson0308 @suchaglencoco @susykat77 @Piperella

suchaglencoco

That would be the only other risk I could forsee. And our doctor wasn't concerned with ours splitting into identicals, even though our fresh cycle resulted in a split embryo.
I also don't see why you wouldn't want to AH. If you're concerned, I suppose you could ask the clinic what their statistics are in regards to damaging an embryo during the AH process.

Piperella

@oxinfree - I think you pointed out the only other implication - damage to the embryo, but the methods have improved so that the chance is very, very rare.  With our blasts being grade 4AB, the zona is already very thin, with hatching being the next step. Because we are transferring two, my doctor didn't want to do it. Maybe if I were only transferring one, my RE would possibly suggest AH.  Let me go look at my paperwork.  It includes other resources and information.

Edited to add:  Here's what is in my paperwork (went out to my car to find it):
"Risks that may be associated with assisted hatching include damage to the pre-embryo resulting in loss of pre-embryonic cells, or destruction or death of the pre-embryo.  Artificial manipulation of the pre-embryo may increase the rates of monozygotic (identical) twinning which are significantly more complicated pregnancies.  There may be other risks not yet known."

ChristinaV2015

Thank you ladies. I am worried about damage to the embroyos. They're 8 cell grade 3B and 3C. I just want what's best for my embabies. I feel better that several of you have had the procedure. I've been researching it and I'm confident in my doctors protocol.

mclorn

Just to chime in, my RE does AH as standard practice... seems the benefits outweigh the risks, at least in his opinion.