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For the first few days following fertilization, the fertilized egg (embryo) is surrounded by a protective membrane called ‘zona pellucida’. The zona creates a barrier to prevent more than one sperm to fertilize the egg. The membrane also keeps the embryo whole while it is growing from a mere 2 cells into approximately 100 cells 5 days after the retrieval. Finally, the zona pellucida allows the embryo to hatch out so that it can implant into the uterus. When the embryo starts to attach to the uterine wall, this zona partially dissolves, allowing the embryo to hatch out. This is when the implantation process begins.
What is Assisted Hatching in IVF
In some patients, the zona pellucida is distinctively harder, which makes it difficult for the embryo to hatch out. Assisted hatching is a laboratory technique carried out before embryo transfer to facilitate implantation. Here at euroCARE IVF, we use cutting-edge laser technology to make a small opening in the zona. Once it is transferred to the uterus, the embryo can hatch out and start implanting into the uterine lining with more ease.
Who Needs Assisted Hatching
The most common indications for assisted hatching during IVF Cyprus cycles include:
- Age factor – the female patient is older than 35
- Egg quality factor – elevated levels of Follicle-stimulating hormone (FSH), low Anti-Mullerian hormone (AMH) levels or diminished ovarian reserve
- Embryo quality factor – poor quality embryos with severe fragmentation or slow growth
- Zona pellucida factor – embryos that have an excessively thick zona pellucida
- Failed IVF cycles – one or more previous failed IVF cycles
Although we found that everyone can benefit from assisted hatching, this technique has shown to be especially helpful for:
- Women after the age of 35 and beyond
- Women have high FSH (follicle-stimulating hormone) levels
- Couples with multiple failed IVF cycles
- Women who produce eggs with thicker zona pellucida
- Women who have a frozen embryo transfer (FET) cycle
IVF Process with Assisted Hatching
IVF in Cyprus is the process of collecting eggs from a woman’s ovaries, fertilizing them in a lab and transferring the resulting embryos to the uterus. At euroCARE IVF, the IVF process using assisted hatching follows several steps:
Day 1 – First day of menstruation
Day 2 – Stimulation injections begin
Day 6 – Scan
Day 9 – Fly to Cyprus
Day 10/11 – Scan & hCG injection (when eggs are ready)
Day 13 – Egg & Sperm collection
Day 18 – Assisted hatching & Embryo transfer
At your initial consultation, our euroCARE IVF fertility specialists will review your medical history and all previous medical records. Depending on your situation, you (and your partner) may need to undergo fertility testing to determine the cause(s) of infertility. On the next meeting with our fertility specialist, you’ll confirm the details of your treatment plan.
Our doctor will prescribe fertility drugs to encourage the ovaries to produce multiple eggs. Medications contain the same hormones that the female body produces to stimulate egg production. These medications usually contain follicle-stimulating hormone (FSH) or a combination of FSH and luteinizing hormone (LH). They are injected daily during the stimulation phase. The goal is to produce multiple eggs that will be retrieved and fertilized via IVF.
The IVF team will closely monitor you during the entire IVF cycle through blood tests and ultrasounds. When it is determined that your eggs are mature, you will receive a final injection of chorionic gonadotropin (hCG), also known as a trigger shot, to finalize the egg maturation process and prepare you for retrieval.
The egg retrieval procedure is performed using ultrasound-guided aspiration. The patient is under sedation during the process. Once the tube is inserted, a very fine needle will aspirate the mature eggs which are then transported to the embryologist in the next room. This procedure takes about 15 minutes to collect all eggs from the ovaries. Our lab team will identify the mature eggs and prepare them for fertilization.
ICSI is a very important and effective method of fertilization of the eggs with the sperm. We perform ICSI on all our patients. This technique works by inserting single sperm cells into each collected egg using micromanipulation devices such as micromanipulator, microinjectors, and micropipettes.
Embryos are monitored regularly during the grading cycle to determine if they are developing properly. A final quality assessment is carried out before transfer to identify the best-looking embryos that will be placed into the patient’s uterus.
Once the best embryos have been selected, the next step in the IVF process is to carry out assisted hatching. A microscopic hole is made in the zona pellucida using laser technology. The embryo transfer procedure is done shortly after assisted hatching.
The patient returns to the IVF clinic for the embryo transfer. This process involves using a small catheter to gently place the embryo(s) into the uterus. The procedure takes only 15 minutes and does not require any sedation. However, the patient is given a light sedative to help her feel more relaxed. A blood pregnancy test is done 12 days after the transfer to determine if pregnancy has occurred.
Post Transfer Supplementation
The patient uses daily doses of hormone medication after the embryo transfer to prepare her uterus for a potential pregnancy. This medication helps the uterine lining to grow and get thicker. A thick lining creates an optimal environment for the embryos to implant and continue growing after the transfer.
Laser Assisted Hatching
The laser assisted hatching method has become the most widely used, most efficient and most accurate technique for breaking through the zona pellucida. It is performed with maximum precision and with the use of high magnification so that the laser beam is directed to specific areas of the zona pellucida. The same technique is used for removing cells from embryos for preimplantation genetic testing like PGD and PGS.
Laser Assisted Hatching Procedure
Laser-assisted hatching (LAH) uses a highly focused infrared laser beam to remove the zona pellucida with high precision. This technique requires less time to cut open the zona compared to the standard assisted hatching methods. Also, laser-assisted hatching is much faster and, therefore, less time is required for the embryo to stay outside the incubator. The laser technology provides easier, faster, and safer micromanipulation of the zona pellucida.
Laser Assisted Hatching Success Rates
The performance of laser assisted hatching (LAH) significantly increases clinical pregnancy rates in all euroCARE IVF North Cyprus patients. A study found the chemical (50.99%) and clinical (50%) rates were significantly improved after LAH was applied. In the patients with advanced female age ≥35, the performance of LAH significantly increased chemical (30.12%) and clinical pregnancy (27.71%) rates compared to those without LAH (18.96% and 16.37% respectively).
Assisted Hatching on Day 3 Embryos
Many factors may prevent a day-3 (cleavage-stage) embryo to hatch successfully. Assisted hatching has been shown to be extremely successful with frozen embryo transfer (FET) procedures performed at the leading IVF clinic in North Cyprus. During the freezing process, the zona pellucida may become slightly harder. Prior to the transfer, the frozen-thawed embryo undergoes a fast-assisted hatching procedure at our lab. The zona is often harder in women 38 years of age and older. Assisted hatching is also performed on day-3 embryos of younger women if the zona is thicker or if the embryo is of lower quality.
Assisted Hatching Day 5 Embryos
When an embryo reaches the blastocyst stage of development, it stretches and thins the zona pellucida, ultimately hatching out of it before implantation takes place. At our North Cyprus IVF centre, assisted hatching has been developed to overcome a potential implantation failure. By making a small opening in the zona, “naked” fully-hatched blastocysts are prepared for immediate implantation. Our findings suggest a distinct benefit of fully-hatched blastocysts in terms of implantation when compared to day-5 embryos that were left to hatch out on themselves.
Does Assisted Hatching Improve Implantation Rates
Implantation takes place between 1 and 5 days when a blastocyst (day-5) embryo is transferred. If you had a day-3 transfer, the implantation window is 6 to 10 days after the transfer. Assisted hatching can significantly improve the chances of implantation during IVF if patients are able to achieve good fertilization and embryo development, but the zona pellucida is excessively thick. In such cases, a micro manipulative intervention is needed to help patients achieve IVF success.
Assisted Hatching and Embryo Glue
Once the assisted hatching procedure is over, the next step is to dip the embryos into a special solution called ‘embryo glue’. The embryo glue contains, among other things, high levels of hyaluronic acid which aids fertilization, implantation, and embryo development. The hyaluronic acid is produced in the womb, fallopian tubes and ovaries. The glue has the same effect as those uterine secretions that facilitate implantation and support pregnancy. Before being placed into the womb, embryos are immersed in the sticky solution which can help them attach easier to the uterine lining. Embryo glue is particularly beneficial for women who’ve had repeated implantation failure or are diagnosed with unexplained infertility.
Assisted Hatching and Birth Defects
The zona pellucida is a non-living component of the embryo, and penetrating this outer layer poses no threat to the embryo growth! Laser-assisted hatching is superior compared to the other standard assisted hatching techniques that were used in the past. Laser technology is extremely precise and efficient, thus making the procedure much shorter and safer for the embryo(s). This technique does not have any negative thermal effects such as overheating or causing damage to the embyo.
Assisted Hatching and Twins
Research showed that assisted hatching can increase the rate of monozygotic (identical) twins. The scientists assumed that this could be a result of making a hole in the zona pellucida, which possibly can cause the embryo to split into two identical parts around the time of implantation. However, further research is needed to understand the causes of twins and the full effects that this technique has on embryos.
Assisted Hatching and ICSI
Among the IVF treatments offered at euroCARE IVF, assisted hatching and intracytoplasmic sperm injection (ICSI) provide many benefits for our patients. Intracytoplasmic sperm injection (ICSI) is a technique used in IVF cycles to aid fertilization. This procedure involves injecting a single sperm cell into the egg which results in fertilization and the development of an embryo for implantation. Once a healthy embryo of good quality has been produced, our euroCARE IVF doctor will determine the embryo transfer date. Before being placed into the womb, the selected embryo(s) will undergo assisted hatching to prepare them for implantation.
Benefits of Assisted Hatching
- Assisted hatching can increase the likelihood of embryo implantation. Our embryologists use laser technology to make a small hole in the zona pellucida that surrounds the embryo before it’s placed inside the woman’s uterus. This makes it easier for the embryo to attach to the uterine wall.
- Assisted hatching can improve pregnancy rates. Hatched embryos can implant into the uterus one day earlier than those that were not hatched. Laser-assisted hatching allows for a better chance of implantation to happen, which also improves the pregnancy rates in IVF cycles.
- Women with multiple failed IVF cycles, women whose eggs have a thicker shell, women whose embryos are excessively thick or have been previously cryopreserved may all benefit from assisted hatching.
How Much is Assisted Hatching at euroCARE IVF
There is no additional fee for assisted hatching at our IVF clinic in North Cyprus. Assisted hatching is performed during the IVF cycle and is therefore included in the price for the whole treatment.
Assisted Hatching in North Cyprus
For women who have experienced IVF failure in the past, assisted hatching can improve implantation and pregnancy success. This technique is especially helpful in improving pregnancy rates in women who have failed to conceive previously and those with a poor prognosis for IVF success. This advanced technology can help the embryo to implant into the uterine wall with more ease, which ultimately result in a successful pregnancy and a healthy baby. euroCARE IVF offers assisted hatching at no extra cost! If you are considering IVF treatment in Cyprus, contact our patient coordinators to learn more about the cost and process of IVF!
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