Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI))

摘要: Background Failure of implantation and conception may result from inability the blastocyst to escape its outer coat, which is known as zona pellucida. Artificial disruption this coat assisted hatching has been proposed a method for improving success by facilitating embryo implantation. Objectives To determine effects (AH) embryos derived on live birth multiple pregnancy rates. SEARCH METHODS: We searched Cochrane Gynaecology Fertility Group Specialised Register (until May 2020), Central Controlled Trials (CENTRAL; until in Library; MEDLINE (1966 2020); Embase (1980 2020). also trial registers ongoing registered trials (http://www.clinicaltrials.gov - service US National Institutes Health; http://www.who.int/trialsearch/Default.aspx The World Health Organization International Registry Platform search portal) (May Selection criteria Two review authors identified independently screened trials. included randomised controlled (RCTs) AH (mechanical, chemical, or laser pellucida before replacement) versus no that reported clinical data. Data collection analysis used standard methodological procedures recommended Cochrane. performed quality assessments data extraction. Main results 39 RCTs (7249 women). All data, including 2486 pregnancies. Only 14 studies with 834 events. evidence ranged very low low. main limitations were serious risk bias associated poor reporting study methods, inconsistency, imprecision, publication bias. Five are currently ongoing. uncertain whether improved rates compared (odds ratio (OR) 1.09, 95% confidence interval (CI) 0.92 1.29; RCTs, N = 2849; I² 20%; low-quality evidence). This suggests if rate women not using about 28%, those will be between 27% 34%. Analysis per woman showed who AH, there have slight increase (OR 1.38, CI 1.13 1.68; 18 4308; 48%; 9%, 10% 14%. When all (39) pooled, underwent improve slightly comparison 1.20, 1.09 1.33; 7249; 55%; However, when random-effects model due high heterogeneity, little difference (P 0.04). rates, these illustrates make 1.07, 1.25; 2848; 45%). affects miscarriage 1.13, 0.82 1.56; 17 2810; 0%; Authors' conclusions update we lead increased pregnancy. risks complications without demonstrate an rate, warranting careful consideration routine use couples undergoing vitro fertilisation (IVF) intracytoplasmic sperm injection (ICSI). offer chance achieving pregnancy, but was grade. influences