One of the most frustrating aspects of assisted reproductive technology for patients and fertility professionals alike is having to deal with failure. This is especially true in couples who have attempted assisted reproductive procedures many times, and also in those whose time is running out because of their age. Now, a recently developed technique, assisted hatching, is offering new hope to couples who fall into these categories.

Assisted hatching was developed from the observation that embryos which had a thin zona pellucida (shell) had a higher rate of implantation during in vitro fertilization. It was postulated that creating a minor defect in the zona might result in a greater chance of the embryo “hatching,” or shedding its shell, allowing for a better chance of implantation in the endometrium.

There is a small risk of damage to the embryo during the micromanipulation process or at the time of transfer, and there is a slight increase in identical twinning . There is a greater chance of fetal complications and abnormalities in some identical twins.

Assisted hatching not only improves the success rate of the patients with the poorest chance of pregnancy because of their age, previous failure or elevated FSH level, but it can also make these “poor prognosis” patients almost as likely to succeed as any patient going through in vitro fertilization.

Assisted hatching is most effective through age 42. We feel that patients over age 42 would be better served by egg donation if they are willing to accept the concept. It is important to remember that these observations are preliminary and made on the basis of a small number of cases and we will need the confirmation of our and other’s ongoing experience.