Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da, Universidade de São Paulo, Av. dos Bandeirantes 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
Hum Reprod Update. 2011 Jul-Aug;17(4):438-53. doi: 10.1093/humupd/dmr012. Epub 2011 Apr 7.
Assisted hatching (AH) is a manipulation of zona pellucida aiming to facilitate embryo implantation.
Systematic review and meta-analysis of medical literature was used to evaluate the effect of AH on assisted reproduction outcomes: clinical pregnancy, live birth, multiple pregnancy and miscarriage. Additional analysis was performed in these subgroups: (i) fresh embryos transferred to unselected or non-poor prognosis women; (ii) fresh embryos transferred to women with previous repeated failure; (iii) fresh embryos transferred to women of advanced age; (iv) frozen-thawed embryos transferred to unselected or non-poor prognosis women. Analyses were based on risk ratio and 95% confidence intervals (RR, 95% CIs) using Mantel-Haenszel random effects model.
There were 28 studies (5507 participants) included. AH was related to a trend toward increased clinical pregnancy for all participants (RR = 1.11, 95% CI = 1.00-1.24), with a significant increase in subgroups 2 (RR = 1.73; 95% CI = 1.37-2.17) and 4 (RR = 1.36; 95% CI = 1.08-1.72, P< 0.01), but not for subgroups 1 and 3. For multiple pregnancy, a significant increase was observed for all participants (RR = 1.45; 95% CI = 1.11-1.90) and for subgroups 2 (RR = 2.53; 95% CI = 1.23-5.21) and 4 (RR = 3.40; 95% CI = 1.93-6.01). No significant heterogeneity was observed in subgroup analysis.
AH was related to increased clinical pregnancy and multiple pregnancy rates in women with previous repeated failure or frozen-thawed embryos. However, AH is unlikely to increase clinical pregnancy rates when performed in fresh embryos transferred to unselected or non-poor prognosis women or to women of advanced age. Due to the small sample evaluated by the pool of included studies, no proper conclusions could be drawn regarding miscarriage or live birth.
辅助孵化（AH）是一种对透明带进行操作的方法，旨在促进胚胎着床。
系统回顾和医学文献荟萃分析用于评估 AH 对辅助生殖结局的影响：临床妊娠、活产、多胎妊娠和流产。还对以下亚组进行了额外分析：（i）新鲜胚胎移植给未经选择或非预后不良的女性；（ii）新鲜胚胎移植给既往多次失败的女性；（iii）新鲜胚胎移植给高龄女性；（iv）冷冻-解冻胚胎移植给未经选择或非预后不良的女性。分析基于风险比和 95%置信区间（RR，95%CI），采用 Mantel-Haenszel 随机效应模型。
共纳入 28 项研究（5507 名参与者）。AH 与所有参与者的临床妊娠率呈上升趋势相关（RR=1.11，95%CI=1.00-1.24），在亚组 2（RR=1.73；95%CI=1.37-2.17）和 4（RR=1.36；95%CI=1.08-1.72，P<0.01）中具有显著增加，但在亚组 1 和 3 中没有。对于多胎妊娠，所有参与者（RR=1.45；95%CI=1.11-1.90）和亚组 2（RR=2.53；95%CI=1.23-5.21）和 4（RR=3.40；95%CI=1.93-6.01）的多胎妊娠率均有显著增加。亚组分析未见明显异质性。
AH 与既往多次失败或冷冻-解冻胚胎的女性的临床妊娠和多胎妊娠率增加有关。然而，当在新鲜胚胎移植给未经选择或非预后不良的女性或高龄女性时，AH 不太可能增加临床妊娠率。由于纳入研究的样本量较小，对于流产或活产，无法得出适当的结论。
