Kim Woo Jeong, Jee Byung Chul
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Clin Exp Reprod Med. 2025 Sep;52(3):244-251. doi: 10.5653/cerm.2024.07073. Epub 2025 Mar 6.
Laser-assisted hatching (LAH) employs two distinct techniques: thinning and breaching. This study aimed to compare the clinical efficacy of combined thinning and breaching versus breaching alone in vitrified-warmed embryo or blastocyst transfer cycles.
In total, 110 vitrified-warmed day-3 embryo transfer cycles and 50 vitrified-warmed day-5 blastocyst transfer cycles were retrospectively selected. All transfers were performed between 2021 and 2022 at a university-based infertility center. Combined thinning and breaching involved thinning either one-quarter or one-sixth of the zona pellucida circumference combined with breaching at a single point.
In vitrified-warmed day-3 embryo transfer cycles, the 'thinning and breaching' and 'breaching only' groups were similar regarding the median age of the woman (36 years vs. 37 years, respectively), number of embryos transferred (2 vs. 2), and embryo score (89 vs. 31.5). The clinical pregnancy rate (PR) (23.5% vs. 21.1%), embryo implantation rate (IR) (11.4% vs. 11.3%), and clinical miscarriage rate (25% vs. 37.5%) were also comparable between the two LAH groups. In vitrified-warmed day-5 blastocyst transfer cycles, the combination and breaching-only groups were similar in the median age of the woman (36 years vs. 36.5 years, respectively), number of blastocysts transferred (1 vs. 1), and blastocyst score (45 vs. 31.5). The clinical PR (45.5% vs. 42.9%), IR (35.4% vs. 33.3%), and clinical miscarriage rate (20% vs. 33.3%) were also similar between groups.
Breaching alone displayed similar efficacy to combined thinning and breaching in terms of clinical PR, IR, and miscarriage rate. Thus, breaching alone appears sufficient to achieve favorable pregnancy outcomes.
激光辅助孵化（LAH）采用两种不同技术：变薄和穿孔。本研究旨在比较在玻璃化冷冻复苏胚胎或囊胚移植周期中，联合变薄和穿孔与单纯穿孔的临床疗效。
回顾性选取了总共110个玻璃化冷冻复苏第3天胚胎移植周期和50个玻璃化冷冻复苏第5天囊胚移植周期。所有移植均于2021年至2022年在一家大学附属医院的不孕不育中心进行。联合变薄和穿孔包括将透明带周长的四分之一或六分之一变薄并在单个点进行穿孔。
在玻璃化冷冻复苏第3天胚胎移植周期中，“变薄和穿孔”组与“仅穿孔”组在女性中位年龄（分别为36岁和37岁）、移植胚胎数量（均为2个）和胚胎评分（分别为89和31.5）方面相似。两组LAH的临床妊娠率（PR）（分别为23.5%和21.1%）、胚胎着床率（IR）（分别为11.4%和11.3%）以及临床流产率（分别为25%和37.5%）也相当。在玻璃化冷冻复苏第5天囊胚移植周期中，联合组和仅穿孔组在女性中位年龄（分别为36岁和36.5岁）、移植囊胚数量（均为1个）和囊胚评分（分别为45和31.5）方面相似。两组之间的临床PR（分别为45.5%和42.9%）、IR（分别为35.4%和33.3%）以及临床流产率（分别为20%和33.3%）也相似。
就临床PR、IR和流产率而言，单纯穿孔与联合变薄和穿孔显示出相似的疗效。因此，仅穿孔似乎足以实现良好的妊娠结局。
