Need some advice

I have to sign these IVF consent forms and even though I thought I read them all, I am now not sure. One of the things is if we consent to ICSI. The answer to that is clear. The other thing is if we will consent to AH (assistant hatching). This I know nothing about. Is this done routinely or are they having me sign it just in case? I am sure I can ask tomorrow, but I wanted to get some ideas first so I know what I am talking about.

Thanks

Re: Need some advice

Hmmmmm I have no idea..I will probably asking some of these questions myself in the next month. I don't even know what AH IS..! Sorry

Message edited 12/8/2005 11:12:00 PM.

Re: Need some advice

Maaybe this info helps??


Assisted hatching
The assisted hatching procedure involves thinning or making a small hole in the zona pellucida that surrounds the embryo (a protective layer). There some evidence that assisted hatching may improve implantation rate. Before an embryo implant into the uterus it must hatch from the zona pellucida. There is some evidence that in some women the zona becomes toughened, restricting the embryo to hatch. Making a small hole in the zona using a micromanipulation, this may make it easier for hatching to occur.

How is assisted hatching is performed?
Just before the embryos are replaced, whether they are fresh or frozen/thawed, a small hole is made in the zona, or by thinning it using a micromanipulation technique. The process is repeated for each embryo. The main methods currently in use for assisted hatching are: chemical, mechanical and laser. The process will damage about 1% of embryos.

Most IVF clinics will not perform assisted hatching if there is one embryo available because of possible damage to this embryo would result in no embryo transfer. The assisted hatched embryos are then transferred into the uterine cavity as usual. Some clinics will give the woman a course of antibiotics to prevent infection. (Assisted hatching deprives the embryo of its intact protective coat, which shields it from exposure to any harmful factors in the uterus). Assisted hatching has been implicated in an increased rate of monozygotic twins.

Success rates after assisted hatching
The success rate of assisted hatching varies widely between different clinics. This could be due to differences in their patient populations, experienced and the technique used for assisted hatching. Some clinics reported no benefit when assisted hatching was offered to all patients, while others reported significant increases in clinical pregnancy and implantation rates following assisted hatching when the procedure was performed in selected groups of patients.

To whom assisted hatching may be advised?
Women over 39 years and using their own eggs.
Women who had recurrent failure of embryo implantation (three or more embryo transfers without a pregnancy).
Women whose embryos exhibit thick zona pellucida.
Women with elevated FSH levels.

BENEFITS OF ASSISTED HATCHING


There is some evidence that Assisted Hatching of embryos in selected cases (set out above) may improve the percentage of embryos that implant. Current research shows that pregnancy rates after Assisted Hatching in various units around the world have either increased in those groups that are thought to benefit from this procedure or remained unchanged. Results from research by Cohen and colleagues has shown that the implantation rate of embryos with thickened zonae that were assisted to hatch was 25% compared to 18% in embryos that did not have Assisted Hatching. In these studies the increase in implantation rate occurred without causing damage to the embryo nor increasing rates of miscarriage or birth defects.

Other research shows that no differences in the rate of birth defects were observed in babies born from embryos that were assisted to "hatch" (2.4%) compared with those did not have Assisted Hatching (2.6%).

DISADVANTAGES OF ASSISTED HATCHING

In some instances, the creation of a weakness in the zona pellucida will not be enough to improve the chances of the embryo to adequately hatch.

Current research shows that the benefits of Assisted Hatching are limited to selected cases and there is no evidence of benefit for the overall patient population.

Although some centres around the world report no changes in the rate of multiple pregnancy following Assisted Hatching, research from other centres suggests that there may be an increase in multiple pregnancy following Assisted Hatching. One study has shown that although Assisted Hatching did not increase the multiple pregnancy rate, it was associated with a 2-fold increase in monozygotic twins (identical). It is therefore important to carefully consider the number of embryos assisted to "hatch" and the potential risks associated with multiple pregnancy, particulary monozygotic twinning. These issues should be discussed with your Gynaecologist.

Assisted Hatching procedure can only be performed in association with IVF/ICSI. (see IVF/ICSI Information Sheets).

MANAGEMENT OF ASSISTED HATCHING

Usually up to 2 embryos (3 in exceptional circumstances) may be assisted to "hatch". This can only be performed on embryos with at least 6 cells, so replacement of embryos will usually be undertaken 3 days after egg collection.

Message edited 12/8/2005 11:19:20 PM.

Re: Need some advice

thanks Donna, this does help. I dont really fall into these categories but I guess they have you sign it so if the embryos do have one of these problems they can do AH.

Re: Need some advice

Yes, they always have you sign consents "just in case". They leave it up to the embryologist.

Re: Need some advice

Re: Need some advice

We had ICSI and assisted hatching done. I'm pretty sure that I remember having to consent to both those things being done.

Re: Need some advice

We consented for both also. Half my eggs were ICSI because of my age (35) and they did not do the assisted hatching for me.

Re: Need some advice

WE had to consent to both also. My RE does addisted hatching if you are an "older" Mom, because as the egg ages, the outer coating gets harder and more difficult for the cells to break out of. RIght before transfer, they etch away a tiny bit of the outer shell, so the cells can break out and implant.