Assisted Hatching

Who Needs Assisted Hatching?

Assisted hatching is not for all IVF patients. It is offered to selected individuals who have specific clinical features that indicate the procedure could be of value. Typical indications for assisted hatching include:

• Maternal age (usually over 35 years)
• Repeated IVF failures
• Embryos with thicker-than-normal zona 
• Frozen and thawed embryos where the outer layer may have hardened further

Assisted Hatching Types

There are several techniques for accomplishing assisted hatching. The method chosen will depend on the capabilities of the embryology laboratory and patient centers.

Laser-Assisted Hatching (LAH)

• The method of choice when assisted hatching is indicated. 
• It is precise and the most common technique.
• A focused high-intensity laser creates a small opening in the zona pellucida.
• Minimises handling of the embryo and exposure time.

Chemical-Assisted Hatching

• A very diluted acidic solution (acid Tyrode’s solution) is applied to the zona pellucida to create an opening. 
• This method of assisted hatching must be performed in a way that combats overexposure.

Mechanical-Assisted Hatching

• A fine needle or pipette is used to puncture the zona pellucida under the microscope.
• The least used method to perform assisted hatching is due to the risk of embryo damage.

In terms of safety, laser-assisted hatching is the best method to use as the risk to the embryo is minimal, and, therefore, it is the most efficient method.

Pre-Treatment Evaluation and Diagnostics

Before proceeding with assisted hatching, a complete evaluation will be performed in order to ensure that it is appropriate for the specific fertility profile of the patient. The standard assessments included are:

1. Detailed IVF History: Number of IVF cycles, implantation rates, and embryo quality.
2. Age and Ovarian Reserve: AMH, antral follicle count, and baseline FSH level to determine fertility potential.
3. Embryo Assessment: Evaluation of embryo development on Day 3 or Day 5.
4. Uterine Assessment: Ultrasound assessment or hysteroscopy to assess the endometrial lining and uterine receptivity.
5. Risks and Benefits: Detailed counseling by your fertility specialist regarding the outcome of each option.

Assisted hatching is generally scheduled at the time of embryo transfer during an IVF or ICSI cycle based on the assessments of the embryology lab.

Selection and Planning of the Procedures

The selection is undertaken by the IVF specialist and the embryology team. The following factors are important considerations:

• What is the patient's age, and any experience with implantation?
• What is the quality and stage of the embryo?
• Are we doing a fresh or frozen-thawed embryo transfer?
• What are the risks of handling embryos?

Patients are usually informed in advance if assisted hatching could assist in their circumstances. It is usually performed on the day of the transfer without additional time in the hospital or medication. 

Assisted Hatching Procedure

The procedure is undertaken in the IVF laboratory under strict sterile conditions and utilizes specialized equipment.

• Embryo Evaluation - The developmental stage and quality of the embryo are evaluated, with an eye on aspects like fragmentation, symmetry, and cell number. 
• Zona Pellucida Identification - The zona pellucida is identified under the microscope.  
• Zona Breaching - This involves creating a small hole or thinning the zona pellucida and may be done with a laser, mechanically, or with chemicals. 
• Post-Procedure Embryo Culture - After the procedure is finished, the embryo is cultured in the lab to track its development and ensure its readiness for the transfer. 
• Embryo Transfer - The embryo is transferred into the uterus, ideally at the blastocyst stage (day 5 or 6 of development). 

The assisted hatching procedure takes a matter of minutes, and no transfer recovery time is needed by the patient.

Risks & Potential Complications of Assisted Hatching

Assisted hatching is generally safe; however, any use of medical assistance carries well-managed risk:

• Accidental damage to the embryo, if the procedure is not performed correctly
• Possible increase in monozygotic (identical) twins
• A minimal-risk embryo can arrest or fail to implant

Additional considerations:

• While assisted hatching can be beneficial, there are no guarantees of implantation or pregnancy. 
• Assisted hatching may not be of much benefit to younger women or women with good-quality embryos. 

The risk of harm to the embryo is minimized, and the precision of the process is maximized with laser-assisted hatching, the preferred method in most advanced fertility centers.

What to Expect After an Assisted Hatching Procedure?

There are no direct side effects from assisted hatching, nor are there any special recovery considerations for patients going through assisted hatching. 

• Instructions after the transfer: Patients are encouraged to rest for a short period after the transfer and follow standard post-IVF care instructions. The embryo is transferred on the same day as assisted hatching. 
• Medications: The progesterone and any other medications will continue as prescribed.
• Follow-up testing: Beta-hCG blood test will be done in 10 to 14 days to confirm pregnancy.

Post-Treatment Recovery and Long-Term Care

Post-procedure recovery is consistent with standard IVF procedures. Recovery care that will occur after the procedure remains consistent with the following:

• Consistent use of medication: Continue to use progesterone support to facilitate implantation.
• Lifestyle Recommendations: Gentle physical activity, stress management, and a healthy diet.
• Symptom Monitoring: Report any discomfort, cramping, or bleeding to the treating specialist.
• Emotional Support: Psychological counseling may be offered to help manage the emotional aspects of fertility treatments.
• Continued Follow-Up: Regular ultrasound and hormone monitoring if pregnancy is achieved.

Long-term care is primarily focused on pregnancy monitoring and prenatal care following successful implantation.

Assisted Hatching Success Rate in India

Reported success rates in India’s top IVF centers:

• Implantation rate improvement: 10–20% in selected cases
• Overall clinical pregnancy rates: 35–50%, depending on age and embryo quality
• Higher success: When combined with blastocyst transfer and laser-assisted technique

It is important to note that success rates vary based on individual factors, lab expertise, and embryo quality.

Cost of Assisted Hatching in India

In India, the cost of assisted hatching typically ranges from USD 300 to USD 800 per cycle, depending on the clinic and the specific services offered. Factors influencing the price include the expertise of the medical team, the technology used, and the overall treatment package. Many patients find that, while the cost is an important consideration, the potential benefits of enhanced implantation rates make it a worthwhile investment in their fertility journey. It's advisable to consult with multiple clinics to compare prices and services before making a decision.

Why Choose India for Assisted Hatching?

India offers high-quality assisted reproductive care with advanced technologies, skilled embryologists, and competitive pricing. Key advantages include:

• Highly experienced fertility specialists and embryology teams
• Access to laser-assisted hatching, which ensures precision and safety
• Affordable IVF packages compared to Western countries
• Short waiting times and seamless treatment coordination for international patients
• Multilingual support and medical tourism assistance

IVF centers such as Nova IVF Fertility, Cloudnine Fertility, Apollo Fertility, and Indira IVF offer state-of-the-art assisted hatching as part of their comprehensive ART services.

Documents Required for Patients Traveling to India for Assisted Hatching Procedure

For international patients contemplating an assisted hatching procedure in India, it is necessary to present certain documentation to have a smooth medical journey. These include:

• Valid Passport: Valid for a minimum of six months after the date you travel.
• Medical Visa (M Visa): Granted by the Indian Embassy/Consulate on medical grounds.
• Invitation Letter from Indian Hospital: A formal letter explaining the course of treatment and how long it will last.
• Recent medical records: X-rays, MRIs, blood tests, and a referral note by a doctor in the home country.
• Completed visa application form: With passport-size photographs according to specifications.
• Proof of means: Bank statements dated in the past few months or health insurance.
• Medical Attendant visa: Needed for a companion or caregiver traveling with the patient.

It is advisable to refer to the Indian consulate or your medical facilitator for the latest information and help in documentation.

NOTE: Single parents and same-sex couples should confirm legal requirements with the clinic before starting.

Top Assisted Hatching Specialists in India

Here are some of the leading specialists for assisted hatching in the country. 

1. Dr. Firuza Parikh, Jaslok Hospital, Mumbai
2. Dr. Durvasula Ratna, Rainbow Children’s & Birth Right by Rainbow Hospital, Hyderabad
3. Dr. Kamini Rao, Milann Fertility Centre, Bangalore
4. Dr. Hrishikesh Pai, Fortis Bloom IVF Centre, Mumbai
5. Dr. Sanjay Kumar Biswas, Ruby General Hospital, Kolkata

Best Hospitals for Assisted Hatching in India

These are some of the top hospitals for assisted hatching in India. 

1. Apollo Cradle Hospital, Gurgaon
2. Nova IVF Fertility, Multiple Locations
3. Cloudnine Fertility, Gurgaon
4. Indira IVF, Multiple Locations
5. Jaslok Hospital, Mumbai

Frequently Asked Questions (FAQs)

Is assisted hatching painful?

No, the procedure is performed in the laboratory and does not involve any additional discomfort for the patient.

Does assisted hatching guarantee pregnancy?

No, it improves the chances of implantation in selected cases but does not guarantee pregnancy.

Is assisted hatching necessary for all IVF cycles?

No, it is typically recommended for specific patients, such as those with repeated IVF failures, older women, or poor embryo quality.

Can assisted hatching increase the risk of twins?

There is a slightly higher risk of identical (monozygotic) twinning associated with assisted hatching.

How is assisted hatching different from embryo biopsy?

Assisted hatching creates a small opening in the zona pellucida, while embryo biopsy involves removing cells for genetic testing.