Carolinas HealthCare System

Assisted hatching and intracytoplasmic sperm injection (ICSI) are micromanipulation techniques sometimes used during IVF procedures.

Assisted Hatching

Watch a video of Assisted Hatching and ICSI
Assisted hatching is performed to help an embryo hatch out of its protective layering and implant into the uterus. During the initial stages of development, your embryo is contained in a layer of proteins, known as the zona pellicuda. The zona pellicuda is designed to protect the embryo until it reaches the blastocyst stage of development. In order to successfully implant into the uterine lining, the embryo needs to hatch out of this zona pellicuda and attach to the walls of the uterus. Sometimes, embryos have a difficult time hatching out of their protective layer. This can occur if the zona pellicuda is too thick or if the embryo does not have enough energy to break through the layer. Assisted hatching attempts to help these embryos break out away from the zona pellicuda by creating a small hole in this outer lining.

How is Assisted Hatching Performed?

Assisted hatching is a very delicate procedure, requiring immense skill. It is performed using micromanipulation techniques, under a microscope, during the fourth day of embryo development.

The embryo is first placed in a petrie dish containing culture solution. A special pipette is then used to hold the embryo in place. The embryologist takes a hollow needle that contains an acidic solution and places it next to the zona pellicuda. A tiny bit of this acidic solution is released from the needle so that it comes into contact with the zona pellicuda. This acidic solution begins to slowly digest the protective layering, creating a small hole. The embryo is then washed in a special solution and placed back inside an incubator until embryo transfer can take place.

Who Can Use Assisted Hatching?

Assisted hatching techniques aren't suitable for every couple. Instead, the procedure is typically recommended for:

  • women over the age of 37
  • women with elevated FSH on day 3 of their menstrual cycle
  • couples who have experienced failed IVF cycles
  • couples whose embryos have a particularly thick zona pellicuda

Risks Associated with Assisted Hatching

Unfortunately, there are some risks associated with assisted hatching procedures. In particular, assisted hatching procedures do seem to increase the likelihood that you will have identical twins (also known as monozygotic twins). This is because the micromanipulation technique used to break through the zona pellicuda can sometimes cause the embryo to split into two identical halves.

There is also an increased risk of:

  • damage to the embryo
  • fetal complications
  • physical deformity
  • conjoined twins

The procedure can sometimes also cause complications for the mother, including:

  • high blood pressure
  • infection
  • nausea
  • mood swings

These side effects are the result of the steroids and antibiotics that you must take during the transfer procedure. Because the protective layer surrounding the embryo has been compromised, it is essential that you take medications to slow your immune system down and to prevent infection of the embryo.

Advantages of the Assisted Hatching Procedure

Many couples elect to pursue assisted hatching during their IVF procedures. This is because the technique is associated with a number of benefits including:

  • fewer embryos required for transfer
  • increased implantation success rates
  • allows for blastocyst culture

Disadvantages of the Assisted Hatching Procedure

Unfortunately, assisted hatching does have its drawbacks.

Specifically, assisted hatching is:

  • only suitable for certain groups of women
  • very difficult to perform and requires immense skills
  • can be associated with an increased risk of dangerous pregnancy complications

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a procedure utilized to treat moderate to severe male factor infertility. Before a man's sperm can fertilize a woman's egg, the head of the sperm has to attach to the outside of the egg. Then it pushes through the outer layer of the egg to the inside of the egg (cytoplasm). Sometimes the sperm are not able to penetrate the outer layer of the egg. A procedure called intracytoplasmic sperm injection (ICSI) can help by injecting the sperm directly into the egg.

How does ICSI work?
In traditional IVF, the sperm are mixed with the woman's egg in a laboratory. If ICSI is needed, a small needle is used to inject a sperm into the center of the egg. The fertilized egg grows in a laboratory for one to five days, then it is placed in the woman's uterus (womb).

Why would I need ICSI?
ICSI helps to overcome a man's fertility problems, for instance:

  • He may produce too few sperm
  • His sperm may not be shaped correctly or move in a normal fashion
  • The sperm may have trouble attaching to the egg
  • A blockage in his reproductive tract may keep sperm from getting out

ICSI can also be used when the use of traditional IVF has not produced fertilization, regardless of the condition of the sperm.

How is sperm retrieved for use in ICSI?
For men who have low sperm count and sperm with low mobility, the sperm may be collected through normal ejaculation. If the man has had a vasectomy, the microsurgical vasectomy reversal is the most cost-effective first choice option for fulfilling the desire to have children.

Sperm aspiration refers to the group of procedures used to obtain viable sperm from the male reproductive tract. Needle aspiration or microsurgical sperm retrieval, are good alternatives when a competent microsurgical vasectomy reversal has failed, or when the man is opposed to surgery. Needle aspiration allows physicians to easily and quickly obtain adequate numbers of sperm for the ICSI procedure. A tiny needle is used to extract sperm directly from the testis. Needle aspiration is a simple procedure performed under sedation with minimal discomfort; however there is potential pain and swelling afterwards. The sperm obtained from testis is only appropriate for ICSI procedures when testicular sperm is not able to penetrate an egg by itself.