Assisted hatching Trends and pregnancy outcomes United States 2000 2010

Assisted hatching use has increased but is not associated with improved pregnancy outcomes, even in poor prognosis patients. Prospective studies should better assess the potential benefits of assisted hatching.

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Dmitry M. Kissin, M.D., M.P.H., Jennifer F. Kawwass, M.D., Michael Monsour, Ph.D., Sheree L. Boulet, Dr.P.H., Donna R. Session, M.D., Denise J. Jamieson, M.D., M.P.H. for the National ART Surveillance System (NASS) Group

Volume 102, Issue 3, Pages 795-801



To assess trends and outcomes of assisted hatching among assisted reproductive technology (ART) cycles.


Retrospective cohort analysis using National ART Surveillance System (NASS) data.


U.S. fertility centers reporting to NASS.


Fresh autologous noncanceled ART cycles conducted from 2000–2010.



Main Outcome Measure(s):

Implantation, clinical pregnancy, live-birth, miscarriage, multiple gestation.


Assisted hatching use statistically significantly increased in absolute number (from 25,724 to 35,518 cycles), percentages of day-3 (from 50.7% to 56.3%) and day-5 transfers (from 15.9% to 22.8%), and percentage of transfers among women ≥38 years (from 17.8% to 21.8%) or women with ≥2 prior ART cycles and no live birth(s) (from 4.3% to 7.4%). Both day-3 and day-5 cycles involving assisted hatching were associated with lower odds of implantation (adjusted odds ratios [aOR] 0.7 and 0.6, respectively), clinical pregnancy (aOR 0.8 and 0.7, respectively), live birth (aOR 0.8 and 0.7, respectively), and increased odds of miscarriage (aOR 1.4 and 1.4, respectively), as compared with cycles without assisted hatching. Assisted hatching was associated with lower odds of multiple gestation in day-5 cycles (aOR 0.8). In cycles for women with a “poor prognosis,” the association of assisted hatching with pregnancy outcomes was not statistically significant.


Assisted hatching use had an increasing trend but was not associated with improved pregnancy outcomes, even in poor-prognosis patients. Prospective studies are needed to identify the patients who may benefit from assisted hatching.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.