Assisted Hatching is another laboratory procedure which enhances pregnancy rates in certain women undergoing IVF. A small opening is made in the shell surrounding the embryo just prior to transfer of the embryo into the uterus. This increases the likelihood that the embryo will implant into the wall of the uterus resulting in a successful pregnancy. AZH maybe recommended for women who have elevated Day-3 FSH level or those who have failed IVF > 2 times and embryos having thicker zonas.

Microembryonic hatching is the technique in which the embryologist creates microscopic holes in embryonic shell to facilitate easier release of the embryo into endometrial cavity that improves implantation. Under a high-powered microscope, a small, slit-like opening is mechanically created using a fine glass needle while the embryo is held by gentle suction. Breeches are made in ZP of early cleavage embryos. Removal of necrotic blastomere from frozen, thawed, partially damaged embryo improves implantation rate.

Embryo Transfer (ET): Empbryo Transfer done 3-5 days following egg retrieval is a simple procedure that takes less than 10 minutes and does not require anesthesia. The woman after undressing lies in Lithotomy position with full bladder. Cervix is exposed with bivalve vaginal speculum. Cervical mucus is cleared by gentle aspiration.

A delicate special plastic catheter is introduced through the vagina and cervix into the uterus with its tip in the uterine cavity. The embryos are placed in similar thinner tubing used to transport the embryos from the laboratory container to the womb. The embryos are then transferred through this thinner plastic tubing which is passed through the catheter. The insertion is controlled by Transabdominal ultrasound display.

Typically 2-4 embryos are transferred. Those with good morphology are transferred to uterine cavity. The number of embryos to be transferred depends on the age of the woman. Women in the twenties have fewer and women in the thirties and over have more embryos transferred; < 30 years 2 to 3, 31-34 years 3, 35 years 4, and > 42 years 5.

After ET the legs of the woman are repositioned to be comfortable. We require her to remain lying down for about an hour after the embryos have been replaced into the uterus. she then walks out.

Blastocyst Transfer is possible now in some cases. Blastocyst embryo is further along in development and usually fewer of them need to be transferred. Blastocyst transfer is appealing because of its ability to decrease multiple pregnancy rates. It can only be attempted if there are a high number of rapidly dividing embryos and synchronization between embryos and endometrium. Blastocyst Transfer is not done in all the cases because the majority of embryos cannot with existing technology make it to this final stage.

Blastocyst transfer uses a large number of fresh embryos and in many circumstances will not leave any more embryos for freezing and future transfers. All women at the present time are considered for blastocyst transfer if they have 4 or more, higher quality embryos at 72 hours. The blastocyst transfer is to be considered a technique to lower multiple pregnancy rates rather than to increase pregnancy rates.

Patient Criteria for blastocyst culture are; Young women under 35 years with good ovarian reserve and older women with good number of > pronuclear embryos.

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