Assisted hatching
No clear live birth benefit, and a consistent increase in twins.
The idea is that thinning or breaching the shell around the embryo helps it escape and implant. It is offered particularly to older patients and after failed cycles.
The Cochrane review covers 39 randomized trials in 7,249 women. Only 14 of those trials, covering 2,849 women, reported live birth at all.
| Outcome | Effect | In absolute terms |
|---|---|---|
| Live birth | Odds ratio 1.09 (95% CI 0.92 to 1.29), low quality | Baseline 28% becomes 27% to 34% |
| Multiple pregnancy | Odds ratio 1.38 (95% CI 1.13 to 1.68), low quality | Baseline 9% becomes 10% to 14% |
The reviewers describe serious risk of bias associated with poor reporting of study methods, inconsistency, imprecision, and publication bias.
Note the asymmetryThe live birth benefit is not established. The increase in multiple pregnancy is the more consistent of the two findings.
Given what the earlier topic showed about twins, an add-on that does not clearly raise your chance of a baby but does raise your chance of a twin pregnancy has a negative expected value for you, not a neutral one.
Given what the earlier topic showed about twins, an add-on that does not clearly raise your chance of a baby but does raise your chance of a twin pregnancy has a negative expected value for you, not a neutral one.
The UK regulator rates assisted hatching grey, meaning there is not enough moderate or high quality evidence to rate it. In an audit of 40 Australian and New Zealand clinic websites, 28% advertised it.
Where this comes from:
80. Lacey L, Hassan S, Franik S, Seif MW, Akhtar MA. Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI)). Cochrane Database Syst Rev. 2021;3(3):CD001894.
84. Human Fertilisation and Embryology Authority. Treatment add-ons with limited evidence. London: HFEA; published October 16, 2023, last reviewed February 26, 2026.
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