My fertility doctor has really got me puzzled. The first attempt at IVF failed. Now he's told me of a procedure that involves cutting a slit in the egg. Why didn't he do all he could do the first time?

Carrie

"Assisted hatching" (AH) is a procedure that involves creating a small hole in the zona pellucida, a shell-like protein investiture surrounding the fertilized egg. On or around the fifth day, the zona pellucida "hatches" and the embryo, now called a blastocyst, is ready to implant. Studies have suggested that a certain subgroup of IVF patients stand a better chance of success with the procedure. This includes patients having culture in a laboratory setting, high doses of ovulation medication, advanced age, higher FSH levels, thick zona and previous IVF failures. Studies have shown, however, that AH is of no benefit when performed on every embryo. In fact, the procedure is time consuming, adds to the cost of IVF and may in fact damage healthy embryos. So, avoiding this on the first go-around is the normal policy unless factors would indicate you would likely benefit.