ABSTRACT

Three procedures that have been proposed at one time or another, to be performed for all IVF patients, assisted hatching (AH)—originally reported to improve implantation rates, intracytoplasmic sperm injection (ICSI)—wellestablished for severe male-factor cases, and extended embryo culture with blastocyst transfer-developed to facilitate embryo selection and thereby, increase implantation and pregnancy rates and reduce the incidence of multiple gestations. Initial results for all three of these procedures were very encouraging for selected groups of patients, but continued research revealed, however, that not all patients benefit from the “one for all and all for one” approach to these techniques. This, in conjunction with the possible risks imposed by each of these procedures requires that great care must be taken when performing any one of them. This paper will review the benefits and risks associated with AH, ICSI and blastocyst culture and transfer and attempt to establish if these procedures should be applied to all patients.