Outcomes of Embryo Transfer Following Laser-assisted Hatching in Patients with Recurrent Implantation Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Recurrent implantation failure (RIF) affects approximately 10% of women undergoing embryo transfer. While laser-assisted hatching (LAH) has been proposed to improve outcomes, its efficacy remains uncertain in RIF patients. This study evaluated whether LAH improves outcomes for women with RIF. A systematic review was conducted in PubMed, Web of Science, Scopus, and Embase on January 22, 2025, for randomized controlled trials comparing embryo transfer outcomes following LAH versus controls in RIF. Random-effects meta-analyses generated log odds ratios (LOR), with evidence certainty graded using the Grading of Recommendations Assessment, Development and Evaluation tool. Nine studies involving 2,481 women with RIF were included. Meta-analysis revealed significantly higher rates in the LAH group compared to controls for clinical pregnancy (LOR = 0.643 [0.267, 1.019]; I² = 70.62%, very low certainty), ongoing pregnancy (LOR = 0.811 [0.076, 1.546]; I² = 63.54%, very low certainty), and live birth rate (LOR = 0.519 [0.127, 0.911]; I² = 15.21%, moderate certainty). Additionally, the LAH group had a significantly lower miscarriage rate (LOR = -0.632 [-1.136, -0.127]; I² = 0.00%, moderate certainty). No significant differences were observed for implantation rates (LOR = 0.691 [-0.036, 1.417]; I² = 87.14%, very low certainty) or multiple pregnancy rates per clinical pregnancy (LOR = 0.166 [-0.269, 0.600]; I² = 0.00%, moderate certainty). Our findings suggest that LAH before embryo transfer may improve pregnancy and live birth rates following embryo transfer in women with RIF; however, no significant effect was observed on implantation. Due to observed heterogeneity and the low quality of available studies, high-quality, large-scale randomized controlled trials are needed to confirm these results.