Objective:To systematically compare the clinical effects of simultaneous zona pellucida opening and prehatching in ectodermal biopsy techniques and to provide evidence-based medical evidence for the establishment of standard blastocyst biopsy procedure.Methods:We systematically searched PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP and Wanfang Data published until August 2023. We searched the literatures for studies that compared the effects of two zona pellucida opening. Primary evaluation measures included clinical pregnancy rate and live birth rate, and secondary evaluation indicators included biopsy success rate, euploid blastocyst rate, and miscarriage rate. Meta-analysis was performed using the R4.2.2 software meta package.Results:Six studies, including 12 223 biopsy embryos and 2 374 transfer cycles were subjected to analysis. The results of meta-analysis showed that the clinical pregnancy rate ( RR=1.22, 95% CI: 1.14-1.30, P<0.01) and the live birth rate ( RR=1.22, 95% CI: 1.12-1.32, P<0.01) in the simultaneous zona pellucida opening group were significantly higher than those in the prehatching group, and there were no significant differences between the two groups in biopsy success rate ( RR=1.38, 95% CI: 0.30-6.25, P=0.68), euploid blastocyst rate ( RR=0.98, 95% CI: 0.83-1.15, P=0.81) and miscarriage rate ( RR=1.06, 95% CI: 0.77-1.47, P=0.73). Conclusion:Stimultaneous zona pellucida opening blastocyst biopsy protocol is better than prehatching in terms of clinical pregnancy rate and live birth rate. Due to the limitation of sample size and quality of included studies, more high-quality studies are needed on the effect of zona pellucida opening timing on clinical outcomes.

Objective:To systematically compare the clinical effects of simultaneous zona pellucida opening and prehatching in ectodermal biopsy techniques and to provide evidence-based medical evidence for the establishment of standard blastocyst biopsy procedure.Methods:We systematically searched PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP and Wanfang Data published until August 2023. We searched the literatures for studies that compared the effects of two zona pellucida opening. Primary evaluation measures included clinical pregnancy rate and live birth rate, and secondary evaluation indicators included biopsy success rate, euploid blastocyst rate, and miscarriage rate. Meta-analysis was performed using the R4.2.2 software meta package.Results:Six studies, including 12 223 biopsy embryos and 2 374 transfer cycles were subjected to analysis. The results of meta-analysis showed that the clinical pregnancy rate ( RR=1.22, 95% CI: 1.14-1.30, P<0.01) and the live birth rate ( RR=1.22, 95% CI: 1.12-1.32, P<0.01) in the simultaneous zona pellucida opening group were significantly higher than those in the prehatching group, and there were no significant differences between the two groups in biopsy success rate ( RR=1.38, 95% CI: 0.30-6.25, P=0.68), euploid blastocyst rate ( RR=0.98, 95% CI: 0.83-1.15, P=0.81) and miscarriage rate ( RR=1.06, 95% CI: 0.77-1.47, P=0.73). Conclusion:Stimultaneous zona pellucida opening blastocyst biopsy protocol is better than prehatching in terms of clinical pregnancy rate and live birth rate. Due to the limitation of sample size and quality of included studies, more high-quality studies are needed on the effect of zona pellucida opening timing on clinical outcomes.