Deputy Laboratory Manager at GENNET City Fertility, GENNET City Fertility
Embryo Transfer, IVF laboratory
Our lab doesn’t do in vitro egg maturation, I don’t know if it’s widely done in the UK, and that might just be because of the HFEA and their restrictions. With MI eggs that are frozen, it may survive the thawing, there’s no reason to think it wouldn’t. Hopefully, it can mature, it will depend on when it was frozen and how long it was left to see if it would mature before the freezing.
What I would probably advise is if it matures the day after it’s thawed, for example, so it does mature, it does fertilize, and if it creates a blastocyst, I would probably advise having a genetic test on it, just to make sure that there’s no aneuploidy there.
Some research shows that eggs that mature quite late might have quite a high incidence of aneuploidy, which means the chromosomes aren’t balanced, which could lead to other problems. If it gets to blastocyst, you might want to consider doing some extra tests on it. There’s no reason for me to think that it wouldn’t survive the thawing, everything else is quite dependent on the actual quality of the egg.
Sometimes you can, and sometimes you wouldn’t. It will vary between labs, and it will vary based on which brand media you’re using. You can get sequential culture media which is the kind where you will have culture media that’s optimal for embryos to develop from day zero up to day three, and then you would change it to a different type of culture media from day three to day five.
You can also get single-step culture media which is designed to support embryo growth from day zero up to day five, and this is what we currently use in the lab. As I’ve mentioned with the time-lapse incubation that we use, the real benefit of it is that we never have to remove the dishes from the incubator until we get to the final day just before transfer.
If we were to be taking the dishes out and refreshing the media, that could expose the embryos to the conditions we’re trying to avoid, and there’s always a small amount of risk whenever you have to move a dish. It’s not something that we do in our lab, we use the single-step media, and we get good results from it, but every lab will vary based on what they like to use best and what they get the best results from.
I have not advised patients not to wear make-up during transfer. I know you don’t wear it during egg collection, particularly if you have it in sedation because there are signs that the anaesthetist will look out for on your face, which make-up can hide.
I don’t know if make-up during embryo transfers is a particular problem unless there is alcohol in it, high alcohol content should be avoided. If you check your make-up, if you check the ingredients list and if alcohol either isn’t in there or it’s quite far down the ingredients list, it’s probably safe to use. If you’re worried and don’t want to take the risk, then just don’t do it. It is up to you, but I haven’t advised people not to wear makeup during a transfer.
I think skin cream is fine, as long as it’s not heavily scented and doesn’t have a high content of alcohol in it, then it should be fine. I use skin cream on my face daily, not scented obviously, but I think I would dry up if I didn’t, so I use it.
Day-6 blastocysts are fine, I wouldn’t worry about a day-6 blastocyst, we do see good results from transferring day-6 blastocysts. Concerning day-7 blastocyst, we don’t culture to day-7, it’s not something that’s routinely done, I think in the UK. It has been done, but again, I think I would probably recommend performing a genetic test if you have that available to you for any day-7 blastocyst.
It’s not something that we tend to sort of wait to see if it happens, we tend to have day-6 as the cut-off, but again, I wouldn’t write them off if you’ve got good quality day-7 blastocyst and it’s frozen, but I would probably say take extra precautions before having them transferred.
I would say it’s reliable. With everything that we do, it’s not 100% perfect, but I would say that if you have a good reason for wanting your embryos to be genetically tested, for things like recurrent miscarriages or if the female partner is maybe a bit of increased age, then yes, it can be worthwhile. When we’re selecting embryos in the lab, we will watch how they develop, we watch the quality of them on day-5 or day-6. We can never tell what’s going on inside the cells and if you have increased risk factors for aneuploidy or something that could change the chromosomal makeup of the embryos.
I would say it’s worthwhile to at least consider it and have an appointment with a genetic counsellor so that you know what you’re getting into, and then if you think that it’s something that would work for you, I would say it’s a good option to at least give you peace of mind that any embryo that you’re having transferred back is chromosomally normal and it’s just worthwhile finding out if you could be in one of those risk categories.
Egg testing is possible, you can take a small biopsy of what’s called the polar body from the egg and it’s not something that I think is particularly reliable, I’m not sure if we still do it in the UK. The reason is that you can get the quality of the egg, so maybe it could help in terms of ruling out a particular embryo, but you can’t guarantee that an embryo that has developed from a perfectly healthy egg is still perfectly healthy. It’s something that is not as reliable as testing the embryos on day-5 or day-6.
They are developing ways that we can get to know the quality without doing a biopsy of an embryo, so they’re hoping to develop ways of testing the culture media in which the embryo has grown. If you can test that media, you might be able to find out if there are chromosomal abnormalities in that embryo. It’s not perfect yet though, so it might be a way off coming, there is something on the horizon at least, and then it’s just things like if you have access to time-lapse incubation that can help because if you can see the divisions that the embryo has made, it can give you a good idea of everything that is going on.
Add-ons have had such bad press recently, some of them probably rightfully so, and some of them they’re just getting a bad time because the gold standard of scientific trials was randomized, controlled tests just can’t be performed on it. Things like assisted hatching can be very useful. If you’re in the risk category if you’ve had repeated failed implantation, for example, if you had a few transfers of frozen embryos and again if you’re in an advanced stage category, sometimes it can be useful to have something like assisted hatching.
Assisted hatching, it’s such a simple process, and when it’s done properly, it doesn’t damage the embryos, and yes, at least we know then that the embryos will be able to hatch out of their shell. It’s difficult for me to say if they work because all the scientists, all the embryologists in the country can’t come up with scientific proof that it does. It’s something that we do in the lab, we do believe that there is good reasoning behind it. If somebody has had the repeated cycles, why not try something different that won’t harm the embryos, and it might just increase your chances, so it’s something that I think is worthwhile.
We use PICSI more routinely than we use IMSI. PICSI is basically where you do ICSI, and you use a dish that allows the sperm or only mature sperm to bind to hyaluronan, which is on the dish, so this is something found in the shell of the egg. The theory behind this is that any mature sperm which would have the physical capability of fertilizing an egg will be bound to the bottom of the dish, and we then go along and select the best-looking one. Anything that’s not bound to the dish, we know it’s not mature, so it gives us an extra level of knowing which sperm to pick while we’re doing an ICSI.
If you have had a sperm test, which has suggested that you have a higher concentration of immature sperms, the sperm that doesn’t bind to hyaluronan, then yes, they might suggest PICSI. If you’ve got the higher concentration, there is a higher chance of an embryologist selecting an immature sperm by accident because otherwise, without it, we can’t necessarily tell.
IMSI is doing ICSI but with a higher magnification. If there are things like vacuoles in the sperm head or if the sperm tends to misshapen, then we might use IMSI. To make sure that we are looking at each sperm cell that we’re selecting. It depends on the semen analysis that you might have had if it’s recommended for use.
I suppose you’d want to know things mostly about success rates and you can go into all the details, you could ask for all of their service reports, all of their qualifications, but at the end of the day, that doesn’t mean that they’re going to be doing the best work for you. I think you can look at the individual success rates of a clinic, that’s going to give you a much better picture. At the end of the day, it’s not just the embryologists that will contribute to your treatment. It’s so important to take all into account, the nurses, the doctors, the stimulation that they give you, the procedures that they do,
I probably wouldn’t advise you to only look at the embryologists when you’re selecting a clinic. Look at the success rates as a whole, and if you can look at the treatments that they offer in terms of IMSI or PICSI and genetic testing, anything that you think you might want to look into. Then at least you have the option if you need to without having to change clinics.
It will vary between clinics. Generally speaking, ICSI and IVF have comparable success rates. It will vary between clinics, and I can’t comment on everyone’s success rates, but certainly, the clinics I’ve worked at, ICSI and IVF, do tend to be very comparable.
I have no idea, and as incompetent as that probably makes me sound, the reality is we know that our culture media works, we validate it for the processes that we do, but in terms of the ingredients, that’s not something that the manufacturers published to us. We know that they’ve got antibiotics and glucose, pyruvate, and much more than that, but they don’t tend to share with us, so it’s very difficult for me to answer that one, I’m afraid.
In your lab, we have good rates, so embryo thawing, I think we’re at about 90 to 95% survival rate, which is good. The egg survival rate is always slightly lower just because of the nature of egg cells and how they survive, I’m not sure of the exact survival rates of eggs after thawing, it’s usually around 60 to 70%.
It’s a nice, comfy temperature, about 23 degrees generally. We don’t keep the lab at 37 degrees because we’d all pass out, but we keep a nice, warm temperature to minimize any effects on taking any dishes out.
Our pH tends to be around about 7.2, it will vary between labs, but it’s what we calibrate our media.