This is a guest post by Saiprasad Gundeti, Senior Embryologist, Malpani Infertility Clinic.
As an embryologist, I help in making the dreams of infertile couples come true ! Most couples do not know what happens in an IVF lab, so I am happy to describe a day in my life !
This is the daily routine we follow at our centre :
First thing in the morning –
Cleanliness is a very important factor in IVF Lab. We need to make sure everything is sterile ! Because I work alone in our lab, it's much easier for me to ensure that everything is clean !
- Hood and bench work surfaces (including microscope working areas, heat baths, petridish warmer) are cleaned and wiped down with 6% Hydrogen Peroxide.
- Once a week centrifuge rotors and carriers as well as outside area of the centrifuge are cleaned and disinfected using 6 % Hydrogen peroxide
- Floor is nicely cleaned with 6 % Hydrogen Peroxide.
Monitoring and Maintenance of All Equipments
Your embryos can be quite demanding, and we need to keep them happy in the IVF lab ! We do this by ensuring that the conditions in the lab are just right for your embryos !
- The Incubator CO2 % is confirmed with the help of CO2 analyzer. Calibrated if any anomaly seen in the readings. Temperature is measured with the help of digital thermometer. Calibration is done in case of any temperature variation seen.
- Temperature is measured for all heating baths, heating plates of all microscopes and petridish warmer.
- Gas cylinders connected to CO2 incubators are checked. Cylinders are changed if they are found half empty.
Monitoring of embryo development
- Fertilization assessment of each patients eggs on which ICSI was performed a day before.
- Stripping (denudation) of eggs on which IVF was preferred.
- Transferring fertilized eggs to new dishes (prepared, labeled with patients name and incubated a day before)
- Assessment of embryo development grading of day2, day3, day4, day 5, day 6 embryos.
- Documentation in IVF file as hard copy and IVYSITE ( our electronic medical record) as soft copy.
- We routinely give all our patients photos of their embryos. We take pride on our work, and good quality embryos are a testimony to the fact that we are providing a high quality service to our patients !
Preparation for the Cases
- Preparation for ICSI procedure -
- Preparation of ICSI dishes
- Preparation of Hylase dishes (for stripping eggs before ICSI procedure)
EMBRYO TRANSFER PROCEDURE
This procedure involves the transfer / placement of day-2 or day-3 embryos to the patient's uterus. It is performed transcervically with or without anesthesia.
Showing embryos to the patient
We at our centre show every patient their embryos before transferring them to their uterus.
- The nurse in charge brings the patient couple to the lab and introduces them to me.
- I walk them through their cycle, giving them details about –
- Number of eggs retrieved
- Procedure done (IVF/ICSI)
- Number of mature eggs
- Details about husband's sperms (fresh/frozen/epidydimal/testicular)
- Number of eggs fertilized
- Quality of embryos
- Number of top quality embryos
- Number of embryos that will be transferred
- Number of embryos that will be cryopreserved
- I show them the embryos and grade them in front of the patient couple. Many women get quite emotional on seeing their embryos !
- Guide them to the operation theatre.
- I select the best embryos and transfer them to "Embryo transfer" dish.
- When the OT is ready, I confirm with the doctor, as to which catheter to be used.
- I load the embryos into the catheter. A nurse stands as a witness while loading.
- I hand over the catheter to the doctor, by verbally confirming the name of the patient.
- The doctor gently guides the catheter through the cervix and gently pushes the embryos into the uterus.
EMBRYO CRYOPRESERVATION PROCEDURE
This procedure involves freezing of supernumerary embryos after transferring the best embryos.
The procedure is done only after taking patient couple's consent.
- This procedure is done at room temperature. So temperature of microscope stage is brought down to room temperature.
- Vitrification (freezing) medium is taken out. Freezing dish is prepared by placing droplets on the dish.
- Cryolocks are labeled with patients name, date of freezing, number of embryos per cryolock.
- After the embryos are frozen, the cryolocks are stored in cryocanisters.
- Details are documented in the register.
COLLECTION OF SEMEN SAMPLE FOR HUSBAND OF PATIENT UNDERGOING OVUM PICK UP PROCEDURE
- The patient is given a pot labeled with his name to collect semen sample.
- Once the sample is collected, it is brought to lab along with the file.
- Sample is processed for the procedure (IVF/ICSI)
PREPARATION FOR OVUM PICK UP ( OPU) PROCEDURE
- Temperature of instruments are checked.
- Patient's ID is checked with doctor/ nurse in charge.
- Petri dishes are arranged on a petridish warmer
- Remind clinician to collect clean follicular fluid (~3-4 ml). I Pour this in warm petri dish.
- subsequent follicular fluid is poured into a fresh warm petridish.
- As soon as egg (Oocyte Cumulus Complex) is located I take clean follicular fluid in to Pasteur pipette and pour 2-3 drops over OCC and then take OCC into the Pasteur pipette and deliver in the dish at 12 O'clock position.
- Inform the clinician by loudly saying "EGG" when the egg is identified.
- I inform Dr. Anjali about presence of egg in the tube by loudly saying "EGG".
- If there is no egg in the tube I inform by loudly saying "NOTHING" and I do inform about the presence of Granulosa cells in the fluid.
- Similarly I identify and collect all the eggs at 12 O' clock position in 60mm petridish.
- I Take out OPU dish labeled with ( Patient Name) and ( Egg Wash)-prepared one day earlier.
- I Rinse all the OCC's in the outer well containing Flushing medium and transfer them in to the centre well of the same dish containing Fertilisation medium
- Following OPU, OCC's are cultured in fertilisation medium in CO2 incubator till IVF or ICSI being done on them.
Continuing medical education
IVF is a field in which technological advances occur very rapidly. I read the journals, Human Reproduction and Fertility Sterility, to ensure that I am uptodate !
Preparation for the Next Day
- I go through the files of all patients that are scheduled for next day.
- Preparation depends on what procedure patient is undergoing.
- Fertilisation check dishes:
dishes for each patient
- Dishes / medium for OVUM PICK UP :
- Dishes for IVF (No. of Dishes dependent on no. of follicles):
- Dishes for ICSI (3 Dishes for each patient):
1 tube with Oil (6ml)
1 tube with Flushing medium (6ml)
- Dishes for Frozen Thaw (2 Dishes for each patient) :
- Medium for Embryo Transfer :