“If you can’t explain it simply, you don’t understand it well enough.” – Albert Einstein
Here are some basic terminology and procedures that may be performed during your experience with fertility. The better you understand these concepts and processes the better you will grasp what choices and decisions you would like to make for your own health. Plus it will help educate you in this process to help explain to others and keep carrying on the message so other women learn and know their options too. We only help each other when we share our resources, knowledge, and wisdom. Keeping knowledge to yourself doesn’t help anyone accomplish anything.
1. Egg Retrieval
Before the time of egg retrieval, patients have already undergone ovarian stimulation with regular monitoring from their physician. In the lab, before any egg retrieval can begin the embryologist performs identity verification and will continue to do so multiple times throughout every procedure performed in the lab. The embryologists confirm first-hand that the patient’s paperwork matches up with their egg, embryo, or sperm sample. In addition, a second embryologist confirms that the patient information matches.
Once the team confirms identification for the retrieval, the physician surgically aspirates each follicle and the attending nurse will bring several vials from the operating room to the embryologist. The vials are (hopefully) filled with eggs that were aspirated during the procedure. At the time of the retrieval, no one knows exactly how many eggs will obtain. Each woman freezing her eggs or using her own eggs for fertility treatments, the quantity of eggs during the physician retrieves can vary. The egg count is dependent upon factors like the woman’s age or the individual diagnosis.
The post-retrieval the embryologist must examine the contents of each vial in a culture dish with an inverted microscope and examine if the vials have a mature egg ready to be fertilized. Using a sterilized pipette, the embryologist hunts through the follicular fluid and blood, looking for the retrieved eggs. Once mature eggs are found, the count is marked down. Then the eggs are put into culture media, specially designed and formulated to replicate in vivo conditions and placed into an incubator.
Vitrification is a revolutionary new medical procedure that has changed fertility treatment. Embryo and egg freezing has been around for many years, but until recently, it wasn’t always reliable. Embryologists had traditionally used a slow-freezing technology, called cryopreservation, which often allowed ice crystals to form inside the egg, thus damaging to the cells.
Vitrification, a fast-freezing process, improved freezing exponentially. To perform vitrification, the embryologist will place the egg or embryo into freezing media droplets on a culture dish. Over the next 10 minutes, the egg or embryo undergoes serial exposure to an increasing concentration of cryo-protectant before it is loaded onto a straw. The straw is then rapidly dipped into liquid nitrogen for less than 1 minute. With that vitrification is complete and the straw is put onto a cane and stored in a cryotank. Eggs and embryos can remain in the tank indefinitely.
The lab carefully tracks and has an abundance of tanks full of clearly labeled eggs and embryos (to eliminate the possibility of identity confusion), largely due to vitrification’s growth in popularity. For example, many women freeze their eggs prior to undergoing chemotherapy treatment for illness like cancer to preserve their current fertility—then return after treatment to use the eggs. This “stopping of the clock” helps as that later date may be otherwise considered advanced maternal age or health conditions affect reproductive organs making it otherwise impossible to conceive a biological child.
3. Embryo Transfer
As with egg retrievals, the IVF team performs a two-step identification confirmation before an embryo transfer can occur. An additional identification confirmation is done with the patient for this procedure. The embryologists do an assessment of each transfer patients’ embryos, selecting the best possible one(s) for transfer. Once the embryologist selects the best embryo they will go into the transfer room to identify the patient directly. All parties involved: the patient, embryologist, physician, and a witness will verbally confirmed and sign off on the number of embryos the physician will transfer. Via ultrasound, the physician places the embryo(s) into the uterus. The embryologist then checks the catheter in the lab to make sure that there are no embryos remaining, thus confirming that there was a successful transfer. After the transfer, the patient will receive a picture of their embryo. For women that are returning to use previously frozen eggs, the embryologist will thaw and fertilize a select number of eggs. Same as with fresh eggs that have fertilized, the newly formed embryos will develop in the lab for typically 5 days prior to the embryo transfer.
4. Preimplantation Genetic Diagnosis (PGD) or Preimplantation Genetic Screening (PGS)
Preimplantation genetic diagnosis or screening is a cellular biopsy looking for specific genetic diseases like cystic fibrosis or sickle cell anemia (to name a few). There are several reasons why a physician may recommend PGD: recurrent pregnancy loss, recurrent in vitro fertilization (IVF) failure, if / when the mother and father are known carriers of a genetic disease that they do not want to be passed on to their future child.
The embryologist performs PGD/PGS in the lab preferably when the embryo has reached the blastocyst stage, meaning that the embryo is made up of several hundred cells. The embryologist removes about three cells from the embryo and sends them to an outside lab for testing. The turnaround time for testing is about 24 hours.
6. Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is a form of fertilization performed in the lab that differs from conventional fertilization. Conventional fertilization occurs when the embryologist places the male partner’s washed sperm directly on top of the egg and leaves it overnight. The embryologist brings together the highest quality egg and sperm and then lets them come together on their own. This doesn’t always work out though, particularly if a male factor of infertility is the known reason or present. This is where ICSI comes in. An embryologist injects a single, healthy sperm into the cytoplasm, or center, of each egg. Since fertilization only requires one healthy sperm, ICSI has become one of the most transformational advances in fertility treatment.
ICSI, like conventional IVF, still needs the embryologist to select the best sperm from the already-washed sample. The embryologist will proceed to ‘catch sperm,’ using a pipette and microscope to identify the sperm they will use for insemination. It’s not just about who is the fastest swimmer, it’s largely about the morphology, or shape, of the sperm. The embryologist will grab the sperm by the tail and bring them onto a culture dish. It might take an embryologist up to an hour to find a single viable sperm. Once they obtain the sperm, it’s time to inseminate. The pipette enters the egg and the embryologist places a single sperm in the center. ICSI is a revolutionary treatment and has changed the reproductive potential for couples experiencing severe male factor infertility.
What did you think? Was this helpful? Do you have questions? What would you like to know more about? How can these procedures and explanations be expanded on? What would you like to learn more about? Are there any concepts that you still don’t understand? Please let us know how we are doing. Tell us what you are thinking. Look forward to hearing from you.