IVF Technology in The Embryology Lab:
Safety and Security:
We want you to know how careful we are in all aspects of embryology in our lab. When we take your egg from the follicular fluid, we carefully put it into a sterile dish. Then, we wash it and we put it directly into an incubator. Because it has been taken from its natural environment, our job is to make sure that we decrease any negative stress on an egg. We do this by mimicking the inside of the body as much as we can. All of our microscopes are warmed to 37 degrees, normal body temperature. The inside of an incubator is warm and humid, and we use a nutritive media to nourish the eggs and embryos.
TRIO has a dedicated air handling system to ensure an optimal environment for embryo development. And we are especially careful about patient identification. We take this very seriously. We create a unique identification number for each patient, as well as a bar coding system associated with your name, unique identification number and a designated barcode. Bar code labels with your unique identification number are placed on each dish or tube that comes into contact with your eggs, sperm and embryos. When we move sperm to eggs, we scan the barcode label from the sperm tube and the label from your dish of eggs. The barcoding tracks all procedures that we perform. We always know which eggs and sperm we’ve used. When the embryos are transferred, we scan the bar code of the chart and the dish embryos are coming from. During certain crucial steps, one person does the job, and one person verifies, and bar codes are always used. We also make sure another pair of eyes verifies the crucial steps. We account for all eggs and all embryos 100 percent of the time.
In conventional IVF, we put 20 to 30 thousand sperm into a dish of two or three eggs and they swim to the egg, fertilizing it. But sometimes, that doesn’t happen. Sometimes, there is not enough sperm, or they don’t move correctly. Then we can take one sperm, put it into a small needle and insert it into the egg. This is called ICSI (Intracytoplasmic sperm injection). We do thousands of eggs each year, on average. Our fertilization rate is 75-80% with ICSI.
TRIO can also provide Spindleview technology, a computerized high-power microscope that allows the embryologist to see the internal structure of each retrieved egg. In one third of retrieved eggs, the spindle is not in its expected position. Without Spindleview technology during ICSI, the embryologist can only make an educated guess when injecting the sperm into the egg. With Spindleview, the procedure will be more accurate and therefore, has a greater chance at successful fertilization. This technology also gives the embryologist a clearer picture of overall egg quality.
As the embryos develop, we can examine them for anything unusual. TRIO has state-of-the-art technology called Embryoscope, a time-lapse incubator that allows us to watch the development of the embryo in real time without having to remove it from the incubator. This technology removes risks that are increased when an embryo is exposed to temperature changes or to light. Embryoscope technology has resulted in a 9% increase in pregnancy rate and a 20% improvement in maturation to the blastocyst stage compared to standard incubators.
On Day 5, the developing embryo is called a blastocyst. A procedure we use to determine if there is a risk of genetic or chromosomal abnormality in the blastocyst is called PGT. We create a tiny hole in the outer coating and take cells from the outer layer of the blastocyst. Then we test these cells for genetic disease or count the chromosomes. We use this technique for a range of reasons, primarily as a diagnostic tool for recurrent pregnancy loss, to identify known genetic disorders, or to identify chromosomally normal embryos for transfer. For example, in patients with recurrent pregnancy loss, we found that embryos under the microscope appeared completely normal, but during PGT testing, it became clear their chromosomes were abnormal resulting in the loss of the pregnancy.
We send the cells to an outside lab that specializes in genetic analysis. They’ve done thousands of these tests and they are experts at this technology. They tell us which embryo is normal and which is not. TRIO only transfers embryos that are reported as normal.
As the embryo grows, it needs to emerge from its coating to implant in the uterus. Sometimes, this coating will not allow the embryo to break through. In these cases, we use Assisted Hatching, cold energy laser technology that gives us the ability to add a small weakness to the coating surrounding the embryo, giving it a better chance to implant. This technology, which is sound and exact, is very safe for the embryo.
Vitrification and FET:
For a typical cycle, we’ve retrieved 12 eggs, have 10 eggs that fertilized, and we have 6 blastocysts. We’ve transferred one blastocyst, but we have 5 blastocysts remaining. These embryos can be frozen safely and transferred in future IVF cycles, either for a first or for subsequent pregnancies. Because they are 99% water, we must be very careful when we are preserving them. We use a technique known as vitrification. We store these additional embryos in liquid nitrogen which freezes very quickly and is very safe. The survival rate is 98% with vitrification. The technology is so sound that today, the success rates for FET (Frozen Embryo Transfers) are equal to those of Fresh Embryo Transfers.