Infertility is the inability to conceive a child naturally. All infertility treatments involve bringing the husband’s sperm and the wife’s egg together. This can take place in her womb or in a laboratory. For instance, intrauterine insemination (IUI), the most basic infertility treatment, involves the collection of the husband’s semen to be washed (motile sperms separated from the seminal fluid) and then introduced into the wife’s uterus using a sterile tube at the correct time of her menstrual cycle.
However, the most common infertility treatment is IVF. In-vitro fertilization or IVF is a procedure where a woman’s eggs are retrieved from her ovaries and fertilized in a laboratory with a man’s sperms; the embryos formed are then transferred back into her uterus. The treatment starts with an evaluation and series of tests for both the partners. Different couples require different approaches to IVF treatment.
How IVF/ICSI is done
The woman is given hormonal injections to stimulate her ovaries. An ultrasound is done to check the response of her ovaries. Eggs are then retrieved from the ovaries under general anesthesia and fresh or frozen semen sample is used. In IVF, the woman’s eggs are allowed to fuse with her husband’s sperms in a glass dish in the lab, envisioning that a good quality sperm will penetrate and fertilize the egg. While in ICSI (intra-cytoplasmic sperm injection), a single sperm is manually selected and injected directly into the egg for activation. ICSI is a skillful technique which requires training and practice. All embryologists at Nova IVI Fertility are well-trained to perform ICSI.
After fertilization (activation of the oocyte), the best embryos are selected and transferred to the uterus on the 3rd or 5th day after egg collection. Other good quality embryos may be frozen for future cycles. A pregnancy test is done after 15 days to check if gestation has been achieved. If the result is positive, pregnancy has been achieved. If it is negative, further evaluation is needed to propose the best treatment plan.
Role of an Embryologist in the Lab
“What does an embryologist do?” is one of the most common questions every patient has in their mind and the best possible answer could be that the embryologist is your child’s first baby-sitter! The embryology department has a huge role to play in the IVF/ICSI process and the contribution of an embryologist in infertility treatment is no less than the fertility specialist or consultant.
The most important activities that the embryologist does are as follows:
- Maintenance of the embryology lab
The embryologist maintains laboratory conditions most conducive for embryos to flourish. Strict regulation of conditions such as temperature, air quality, and humidity are prerequisites of any good IVF laboratory.
- Egg retrieval
During egg retrieval, fluid is removed from the ovaries. This fluid contains the eggs. The embryologist examines this fluid under a microscope, identifies, and collects the eggs.
- Checking for fertilization
The day after the sperms and eggs are combined, the embryologist checks the eggs for fertilization (activation of oocyte) by examining each of them under the microscope.
- Incubation and monitoring
The embryologist places the fertilized eggs inside an incubator regulated to control temperature and pH that mimics the condition of the uterus. These optimal conditions enable the fertilized egg to become an embryo. The embryologist periodically checks the embryos and replaces the culture media.
- Genetic Testing – (PGS/PGD)
Embryologists also perform embryo biopsy in order to screen embryos for chromosomal abnormalities. A biopsy can be performed on either Day 3 or Day 5 of embryo development. Biopsy is done by removing a single cell on Day 3 or a few cells from the Trophectoderm on Day 5 from an embryo while minimizing the risk of damage to it. Most embryos with an abnormal number of chromosomes fail to implant or lead to miscarriages. Genetic testing greatly increases the chances of a healthy pregnancy.
- Assisted hatching
Assisted hatching is recommended in a few cases where the outer shell of the embryo known as zona pellucida is thinned with the help of laser in order to facilitate implantation.
- Embryo Transfer
Embryologists select the best quality embryos and load them into the transfer catheter. This is then carefully handed over to the fertility specialist to deposit the embryos safely into the uterus.
The embryologist is responsible for the cryopreservation of extra embryos during the IVF procedure. Any good quality embryos that are not transferred are identified and frozen for later use.
The know-how of an expert embryologist is critical for the success of IVF treatments. The skills mentioned here are complex, delicate, and require years of experience. A proficient embryologist could mean the difference between the success and the failure of the infertility treatment. Nova IVI Fertility is proud to have well-qualified, highly-trained, and dedicated embryologists at each of its centers.