How to Induct a Junior Embryologist In Your IVF Laboratory?

IVF Laboratory

An IVF laboratory is not like any other routine laboratory, where, for instance, one can just put on a laboratory coat and begin to work. An IVF laboratory is built keeping in mind how everything is supposed to operate inside it, and any small change caused in the working pattern could produce noticeable ill effects. These changes could include altering the light source, air conditioning, opening or closing the door inappropriately, violating the dress code, having many individuals inside, inappropriate washing up and the list can go on. Therefore, even if we believe that ‘change is good’ and ‘change is inevitable’, the saying doesn’t hold true when it comes to the functioning of the IVF laboratory. This doesn’t mean you cannot make any changes to the laboratory; it just means that any changes to be made need to be measured for the impact they may have and need to be planned well. What we are trying to suggest is that any change needs to be done based on scientific backing only, either based on positive practical experiences or proven globally. Like most workplaces, even in IVF, the workplace is driven by a hierarchy, and every person working in the laboratory has to earn it. This hierarchy may not be dependent on the number of years one has spent in an IVF laboratory, but their methodology and meticulous work routine, along with their presence of mind in dealing with troubleshooting situations, that would make them stand out and earn the badge. One of the simplest examples of change in the laboratory is when a new team member is to be inducted for working in the laboratory. No matter how senior or junior, every new member has to be inducted based on the set SOPs. No matter how well-known the laboratory may be, each of them has something that they do differently, which the embryologist will need to adapt to. This wouldn’t be very difficult for junior embryologists, who are just getting started with their professional journey in IVF, as there is no time spent in unlearning their previous habits, and they simply will be implementing the textbook strategies practically, as per the SOPs.

However, first of all, in order to implement the above, it is important that the laboratory has a documented SOP manual of methodology for each process. This SOP manual needs to be updated from time to time, in order to document any and every change that takes place. An important tip at this point would be to create pictorial descriptions of each process and showcase them in the laboratory. This would serve as a ready reckoner for all training team members. All training and work revolves around these mainly, covering every action performed in the laboratory, including how one would document their observations. Let us go through this process in detail.

Though training in an IVF laboratory is a milestone driven process, learning would mean joining pieces of a puzzle and hence, you may be learning about multiple pieces at the same time. Why we say this is because, if you keep practicing or perfecting only one milestone at a time, you may have nothing to for the rest of the day. Thus, it is important to assign a supervisor or a buddy to the junior embryologist, wherein, the junior embryologist acts a shadow to the supervisor for the first week. The idea is to first get the junior embryologist associated with the daily working routine across all processes. After getting acclimatized with this, the real training begins:

First few weeks…

This part of the training is known as ‘giving discipline to the working method of the junior embryologist’. The first and most important activity of the day is to log in the QA/QC parameters of the laboratory and does not need any training. It simply means checking taking the readings off all the equipment in the laboratory at a specified time each day. This specified time is always before the laboratory starts its day’s working, and the values are logged in on a sheet or a software, ensuring no value in any machine is beyond the reference range, either higher or lower. If the values are above or below the reference ranges, then it is of utmost priority to get the machine re-calibrated. If the machines are not calibrated, the gametes/embryo’s will not have the optimal conditions to grow in, thus, hampering their growth which will directly impact the outcome of the IVF cycle.

The next few weeks…

Once this is done, the next stage would involve accompanying the buddy/supervisor for fertilization/embryo checks. Here, two aspects can be learned, which are, observing how the fertilizations and or embryos are graded, as well as, the documentation of the same. The junior embryologist should also initially observe every documentation that is complete, and start entering the data into the software, if there is one. The third and the most important thing to do during these 4 weeks is to take a stock of the inventory and alert the team of the available stock. These initial three habits are the most important and crucial requirements that should form a part of the initial training and, consequently, the subconscious memory of an embryologist. Doing these ensures that the lab is running smoothly, data is up to date and the work will not stop due to unavailability of material. It is important to note that moving to the next step does not mean that one leaves behind their discipline. The junior embryologist continues to update the tasks learnt in week 1 to week 4, and simultaneously moves to the next step. This stage of learning cannot be defined by a certain number of days or weeks, as it depends on how busy your center is. From here on, it is important that the junior embryologist is given a logbook to enter all that he/she has observed/done. As a thumb rule, it is suggested that he/she should observe 10 of each process followed by assisting in 10 of each process. We would advise you to start with observing oocyte pick-ups and grading fertilizations and embryos. It is important to notice how you are evolving from documenting the fertilizations/embryos to now relating to how it is done.

Duration of training: 6 months

Table 1: Schedule of training for weeks 1-8

Week 1 Orientation Induction into the facility and meeting with the team.Observe consultation, nurse led chats and injection teaching (if any), clinical meetings, patient scans (treatment and pregnancy), theatre sessions, observe nurses during scheduling of patients and communication regarding stimulation protocols, Andrology laboratory (diagnostic and treatment), Embryology laboratory, multi-disciplinary team meetings.
Week 2 Diagnostic Andrology Diagnostic Andrology: Observe procedures (for at least 3 days), learn how to record information, do counts and motility to compare with Andrologist. Learn about witnessing procedures.
Week 3 Diagnostic Andrology Speak with patients under the guidance of the Andrologist. Do practice counts and motility. Learn about producing reports and how to discuss results with patients and/or clinicians.
Week 4 Embryology Observe egg collections. Learn about aseptic technique and behaviour in the laboratory as well as laboratory work flow. Practice picking up remaining cumulus cells during this time, to improve dexterity. Orient as to where consumables and equipment are kept in the lab. Start to understand dish prep protocols. Prepare dishes under the guidance of the Embryologists. Learn about laboratory witnessing procedures. Become signed off as competent to witness. This is usually one of the first ways to become incorporated into lab work.
Week 5 (AM) Diagnostic Andrology(PM) Embryology (Mornings) Analysis and reporting of semen samples under the guidance of the Andrologist.(Afternoons) Dish prep under the guidance of the Embryologists. Read SOPs regarding air quality control and monitoring and lab monitoring systems (if any).
Week 6 Sperm prep for treatment Observe procedures (for at least 2 days). Learn about witnessing procedures and orient to as to the set up and flow of the lab. Read SOPs regarding treatment of patient with blood borne viruses (if any). Assist in witnessing, speaking with patients, prior to or after production. Conducts assessment and layering of sperm on gradients, washing, further assessment and recording (under supervision of Andrologist).
Week 7 Embryology Observe egg collections for 1 day. Thereafter do half case egg collections potentially progressing to full cases (under continuous strict guidance). Observe denudation of cumulus cells prior to ICSI, ICSI procedures and IVF insemination. Prepare dishes for treatment. Practice moving eggs that have not been fertilised from 2 days before in spare dishes to improve dexterity. Understand how all treatments are recorded for each patient.
Week 8 Embryology Observe embryo grading for continued culture, embryo transfer and vitrification. Observe embryo transfers (from the theatre and lab standpoint for at least 2 days. Observe vitrification of embryos. Become familiar with witnessing procedures for embryo transfers and vitrification. Practice loading unfertilised eggs into embryo transfer catheters.

For weeks going forward, the following are suggested rotas to increase exposure to various aspects of training as well as the day to day running of the lab. Tasks such as attending clinical meetings where decisions are made about stimulation protocols and frozen embryo transfers as well as unit meetings and lab meetings as well as journal clubs and lectures are incredibly important for learning and time should be allotted for this too. The red circle in brackets (●) denotes events in which the trainee may participate, otherwise, they should only observe, but may practice with unfertilised gametes/embryos afterwards. Witnessing tasks (if competency is achieved) can be conducted whenever required.

Table 2: Rota for week 9 to week 14

Day Task AM Task PM Other where possible
Monday Egg collection (●), denudation, IVF insemination(●), ICSI and dish prep (●) Clinical meetings Lab meetings Presentations Journal clubs
Tuesday Sperm preparation for treatment (●) Diagnostic Andrology (●)
Wednesday Embryo grading and embryo transfer. Vitrification. Discussion with Embryologists about Egg and embryo cryo-storage. Become familiar with relevant SOPs, and understand very basically how the recording system works
Thursday Embryo grading and embryo transfer (if any) Diagnostic andrology (●)
Friday Egg collection (●), denudation, IVF insemination(●),

Table 3: Rota for week 15 to week 18

Day Task AM Task PM Other where possible
Monday Egg collection (●), denudation(● half cases or very few eggs only under supervision), IVF insemination(●), Clinical meetings Lab meetings Presentations Journal clubs
Tuesday Sperm preparation for treatment (●) Discussion with Andrologists about sperm cryo-storage. Become familiar with relevant SOPs, and understand very basically how the recording system works. Learn about storage for donors and oncology patients.
Wednesday Embryo grading and embryo transfer. Vitrification. IVF insemination (●) and dish prep (●)
Thursday Embryo grading and embryo transfer (if any) Diagnostic andrology (●)
Friday Egg collection (●), denudation (●), IVF insemination(●), ICSI and dish prep (●)

Table 4: Rota for week 19 to week 21

Day Task AM Task PM Other where possible
Monday Egg collection (●), denudation(● half cases or very few eggs only under supervision), IVF insemination(●), ICSI and dish prep (●) Clinical meetings Lab meetings Presentations Journal clubs
Tuesday Sperm preparation for treatment (●) Diagnostic Andrology(●)
Wednesday Embryo grading (●only under supervision) and embryo transfer. Vitrification. Oocyte denudation (●) IVF insemination(●) and dish prep (●)
Thursday Embryo grading (●only under supervision) and embryo transfer (if any) Diagnostic andrology (●)
Friday Egg collection (●), denudation (● half cases or very few eggs only under supervision), IVF insemination(●), dish prep for ICSI(●), ICSI.

Table 5: Rota for week 22 to week 25

Day Task AM Task PM Other where possible
Monday Egg collection (●), denudation(●only under supervision), IVF insemination(●),dish prep for ICSI and further culture (●) and ICSI Clinical meeting sLab meetings Presentations Journal clubs
Tuesday Sperm preparation for treatment (●) Diagnostic Andrology (●)
Wednesday Embryo grading (●only under supervision) and embryo transfer. Vitrification. Oocyte denudation (●) IVF insemination(●) and dish prep (●)
Thursday Embryo grading (●only under supervision) and embryo transfer (if any) Diagnostic andrology (●)
Friday Egg collection (●), denudation (●only under supervision), IVF insemination(●), dish prep for ICSI and further culture(●), ICSI.

We have created a guideline of how our training schedule looks like. For those of you who think whether this is possible or not; we can tell you that this is a perfectly tried and tested exercise and we continue to train our junior members in the same way. Of course, the length of training does move up or down depending upon how busy the center is as also on the learning ability of the person. However, if all goes well, you can have a well-trained junior embryologist within 6-7 months of joining except for ICSI and other advanced procedures like embryo biopsy.

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