Introducing myself

embryoman

Hello all! I just wanted to introduce myself as you may see me posting from time to time. I'm an embryologist with several years experience in the clinic and about a decade background in molecular biology. I'm very happy to have found a career that allows me to help people directly (working in science can be pretty lonely) and I'm hoping to share my expertise with others who may need it. I'm also hoping to learn from all of you to better appreciate things from your point of view, which I'm sure will translate into making me a stronger embryologist (and person too!). I'll be cruising this board and others so if anyone has any embryology questions don't be shy to ask and I'll do my best to answer!!

kjk024

Welcome! I think it is great that you are trying to learn more about it from the point of view of those suffering through infertility.

Alyeena

Welcome It's very thoughtful of you to try and see the perspective of infertile people, I am sure it will help you be a better embryologist. 
It will also be nice I am sure to have someone with your expertise on the boards. 

zamoraspin

@embryoman Clinic and lab quality - how do you know if your clinic has a good lab, and your clinic is a good clinic? My clinic seems to have somewhat above average success stats on SART (compared to national averages), and touts its experienced embryologist, lab director, and low oxygen environment for embryos. But I get a little nervous reading articles like this one: https://www.fertilityiq.com/pgs-and-ccs-genetic-testing/does-your-clinic-influence-if-your-embryos-are-good (summarizing a recent study that indicates clinics can have a big impact on the percent of PGS normal embryos an egg donor gets) or looking at SART data from a place like CCRM, which has significantly better stats than my (and I think most) clinics.

I love my RE, we're not interested right now in traveling for IVF, but am I making a mistake in going with the best clinic that is nearby? How do I evaluate these things? Even with a lot of research, I feel ill equipped. 

embryoman

@zamora_spin Sorry for the late reply. Very interesting article! Here's a link to the original paper https://academic.oup.com/humrep/article/32/4/743/3059568. 

In the paper, they analyzed embryos from donor eggs across 42 clinics for a total of 1665 PGS cycles. Average age was 26; range 19-35. Of the 13282 blasts, 69% were euploid across the clinics. Of the 42 clinics, 3 were significantly below this average and 7 above. The remaining 32 were not significantly different from the average euploidy of 69%. So at least most clinics are falling in range.

The authors note that they did not have details on the donors as far as whether they were directed or anonymous (screening criteria is strict with anonymous donors), donor race/ethnicity, or ovarian responsiveness. These factors may play a role and if they were controlled for it's possible that we wouldn't see as much of a difference between clinics.

However if the results are true, the authors give several reasons for this. Some doctors may use increasing amounts of drugs in order to generate more eggs (sacrificing quality for quantity), or may go after smaller follicles with immature eggs. Eggs that are immature at the time of retrieval may mature in culture before insemination, and these embryos may have a higher rate of aneuploidy. From my experience, eggs that mature in culture and then inseminated very rarely make it to the blast stage. 

I have mixed feelings about SART data. Clinics know the importance of these statistics and I feel it can be tampered with. I've heard rumors of certain clinics that choose what kind of clients they treat in an effort to improve their numbers (people less than 40, not overweight, etc). Some clinics also have strict criteria for freezing blasts and this can help boost their stats by reducing the number of failed transfers. I have personally seen Day 7 poorly graded embryos that have come back euploid that go on to make pregnancies. In other clinics these embryos may have been discarded for receiving a poor grade or would never even be carried to day 7. 

I hope that helps!!