24 Aug What are the conditions like in an IVF laboratory?
Interview with Marta Asensio, laboratory director at Reproclinic
The work done in an IVF laboratory is very important. The quality of the actions and the results obtained will result in a high percentage of success in the birth of the baby. Therefore, we can say that it is the engine of a fertility clinic.
Because it plays such an important role in the world of assisted reproduction, it requires that we give it the space and relevance it deserves. For this reason, we wanted to interview the director of the Reproclinic laboratory, Marta Asencio, so that you can understand the work that is done in this laboratory, why it is so important and what details make Reproclinic one of the most important laboratories at an international level.
You say that eggs and embryos are very delicate. Is this true?
Yes, it is true. Gametes and embryos are very sensitive to exposure to environmental pollutants. The quality of the air inside the laboratory and incubators in which embryos are cultured has a great influence on their development and viability for successful implantation in the maternal uterus. Any volatile organic compounds (VOCs) or particles present in the air can be detrimental to fertilisation and embryo development.
VOCs are organic compounds found in various materials present in the laboratory (paints, furniture, equipment, cleaning products) or in the laboratory personnel themselves (perfumes, hairsprays, cosmetics) that are released into the environment by evaporation at ambient temperature and pressure. For this reason, materials free of these compounds should be used in the laboratory and access by personnel who should not use perfumes or other products that may contain them should be restricted as much as possible.
Although the embryo is not completely protected from VOCs in the maternal tract, the mother’s lungs, liver and kidneys provide considerable filtration and detoxification of VOCs, thus reducing the embryo’s exposure. In contrast, the in vitro embryo has no such protective mechanisms and therefore measures must be taken to actively reduce the presence of VOCs in general laboratory air and within the incubator in particular. To obtain good air quality, the laboratory must have an effective filtration system to reduce particles, micro-organisms and VOCs, equipped with HEPA and carbon filters.
We must verify the effectiveness of our filtration system to ensure a safe environment for embryo culture through environmental controls that must be carried out on a regular basis. These controls analyse and quantify the air quality by carrying out microbiological controls, particle quantification, temperature, humidity and positive pressure in the laboratory to prevent the entry of particles and microorganisms from outside.
2. Laboratory processes are very complex and sensitive, what control measures do you have in place?
In addition to air quality, there are key physicochemical factors in the culture system that affect the oocytes and embryo development in the IVF laboratory: temperature, osmolarity and pH of the culture media, and as I have already mentioned, toxic substances.
It is important to have a laboratory quality control system that identifies all these factors on a daily or routine basis, in order to achieve an excellent culture system that allows for proper embryo development.
Temperature: Maintaining the appropriate temperature during cell manipulation and culture is a critical factor in optimising an IVF culture system. Inadequate temperatures can compromise cell function and development and thus reduce IVF outcomes. The optimal temperature for both gamete and embryo manipulation and culture should be 37°C, so this should be done on heated surfaces that provide this temperature. It is important to check the surfaces and culture medium daily with calibrated thermometers.
Humidity: this is necessary to avoid evaporation of the culture medium on the heated surface and, consequently, a change in the osmolarity of the medium. Excessive humidity could favour the growth of micro-organisms in the incubator, impacting negatively on embryo development. To prevent evaporation of the medium, a layer of paraffin oil is added to the culture plates to protect the surface of the medium.
Ph: intracellular ph regulates a wide variety of cellular processes such as cell division or the expression of some genes. Changes in the pH of the medium during the manipulation or culture of gametes or embryos could affect their development. Although the culture media incorporate formulations to stabilise the pH, it is necessary to monitor this variable continuously. It is important to note that changes in temperature conditions, osmolarity or gaseous environment of the culture plate can also affect the pH of the medium. This is why it is so important to have all these parameters under control.
In an IVF laboratory, not only the area of clinical embryology itself must be taken into account, but also a quality management system must be implemented to guarantee the quality of the service offered to patients.
For a reproduction centre to be officially recognised, it must have implemented the official international standards (ISO), specifically ISO 9001 for clinical assistance in the care of infertile couples, and at a national level, the Spanish standard UNE 179007 on quality management systems in assisted reproduction laboratories. This standard is a specialised extension of the ISO 9001 standard that seeks to create sectoral standards and unify criteria for Assisted Reproduction Techniques (ART) laboratories. This accreditation provides a high quality service to patients, clinical staff and suppliers.
The management of a quality system should be detailed in a Quality Manual, which contains information about all the activities carried out in a laboratory and the company’s quality control policy, a record of the processes developed in the laboratory and those responsible for them. Also, there should be quality indicators that allow to analyse whether the procedures are performed with a certain skill and the expected result.
3. Reproclínic is committed to embryo culture up to day 5 and embryo transfer. Why?
Culture to blastocyst provides the opportunity for further evaluation of embryo development including morphological, morphokinetic, metabolic and cytogenetic aspects. This allows for the correct selection of embryos with the highest developmental capacity and implantation potential.
There are publications that describe that embryos at the blastocyst stage have a lower rate of aneuploidy and miscarriages.
In addition, blastocyst transfer provides a better synchrony between the embryo and the uterus than in cell stage embryos.
Improvements in embryo culture techniques and strict quality control in the laboratory have provided us with sufficient tools to have an excellent culture programme until blastocyst, which has allowed us to make a correct selection of a single embryo for transfer without decreasing pregnancy rates and reducing the rate of multiple pregnancies.
Have you learned more about the work carried out in the laboratory and its importance? At Reproclinic we want to be by your side, at all times and throughout the process, to give you the support you need and to be able to resolve any doubts you may have at any time.
Don’t miss the webinar that Aina Canyelles, embryologist at Reproclinic, will be holding in English, in which she will explain what an assisted reproduction laboratory is like from the inside, how the activity is carried out in it, and she will answer all the doubts you may have. If you are interested, you can register through this link and you can access the zoom here.