Elevate Your Embryology Career With Medline Academics

The field of embryology is one that is grounded in precision, accountability, and perpetual learning. Every day, embryologists carry out countless procedures, such as retrieving, fertilizing, culturing, biopsying, and freezing embryos. Each procedure affects the embryo’s survival, and subsequently, the patient’s chances of conceiving a baby.

Although SOPs define how things should be done in a laboratory setting, great embryologists go one step further by understanding why these protocols exist. This scientific mindset is essential for professionals pursuing a Fellowship in IVF and Reproductive Medicine in Bangalore, India, where advanced embryology skills, critical thinking, and quality-focused laboratory practices form the foundation of clinical excellence.

Instead of merely adhering to established practices, embryologists need to continually evaluate their ability to make changes that can improve efficiency. Minor changes in procedures, documentation, equipment validation, or environmental control can greatly improve the performance of a laboratory. This article explores the scientific principles, laboratory practices, and quality management strategies that help embryologists deliver consistently high standards of care while fostering a culture of continuous improvement.

The Complexity of an Embryologist's Daily Workflow

Our typical workflow involves moving a lot of material through a lot of different steps, searching through follicular fluid to do an egg retrieval, rinsing and trimming those cumulus oocyte complexes, trimming them, denuding, doing ICSI, doing FERT, either with ICSI or, and then culturing, trophectoderm biopsy, vitrification.

How could you possibly lose an embryo? And sometimes I sit back and think, do you have any idea how many thousands of embryos and eggs we handle in a day? And not just how many of them we do, but we handle them like 10 times over. So, it's tens of thousands of manipulations that we're all doing. And if you do this long enough, there's going to be an adverse event. So sometimes I have to take a step back and reflect, how is it possible not to lose? And it's pretty amazing how great we really are as embryologists. And I prefer to look at it this way is there's so many opportunities to improve what we do. And one of the things that annoys me is if I hear people say, well, we've been doing it this way for five years, and it's always worked this way.

And in my lab, I've always taken the perspective that if you haven't changed something in the last six months, then you haven't, you haven't taken on, you've missed an opportunity to improve. And it might be a subtle thing, it might be changing your paperwork, small steps, small, subtle steps, but you can always be making progressive improvements. So just something to reflect on.

The impact of an embryologist extends far beyond routine laboratory procedures. Research clearly demonstrates that laboratory practices influence clinical outcomes.

Why Every Embryologist Makes a Difference

I want to start just mentioning this paper so that we really reflect on what we do as embryologists. And this paper talked about looking at egg donor cycles, and blastocyst biopsies, almost 14, over 13,000 blastocyst biopsies through 42 different clinics and 142 different physicians. And this is these goes back away. So, it was a ray CGH, but the mean euploidy rate for egg donor cycles or egg donor embryos was 69%. But the rate the euploidy rate per centre ranged from 40% to greater than 80%. So that's a really huge difference.

And so have a big impact on the embryos that we produce. There's definitely an impact that we have. And I think it's a good reminder for everybody.

Think Like an Egg: Understanding the Embryo's Perspective

Imagine if you're the egg, what is it that you're experiencing? And where is it that you want to be? Well, you want to be in the ovary and then you want to be working your way down the reproductive tract and hopefully, you know, living your life inside a reproductive tract, at least for the first nine months. What we do is we kind of blow up your little world as a little egg. We go in, suck you out of the ovary before you get to get ovulated. And then we pass you through all these crazy steps. So we really implode the little eggs world. So we pass through all those different crazy steps, and then we throw you in the freezer. Ultimately. So if you imagine that you're the egg or the embryo in your lab, are you feeling hot? Are you feeling cold? All of those different steps that we do, we've got opportunities to mess up the temperature control.

And I've been in a lot of different labs and I see stage warmers that are set for 37 degrees. And if your surface temperature on that stage in your hood is set for 37 degrees, if you're putting a temperature monitor on that hood and the surface is 37 degrees, I can guarantee you that the egg and the embryo in your dish is not 37 degrees. And I'm always amazed at how many labs I do go into.

And I see that. And what you'll find on your ICSI scope, if you actually measure the temperature in your dish with a thermocouple, and it really means taking a little thermocouple and putting it in your culture dish and monitoring what the eggs actually experiencing, what you'll find in most labs is that your surface temperature needs to, or your temperature needs to be set probably close to 40 degrees to get the temperature in the dish that you're looking for for your egg. And just because the outside of an incubator reads 37 degrees, that doesn't mean that that's what the dish is actually, that's what the temperature is inside. So to really be, just because it says it on the outside doesn't mean that's what you're experiencing inside.

Temperature Control: A Critical Factor for Embryo Survival

So why is temperature control so important? I mean, this paper goes back to 1990. So this is like more than 30 years that we've known this. We've known that transient cooling to room temperature can cause irreversible disruption of the meiotic spindle in the human oocyte. So this goes back a long way. So that transient cooling, well, how sensitive is it? Well, this paper, again, going back to 1995, says that we could see structural temperature fluctuations of the cytoskeleton organisation in the human oocyte within two minutes of a temperature deviation. So, it really is critical, and it's something that I think most labs really take for granted and don't necessarily think about every step of the way.

Maintaining the Right Culture Environment: pH and Osmolarity

So imagine again, you're the embryo, what's the pH that you're in? How long have your dishes been equilibrated before you get thrown in this pool of salt water or fresh water or whatever as you're going from media to media? Do you have an oil overlay? Are those drops evaporating? And certainly if you're in a media that looks like either of the first two tubes here, you're not a happy embryo. And I think if you don't know what those tubes mean for pH differences, then ask your lab director, look it up so that you know what pH you should be or what colour you should be looking for for your culture media.

There are different strategies within different labs. If you're working in an environment like an isolate, you can control the environment. So you can culture all of your embryos in a bicarbonate environment as opposed to being in hepes in an open system that's in the air.

So these are all considerations. I'm definitely a big proponent of using isolates and controlling. It gives you really excellent temperature control, lets you control the CO2 and the pH of your media, contains your air quality.

It's easier for training new people because they can take their time and you're basically working. I always think of it as working inside the uterus when you're working inside an isolate. So I'm never as stressed about rushing new people when they're training because I figure they're working inside the uterus, essentially a uterus.

And it allows us to eliminate hepes from our culture systems. So imagine that you're the egg or the embryo. What's the osmolarity that you're in? Are you in a hypotonic solution where you're like swelling up? Are you in an isotonic solution where you're just like happily swimming around? Or are you in a hypertonic solution where you're shrinking? So again, are you a happy egg or are you an unhappy egg?

Learning from Real-Life Laboratory Scenarios

And I just want to throw out a couple of real-time, real-life scenarios that I've come across. One of the things that happened in the early days when we were doing PGT, the genetic testing lab said, it's really important for you to wash the biopsies through four different drops. And they wanted us to pick up the biopsy, rinse it through one drop, through another drop, through another drop, through another drop. And I think that was the geneticist telling the embryologist what to without really communicating well with the embryologist.

That's a lot of opportunity to lose the biopsy, to mishandle the biopsy. Plus, so this particular lab I went into spotted down 14 eight microlitre drops to rinse their biopsies through. And that was to rinse three different biopsies through each row.

But what they did with that dish as they were talking and explaining what they were doing to a nurse, they took 10 minutes with that dish out, 10 minutes in a warm, relatively dry environment with those drops evaporating. So you can imagine what's happening to the osmolarity of those drops. So again, think about what you're actually doing with every step of what you're doing, because those drops were not covered with oil. Those were just open drops as they were rinsing biopsies through.

Minimising Embryo Exposure During Culture

Think about minimising the exposure of your embryos versus the clinical data that you're getting. And obviously most labs want to do a FERT check.

If you're doing time-lapse, then you get all of the luxury of doing these steps without having to expose the embryo. But most labs still want to do a FERT check. The majority of labs still aren't using time-lapse, although it's certainly becoming more popular.

Some labs like to see early cleavage. So they're pulling the embryos out of the incubator at around 24 hours after FERT. Do you really need that step? Do you do a day two check and a day three check and a day four check and a day five, six, seven check? That's a lot of exposure with pulling the embryos out.

In our lab, we do a fertilisation check. We don't bother with an early cleavage check. We like doing a day two check because we like the synchrony and looking at the embryos on day two.

And what we did was we put our assisted hatching on day two. And then we don't look at them on day three or day four. And then we look at them for biopsy on day five, six, and seven.

All right. Again, so we perform our assisted hatching on day two rather than day three, just because it gives us a lot more space to get in there and navigate. Plus we like looking at the embryos on day two, because we also know that embryos that are four cell on day two are more likely to be euploid.

And that's data that we've done from our own research, even back in the RMA, when I was at RMA Connecticut. One of the things that you should look at with your data and compare with other labs so that you know where your bar is. I like comparing with NYU, one of my favourite programmes to chat with, to say, hey, what's your blast utilisation rate? Because I think they have, it's good to find a lab that gets good results and then try and match those results and compare and see if you can beat them.

So if you're, one of the measurements that you can do is look at the number of blastocysts that you utilise, the number that are either transferred or frozen from your 2PNs. And ideally you should be across all ages, you should be greater than 50%, even greater than 60% if you're in a really top-notch lab. So just a measurement for you to try and score by.

The comprehension of the science that goes into each procedure in the laboratory is a mark of a good embryologist. The maintenance of optimal temperature, pH levels, osmolarity, and minimizing unnecessary embryo exposure all play a role in embryo viability and success. As much as the science provides the foundation of embryology, excellence in practice also involves a lot more including quality management and communication. We shall look at these in Part 2.

About Medline Academics

The Medline Academics, which is situated in Bangalore, provides a blend of learning opportunities to the healthcare professionals so that they can pursue further studies even while working in their clinics. The Fellowship in Embryology is aimed at professionals from all around the world who work in the field of reproductive medicine. Students also benefit from exposure to renowned experts in reproductive medicine and embryology through training at Dr. Kamini Rao Hospitals, internationally recognised for excellence in fertility care and assisted reproductive technology. This program is suited to those who have different professional ambitions, be it becoming an embryologist or enhancing their clinical knowledge or pursuing a career in the realm of reproduction science. The fellowships program is a combination of online as well as clinical education.

About Dr. Kamini Rao Hospitals

The practical component of Medline Academics' Fellowship program takes place in Dr. Kamini Rao Hospitals, which is the best IVF Hospital in Bangalore. With the assistance from experienced infertility and embryo scientists, the fellows have an opportunity to learn practical aspects of the IVF laboratory work in a real-world environment.