The assisted reproductive technology laboratory: toward evidence-based practice?

How long does it take a man to collect his semen specimen in a busy infertility clinic?

Background

The duration of time required for male patients to collect their semen specimen heavily impacts the workflow of a busy infertility clinic. We analyzed this parameter to optimize the scheduling clinic space in the setting of growing male infertility practices.

Methods

Prospective observational study on men collecting semen specimens for fertility evaluation, sperm cryopreservation or vasectomy at a male infertility clinic. Duration of time required for semen collection by masturbation was measured.

Results

Patients were 136 men with a mean age ± standard deviation of 35.7±7.8 years (range, 18.8 to 62.5 years). Indications for semen collection were: evaluation for male factor infertility in 125 cases (92%), of which 12 (9%) underwent sperm cryopreservation; post-vasectomy evaluation in 7 cases (5%); and post vasoepididymostomy in 4 cases (3%). The median collection time was 11 minutes 57 seconds ± IQR 9 minutes 8 seconds to 17 minutes 5 seconds; and ranging from 3 minutes 9 seconds to 39 minutes 50 seconds. Patients accompanied by their female partner in the collection room were significantly more likely to take longer than 15 minutes compared to unaccompanied patients (P=0.012). Age and indication for semen collection were not associated with duration.

Conclusions

Median collection time in our sample was 11 minutes 57 seconds, with significant variability across the sample. Patients accompanied by their female partners required significantly longer time to collect their sample, while age does not seem to have an impact.

In Vitro Fertilization Research is Translational Research

In vitro fertilization (IVF) is the perfect example of translational research. Changes in IVF and the IVF laboratory have been transmitted to clinical care, showing dramatic improvements in health outcomes, including notable increases in the cumulative pregnancy rate. Current research in the laboratory focusing on culture media, embryo selection criteria, and implementation of genetic testing and manipulation promises to translate to further improvements in our ability to assist human reproduction. The field of IVF and ART remains a large source for clinical and scientific discovery and development, and will require the proper interested and invested personnel, occupational structuring, and funding for continued success.

Time to take human embryo culture seriously

STUDY QUESTION

Is it important that end-users know the composition of human embryo culture media?

SUMMARY ANSWER

We argue that there is as strong case for full transparency concerning the composition of embryo culture media intended for human use.

WHAT IS KNOWN ALREADY

Published data suggest that the composition of embryo culture media may influence the phenotype of the offspring.

STUDY DESIGN, SIZE, DURATION

A review of the literature was carried out.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Data concerning the potential effects on embryo development of culture media were assessed and recommendations for users made.

MAIN RESULTS AND THE ROLE OF CHANCE

The safety of ART procedures, especially with respect to the health of the offspring, is of major importance. There are reports from the literature indicating a possible effect of culture conditions, including culture media, on embryo and fetal development. Since the introduction of commercially available culture media, there has been a rapid development of different formulations, often not fully documented, disclosed or justified. There is now evidence that the environment the early embryo is exposed to can cause reprogramming of embryonic growth leading to alterations in fetal growth trajectory, birthweight, childhood growth and long-term disease including Type II diabetes and cardiovascular problems. The mechanism for this is likely to be epigenetic changes during the preimplantation period of development. In the present paper the ESHRE working group on culture media summarizes the present knowledge of potential effects on embryo development related to culture media, and makes recommendations.

LIMITATIONS, REASONS FOR CAUTION

There is still a need for large prospective randomized trials to further elucidate the link between the composition of embryo culture media used and the phenotype of the offspring. We do not presently know if the phenotypic changes induced by in vitro embryo culture represent a problem for long-term health of the offspring.

WIDER IMPLICATIONS OF THE FINDINGS

Published data indicate that there is a strong case for demanding full transparency concerning the compositions of and the scientific rationale behind the composition of embryo culture media.

STUDY FUNDING/COMPETING INTERESTS

This work was funded by The European Society for Human Reproduction and Embryology. No competing interests to declare.

Genetic mouse embryo assay: improving performance and quality testing for assisted reproductive technology (ART) with a functional bioassay

BACKGROUND

Growing concerns about safety of ART on human gametes, embryos, clinical outcomes and long-term health of offspring require improved methods of risk assessment to provide functionally relevant assays for quality control testing and pre-clinical studies prior to clinical implementation. The one-cell mouse embryo assay (MEA) is the most widely used for development and quality testing of human ART products; however, concerns exist due to the insensitivity/variability of this bioassay which lacks standardization and involves subjective analysis by morphology alone rather than functional analysis of the developing embryos. We hypothesized that improvements to MEA by the use of functional molecular biomarkers could enhance sensitivity and improve detection of suboptimal materials/conditions.

RESULTS

Fresh one-cell transgenic mouse embryos with green fluorescent protein (GFP) expression driven by Pou6f1 or Cdx2 control elements were harvested and cultured to blastocysts in varied test and control conditions to compare assessment by standard morphology alone versus the added dynamic expression of GFP for screening and selection of critical raw materials and detection of suboptimal culture conditions. Transgenic mouse embryos expressing functionally relevant biomarkers of normal early embryo development can be used to monitor the developmental impact of culture conditions.

CONCLUSIONS

This novel approach provides a superior MEA that is more meaningful and sensitive for detection of embryotoxicity than morphological assessment alone.

'By the work, one knows the workman': the practice and profession of the embryologist and its translation to quality in the embryology laboratory

The embryologist presides over the fulfillment of a patient's treatment in the laboratory for IVF through use of assisted reproduction techniques, and is in a unique position to impart quality to the process. Although the technical skill of the embryologist is critical, the embryologist's contribution to quality is equally conveyed through a knowledge of reproductive biology, keen observation and judgment, astute decision-making, the 'grit' to work under pressure and time constraints, and a sense of mission in the provision and continual development of a safe and effective laboratory. The embryologist also ensures that the laboratory complies with the regulations of federal, state, local and institutional authorities and the recommendations and guidelines of professional associations. In these roles, the embryologist assumes unique responsibilities counterbalanced by the unique rewards of assisting patients in having a family. This article aspires to illuminate this singular profession for those who may be contemplating a career in embryology and act as a resource for those who seek insight into this amalgam of basic science, technical proficiency, and managerial skill and acumen that characterize the practice of clinical embryology and the myriad of ways that practitioners contribute to the quality of assisted reproduction techniques and patient care.