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Olmedo C, Veiga E, Sánchez L, Ferrer E, Ortiz N, Mauri A, Fernández M, Martínez L, López-Regalado ML, Iglesias M. ASEBIR Quality Special Interest Group guidance for quality in assisted reproduction technology. Reprod Biomed Online 2024; 48:103730. [PMID: 38368763 DOI: 10.1016/j.rbmo.2023.103730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/03/2023] [Accepted: 11/12/2023] [Indexed: 02/20/2024]
Abstract
Assisted human reproduction has undergone rapid advances since its inception 45 years ago. To keep pace with these advances, assisted reproduction laboratories should adhere to a quality management system that addresses staffing and training, physical space and air quality, equipment maintenance and other operational matters, and ensures gamete and embryo handling in accordance with the latest quality and safety standards. Accordingly, this review aims to provide a reference document that highlights the critical aspects to consider when establishing and operating an ART laboratory. The review collates and expands upon published national and international guidelines and consensus documents, providing easier access to this large body of important information.
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Affiliation(s)
- Carla Olmedo
- Unidad de Medicina Reproductiva, Hospital General Universitario de Valencia, Valencia, Spain.
| | - Ernesto Veiga
- Laboratorio Central/Unidad de Reproducción Humana Asistida, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela A Coruña, Spain
| | - Lourdes Sánchez
- Unidad de Reproducción Asistida, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Empar Ferrer
- Laboratorio de Embriología, Centro Médico de Reproducción Asistida (CREA), Valencia, Spain
| | - Nereida Ortiz
- Unidad de Reproducción, Hospital Universitario Torrejón de Ardóz, Madrid, Spain
| | - Alba Mauri
- Laboratorio de Embriología, Procrear, Reus, Tarragona, Spain
| | - María Fernández
- Laboratorio de Embriología, Clínica Ergo, Gijón, Asturias, Spain
| | - Luis Martínez
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Alteri A, Bosco L, Chamayou S, Casciani V, Cervi M, Cecchele A, Cho YS, Costantini MP, Dal Canto MB, De Stefani S, Fraioli A, Furlan V, Giacone F, Guarneri C, Guglielmino A, Iaccarino M, Miceli A, Minasi MG, Montano L, Notari T, Paffoni A, Palini S, Reschini M, Ruvolo G, Viganó P, Volpes A. The paradox of the Italian clinical embryologist in the national public health system: hints towards harmonization of a postgraduate educational curriculum. HUM FERTIL 2023; 26:1380-1384. [PMID: 35255778 DOI: 10.1080/14647273.2022.2045040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/04/2021] [Indexed: 11/04/2022]
Abstract
Clinical embryologists are highly trained laboratory professionals with multiple roles, including laboratory, clinical, biobanking and quality system management. In most European countries, clinical embryologists are trained to work in Medically Assisted Reproduction (MAR) centres without a specifically dedicated educational path. The criteria required for employment vary according to the educational structure and the public or private nature of the centre. We have herein described the educational profile required by Italian clinical embryologists to work in MAR centres of the National Health System (NHS). Public centres currently represent 36% of all the Italian MAR clinics. According to the Italian law, a future clinical embryologist must achieve a 3-4 year unpaid post-graduate specialization in a different field, choosing from Genetics, Microbiology, Clinical Pathology or Nutrition. Accesses to the above-mentioned post-graduate courses are themselves very limited. Clinical embryologists are basically trained by senior colleagues. This situation makes inevitably difficult to recruit laboratory staff in NHS centres. Moreover, it represents an emblematic example of the need for an equal training curriculum, possibly ensuring a comparable education quality, mobility of trainees and dissemination of skills for clinical embryologists all over Europe.
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Affiliation(s)
| | - Liana Bosco
- Società Italiana di Riproduzione Umana, Roma, Italy
| | | | | | - Marta Cervi
- Società Italiana di Riproduzione Umana, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paola Viganó
- Società Italiana di Riproduzione Umana, Roma, Italy
| | - Aldo Volpes
- Società Italiana di Riproduzione Umana, Roma, Italy
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3
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Choucair F, Atilan O, Almohammadi A, Younis N, Al Hourani A, Curchoe CL, Raad G. Low E-visibility of embryologists on fertility clinic websites: a web-based cross-sectional study. J Assist Reprod Genet 2023; 40:2619-2626. [PMID: 37715874 PMCID: PMC10643726 DOI: 10.1007/s10815-023-02938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE This study assessed the visibility of embryologists on fertility clinic websites among Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member clinics. METHODS During a 1-month interval (March 2022), all Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member fertility clinic websites were evaluated. The professional representation of the primary care team was examined including specialties, the presence of headshots, and biographies. RESULTS A total of 446 fertility clinic websites were scanned in the search. The embryology team has the least common professional identification by their names (53.58%) compared to gynecology clinicians (96.21%, p < 0.001) and nurses (55.58%, p < 0.001). This trend also applies to other types of professional identifiers, such as headshots and biographies. Professional headshots of embryologists (50.34%) were less prominent than those of gynecology clinicians (93.51%, p < 0.001). A similar trend was observed in the biographies of the embryology team (47.20%) compared to gynecology clinicians (95.08%, p < 0.001). CONCLUSION The present study revealed that embryologists have low professional visibility on fertility clinic websites. Fertility clinics may prioritize enhancing the online visibility of their embryology laboratory team. This approach could potentially enhance the recognition of their team, foster transparency, and provide accessible information about the skills and expertise of healthcare professionals involved in the treatment process.
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Affiliation(s)
- Fadi Choucair
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Okan Atilan
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Abdulla Almohammadi
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Nagham Younis
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Ovation Fertility, Grand Rapids, MI, USA
| | - Alia Al Hourani
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Department of IVF and Fertility, International Hospital, Al Salmiya, Kuwait
| | - Carol Lynn Curchoe
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon.
- ART Compass, Newport Beach, CA, USA.
| | - Georges Raad
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- IVF Department, Al Hadi Laboratory and Medical Center, Beirut, Lebanon
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4
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Zhu Y, Feng HL, Jiang MX. Evaluation of an automated dish preparation system for IVF and embryo culture using a mouse mode. Sci Rep 2023; 13:16490. [PMID: 37779165 PMCID: PMC10543539 DOI: 10.1038/s41598-023-43665-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023] Open
Abstract
Manual dish preparation for IVF in human fertility clinics or animal laboratories heavily relies on embryologists' experience, which can lead to occupational illness due to long-term and monotonous operation. Therefore, introducing an automated technique to replace traditional methods is crucial for improving working efficiency and reducing work burden for embryologists. In the current study in the mouse, both manual and automated methods were used to prepare IVF or embryo culture dishes. A one-way analysis of variance was conducted to compare several factors, including preparation time, qualified rates, media osmolality of dishes, fertilization rates, and embryonic development to assess the efficiency and potential of automated preparation. The results showed that automation system significantly reduced the required time and increased the efficiencies and qualified rates of dish preparation, especially for embryo culture dishes, without significantly altering medium osmolalities. There were no significant differences between two preparations in fertilization rates and embryo development in mice. Thus, automated dish preparation can improve working efficiency and qualified rates while maintaining fertilization rates and subsequent embryonic development without compromising osmolality stability of medium. It presents a superior alternative to manual preparation, reducing the workload of embryologists and facilitating the standardization of operational procedures.
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Affiliation(s)
- Yan Zhu
- Medical Experiment Center, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Huai L Feng
- New York Fertility Center, New York-Presbyterian Healthcare System Affiliate Weill Cornell Medical College, New York, USA
| | - Man-Xi Jiang
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China.
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5
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Cherouveim P, Jiang VS, Kanakasabapathy MK, Thirumalaraju P, Souter I, Dimitriadis I, Bormann CL, Shafiee H. Quality assurance (QA) for monitoring the performance of assisted reproductive technology (ART) staff using artificial intelligence (AI). J Assist Reprod Genet 2023; 40:241-249. [PMID: 36374394 PMCID: PMC9935795 DOI: 10.1007/s10815-022-02649-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Deep learning neural networks have been used to predict the developmental fate and implantation potential of embryos with high accuracy. Such networks have been used as an assistive quality assurance (QA) tool to identify perturbations in the embryo culture environment which may impact clinical outcomes. The present study aimed to evaluate the utility of an AI-QA tool to consistently monitor ART staff performance (MD and embryologist) in embryo transfer (ET), embryo vitrification (EV), embryo warming (EW), and trophectoderm biopsy (TBx). METHODS Pregnancy outcomes from groups of 20 consecutive elective single day 5 blastocyst transfers were evaluated for the following procedures: MD performed ET (N = 160 transfers), embryologist performed ET (N = 160 transfers), embryologist performed EV (N = 160 vitrification procedures), embryologist performed EW (N = 160 warming procedures), and embryologist performed TBx (N = 120 biopsies). AI-generated implantation probabilities for the same embryo cohorts were estimated, as were mean AI-predicted and actual implantation rates for each provider and compared using Wilcoxon singed-rank test. RESULTS Actual implantation rates following ET performed by one MD provider: "H" was significantly lower than AI-predicted (20% vs. 61%, p = 0.001). Similar results were observed for one embryologist, "H" (30% vs. 60%, p = 0.011). Embryos thawed by embryologist "H" had lower implantation rates compared to AI prediction (25% vs. 60%, p = 0.004). There were no significant differences between actual and AI-predicted implantation rates for EV, TBx, or for the rest of the clinical staff performing ET or EW. CONCLUSIONS AI-based QA tools could provide accurate, reproducible, and efficient staff performance monitoring in an ART practice.
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Affiliation(s)
- Panagiotis Cherouveim
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Victoria S Jiang
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Hadi Shafiee
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA.
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6
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Veiga E, Olmedo C, Sánchez L, Fernández M, Mauri A, Ferrer E, Ortiz N. Recalculating the staff required to run a modern assisted reproductive technology laboratory. Hum Reprod 2022; 37:1774-1785. [PMID: 35652237 DOI: 10.1093/humrep/deac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What number of staff is sufficient to perform increasingly complicated processes in today's modern ART laboratories? SUMMARY ANSWER The adequate number of personnel required for the efficient and safe operation of modern ART laboratories needs to be calculated. WHAT IS KNOWN ALREADY In today's modern ART laboratories, the amount of time required to perform increasingly complicated processes has more than doubled, with a downward trend in the amount of work an embryologist can do. Different workload unit values have been used to evaluate each workload task and efficiency in a particular ART laboratory, as well as to occasionally compare one laboratory with another. STUDY DESIGN, SIZE, DURATION Seven senior embryologists working at different IVF centers, three public and four private centers, participated in this multicenter study conducted between 2019 and 2020. We prepared a survey to create a calculator for staff using the average (of three attempts) time spent in every laboratory by each embryologist of the center to perform any ART process. PARTICIPANTS/MATERIALS, SETTING, METHODS Different laboratory processes and activities related to quality control, time spent and conventional human double witnessing were included in the survey. To calculate the number of processes that each embryologist can perform per year, an embryologist was considered to be having a full-time contract and working 7 or 8 h/day. The times included in the calculation of each task were those corresponding to the 95th percentile. For the calculations, Microsoft® Office Excel® Professional Plus 2019 was used. MAIN RESULTS AND THE ROLE OF CHANCE The survey showed that the time needed per embryologist to perform the different processes necessary for a classic IVF cycle without time lapse (TL) was 8.11 h, and with TL, it was 10.27 h. The calculated time also considered the time spent in documentation handling, cycle preparation, database management and conventional human double witnessing verification. An ICSI without TL needed 8.55 h, and with TL, it needed 10.71 h. An ICSI-PGT without a TL cycle needed 11.75 h, and with TL, it needed 13.91 h. Furthermore, 1.81 h should be added for every vitrification support needed. The time needed to control more than 200 critical steps, including equipment control and culture parameters, was 30 min per day plus 3.9 min per device to control.The time spent in semen analysis (including documentation handling, cycle preparation and database management) or intrauterine insemination with a partner sperm was 2.7 h. For donor sperm, an additional hour was required for the management involved. The time required to perform a testicular biopsy and cryopreserve the sample was 4 h. Similarly, the time required to perform seminal cryopreservation was 3.7 h. LIMITATIONS, REASONS FOR CAUTION The study was conducted considering a full-time contract embryologist working 7 or 8 h/day, 5 days a week, with days off according to the Spanish regulations. However, our findings can be adapted to foreign regulations using the developed online calculation platform. WIDER IMPLICATIONS OF THE FINDINGS A new advanced staff calculator allows any IVF laboratory to estimate the minimum number of embryologists necessary without compromising the security or success of the results. Nevertheless, we recommend a minimum of two qualified embryologists in every laboratory, regardless of the workload. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Asociación para el Estudio de la Biología de la Reproducción (ASEBIR). None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E Veiga
- Central Laboratory/Assisted Human Reproduction Unit, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - C Olmedo
- Reproductive Medicine Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Sánchez
- Assisted Human Reproduction Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - A Mauri
- Centro Procrear, Reus (Tarragona), Spain
| | - E Ferrer
- CREA, Centro Médico de Reproducción Asistida, Valencia, Spain
| | - N Ortiz
- Instituto Europeo de Fertilidad, Madrid, Spain
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7
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Agarwal A, Finelli R, Durairajanayagam D, Leisegang K, Henkel R, Salvio G, Aghamajidi A, Sengupta P, Crisóstomo L, Tsioulou PA, Roychoudhury S, Finocchi F, Darbandi M, Mottola F, Darbandi S, Iovine C, Santonastaso M, Zaker H, Kesari KK, Nomanzadeh A, Gugnani N, Rambhatla A, Duran MB, Ceyhan E, Kandil H, Arafa M, Saleh R, Shah R, Boitrelle F. Comprehensive Analysis of Global Research on Human Varicocele: A Scientometric Approach. World J Mens Health 2022; 40:636-652. [PMID: 35118839 PMCID: PMC9482861 DOI: 10.5534/wjmh.210202] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. Materials and Methods Varicocele studies published between 1988 and 2020 were retrieved from the Scopus database on April 5, 2021. Original studies on human varicocele were included, irrespective of language. Retrieved articles were manually screened for inclusion in various sub-categories. Bibliometric data was subjected to scientometric analysis using descriptive statistics. Network, heat and geographic mapping were generated using relevant software. Results In total, 1,943 original human studies on varicocele were published. These were predominantly from the northern hemisphere and developed countries, and published in journals from the United States and Germany. Network map analysis for countries showed several interconnected nodal points, with the USA being the largest, and Agarwal A. from Cleveland Clinic, USA, being a center point of worldwide varicocele research collaborations. Studies of adolescents were underrepresented compared with studies of adults. Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. Varicocele surgery was more investigated than non-surgical approaches. To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. Conclusions This study analyzes the publication trends in original research on human varicocele spanning over the last three decades. Our analysis emphasizes areas for further exploration to better understand varicocele’s impact on men’s health and male fertility.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh Campus, Selangor, Malaysia
| | - Kristian Leisegang
- Department of Physiology, School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,LogixX Pharma Ltd., Theale, Berkshire, UK.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Gianmaria Salvio
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Azin Aghamajidi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia
| | - Luís Crisóstomo
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Universidade do Porto, Porto, Portugal
| | - Petroula A Tsioulou
- Department of Physiology, Group of Physiology of Reproduction and Clinical Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Federica Finocchi
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Filomena Mottola
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.,Gamma Analisi Cliniche S.r.l, Caserta, Italy
| | - Marianna Santonastaso
- Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Himasadat Zaker
- Histology and Mcroscopic Analysis Division, RASTA Specialized Research Institute (RSRI), West Azerbaijan Science and Technology Park (WASTP), Urmia, Iran
| | | | - Amir Nomanzadeh
- Histology and Mcroscopic Analysis Division, RASTA Specialized Research Institute (RSRI), West Azerbaijan Science and Technology Park (WASTP), Urmia, Iran
| | | | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mesut Berkan Duran
- Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Erman Ceyhan
- Deparment of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Andrology, Cairo University, Cairo, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.,Ajyal IVF Center, Ajyal Hopsital, Sohag, Egypt
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
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8
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Choucair F, Younis N, Hourani A. The value of the modern embryologist to a successful IVF system: revisiting an age-old question. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00061-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
The embryology laboratory remains one of the primary factors influencing the overall performance of the IVF clinic. Clinical embryology, however, has undergone remarkable advancements over the last decade. These developments in both practice and education have been driven together by science and technology.
Main body
The changes in clinical embryology practice have created a significant challenge for both the profession and the embryologist. New competencies for embryologists have subsequently emerged to provide and manage high-quality services for their patients and clinics. Embryologists’ efficacy behind the scenes reflects positively on the success of the fertility clinic. This framework will serve as the flagship document to shed light on the often-overlooked value of the embryologist as an intellectual and intangible asset for the clinic.
Conclusion
To fully leverage a modern embryologist’s skill set, significant investment is required from the IVF clinics’ leadership, which is associated with a substantial return on the IVF clinic’s success. From their side, embryologists should be up to date on further developments and innovations. On the other hand, mentors need to mend the curriculum to allow for better training of high-caliber embryologists.
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9
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Bormann CL, Curchoe CL, Thirumalaraju P, Kanakasabapathy MK, Gupta R, Pooniwala R, Kandula H, Souter I, Dimitriadis I, Shafiee H. Deep learning early warning system for embryo culture conditions and embryologist performance in the ART laboratory. J Assist Reprod Genet 2021; 38:1641-1646. [PMID: 33904010 DOI: 10.1007/s10815-021-02198-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/18/2021] [Indexed: 12/28/2022] Open
Abstract
Staff competency is a crucial component of the in vitro fertilization (IVF) laboratory quality management system because it impacts clinical outcomes and informs the key performance indicators (KPIs) used to continuously monitor and assess culture conditions. Contemporary quality control and assurance in the IVF lab can be automated (collect, store, retrieve, and analyze), to elevate quality control and assurance beyond the cursory monthly review. Here we demonstrate that statistical KPI monitoring systems for individual embryologist performance and culture conditions can be detected by artificial intelligence systems to provide systemic, early detection of adverse outcomes, and identify clinically relevant shifts in pregnancy rates, providing critical validation for two statistical process controls proposed in the Vienna Consensus Document; intracytoplasmic sperm injection (ICSI) fertilization rate and day 3 embryo quality.
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Affiliation(s)
- Charles L Bormann
- Massachusetts General Hospital Fertility Center, Obstetrics/Gynecology/Reproductive Endocrinology and Infertility, Boston, MA, USA
| | | | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Manoj K Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raghav Gupta
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohan Pooniwala
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hemanth Kandula
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Obstetrics/Gynecology/Reproductive Endocrinology and Infertility, Boston, MA, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Obstetrics/Gynecology/Reproductive Endocrinology and Infertility, Boston, MA, USA
| | - Hadi Shafiee
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Wu DJ, Badamjav O, Reddy VV, Eisenberg M, Behr B. A preliminary study of sperm identification in microdissection testicular sperm extraction samples with deep convolutional neural networks. Asian J Androl 2021; 23:135-139. [PMID: 33106465 PMCID: PMC7991821 DOI: 10.4103/aja.aja_66_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sperm identification and selection is an essential task when processing human testicular samples for in vitro fertilization. Locating and identifying sperm cell(s) in human testicular biopsy samples is labor intensive and time consuming. We developed a new computer-aided sperm analysis (CASA) system, which utilizes deep learning for near human-level performance on testicular sperm extraction (TESE), trained on a custom dataset. The system automates the identification of sperm in testicular biopsy samples. A dataset of 702 de-identified images from testicular biopsy samples of 30 patients was collected. Each image was normalized and passed through glare filters and diffraction correction. The data were split 80%, 10%, and 10% into training, validation, and test sets, respectively. Then, a deep object detection network, composed of a feature extraction network and object detection network, was trained on this dataset. The model was benchmarked against embryologists' performance on the detection task. Our deep learning CASA system achieved a mean average precision (mAP) of 0.741, with an average recall (AR) of 0.376 on our dataset. Our proposed method can work in real time; its speed is effectively limited only by the imaging speed of the microscope. Our results indicate that deep learning-based technologies can improve the efficiency of finding sperm in testicular biopsy samples.
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Affiliation(s)
- Daniel J Wu
- Department of Computer Science, Stanford University, Stanford, CA 94305, USA
| | - Odgerel Badamjav
- Department of Urology, University of Utah Health, Salt Lake City, UT 84108, USA
| | - Vikrant V Reddy
- Department of Obstetrics and Gynecology, Stanford Children's Health, Stanford, CA 94305, USA
| | - Michael Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Barry Behr
- Department of Obstetrics and Gynecology, Stanford Children's Health, Stanford, CA 94305, USA
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Kovačič B, Prados FJ, Plas C, Woodward BJ, Verheyen G, Ramos L, Mäkinen S, Apter SJ, Vidal F, Ziebe S, Magli MC, Lundin K, Sunde A, Plancha CE. ESHRE Clinical Embryologist certification: the first 10 years. Hum Reprod Open 2020; 2020:hoaa026. [PMID: 32864474 PMCID: PMC7448581 DOI: 10.1093/hropen/hoaa026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What has the ESHRE programme ‘ESHRE Certification for Clinical Embryologists’ achieved
after 10 years? SUMMARY ANSWER The post-exam analysis showed a pass rate of 60% for Clinical and 50% for Senior
Clinical Embryologists and a high level of internal consistency of all exams, leading to
a total of 773 certified Clinical and 493 Senior Clinical Embryologists over the
decade. WHAT IS KNOWN ALREADY In an ESHRE survey on the educational and professional status of Clinical Embryology in
Europe, it was found that education of laboratory personnel working in the field of
assisted reproduction is highly variable between countries. In 2008, ESHRE introduced a
programme, curriculum and certification in the field of Clinical Embryology. Knowledge
gained by postgraduate study of recommended literature, following a clear curriculum, is
verified by a written two-level exam for obtaining a certificate for Clinical (basic) or
Senior Clinical (advanced) Embryologists. With a total of 1266 certificates awarded over
a period of 10 years and recognition by the Union Européenne des Médecins Spécialistes
and their Council for European Specialists Medical Assessment, the ESHRE Clinical
Embryology exams have become an internationally recognized educational standard in the
field of Clinical Embryology. STUDY DESIGN, SIZE, DURATION A retrospective analysis of all applications for ESHRE Clinical (2009–2018) and Senior
Clinical Embryologist Certification (2008–2018) and exam results of the first decade was
carried out by the Steering Committee for Clinical Embryologist Certification. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 2894 applications for ESHRE Certification for Clinical Embryologists and the
results of 10 exams for the Clinical (1478 candidates) and 11 exams for Senior Clinical
(987 candidates) levels were analysed. A detailed post-exam retrospective analysis was
performed regarding difficulty, discrimination and reliability levels of 1600
multiple-choice questions (MCQs) with a single best answer among four options, from
eight different curriculum topics (Basic cell biology, Genetics, Developmental biology,
Female reproduction, Male reproduction, IVF laboratory, Cryopreservation and Laboratory
management), representing the core theoretical knowledge of Clinical Embryology.
Difficulty levels of the MCQs were subsequently compared regarding each topic and each
yearly exam. The participation and success rates in the ESHRE Clinical Embryology exams
were also assessed in terms of the educational and geographic backgrounds of
candidates. MAIN RESULTS AND THE ROLE OF CHANCE Over the 10 years studied, the mean pass rate for the Clinical Embryologist exam was
60% (range 41–86%), and for the Senior Clinical Embryologist exam was 50% (range
34–81%). On average, 63% European candidates and 35% non-European candidates passed the
Clinical Embryologist exam, while 52% European candidates and 31% non-European
candidates passed the Senior Clinical Embryologist exam. The candidates’ educational
level impacted on the success of the Clinical Embryologist exam but not of the Senior
Clinical Embryologist exam. The mean difficulty indices by study topic showed that in
the period of 10 years, there were no statistically significant differences between
topics, for either the Clinical or Senior Clinical Embryologist exams. However, the
overall exam difficulty varied between years. Reassuringly, the exam MCQ discrimination
and reliability indices always showed a high level of internal consistency in all
exams. LIMITATIONS, REASONS FOR CAUTION Some data from the initial ESHRE certification programme were not obtained
electronically, in particular data for education, implying tables and figures reflect
the specified valid data periods. Several countries exhibit different study profiles for
those working in ART laboratories, such that laboratory technicians/technologists
predominate in some countries, while in others only biologists and medical doctors are
allowed to work with human embryos. Such differences could consequently affect the exam
performance of candidates from specific countries. WIDER IMPLICATIONS OF THE FINDINGS The ESHRE exams on Clinical Embryology are the most widely, internationally accepted
tests of knowledge in the rapidly growing area of human reproduction. Clinical
Embryology is increasingly recognized as a specific discipline for scientific staff who
are collaborating closely with clinicians in managing human infertility through
medically assisted reproduction. The analysis of the first 10 years of application of a
two-level exam for Clinical Embryology shows a consistent high quality and reliability
of the exam and MCQs used. These results represent an important follow-up of the quality
of the ESHRE Certification programme for Clinical Embryologists, and convincingly
position Clinical Embryology in the wider group of health disciplines that are
harmonized through professional bodies such as ESHRE and European Board & College of
Obstetrics and Gynaecology. The exams provide a clear step towards the increasing
professional recognition and establishment of Clinical Embryology within health systems
at both European and international level. STUDY FUNDING/COMPETING INTEREST(S) No competing interest. All costs of the Steering Committee meetings were covered by
ESHRE.
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Affiliation(s)
- Borut Kovačič
- Department of Reproductive Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | | | | | | | - Greta Verheyen
- University Hospital, Vrije Universiteit Brussel, Centre for Reproductive Medicine, Brussels, Belgium
| | - Liliana Ramos
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Francesca Vidal
- Unitat de Biologia Cellular, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Søren Ziebe
- The Fertility Clinic, Section 4071, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arne Sunde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Carlos E Plancha
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa, Portugal and CEMEARE, Lisboa, Portugal
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