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Shirasawa H, Yamada M, Jwa SC, Kuroda K, Harada M, Osuga Y. Assessment of embryologist sufficiency and associated regional disparities in Japanese assisted reproduction facilities using nationwide survey data (IZANAMI project). J Obstet Gynaecol Res 2024. [PMID: 38961649 DOI: 10.1111/jog.16022] [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: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
AIMS This study aims to comprehensively examine the employment and practices of embryologists in Japan's assisted reproductive technology (ART) laboratories, focusing on the impact of various factors such as ART cycle numbers, add-ons, and regional differences. Additionally, it seeks to assess the extent to which Japanese ART facilities meet international minimum standards set by the American Society for Reproductive Medicine (ASRM). METHODS A survey was conducted from December 2021 to February 2022 among 621 ART facilities in Japan. The study categorized facilities into five ART cycle groups and compared the number of embryologists across these groups. It also examined the correlation between the number of embryologists, ART cycles, add-ons, and regional differences. Data were analyzed using linear regression and multiple linear regression analyses. RESULTS The study's findings revealed a significant correlation between the total number of embryologists at each facility and the ART cycles. Notably, there were significant differences in the number of embryologists across all ART cycle categories. Of the 435 facilities, only 44.6% met the ASRM minimum embryologist staffing requirement. The regression analysis further highlighted the significance of ART cycles and preimplantation genetic testing for aneuploidies as factors. Moreover, the number of embryologists stationed at urban facilities was significantly higher than at nonurban facilities, indicating a potential regional disparity. CONCLUSION In Japan, it was first found that more than 50% of ART facilities do not have sufficient embryologists in place relative to the number of ART cycles. Furthermore, the add-ons and regional differences affect the placement of embryologists.
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Affiliation(s)
- Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Mitsutoshi Yamada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Seung Chik Jwa
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Keiji Kuroda
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
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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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Kromp F, Wagner R, Balaban B, Cottin V, Cuevas-Saiz I, Schachner C, Fancsovits P, Fawzy M, Fischer L, Findikli N, Kovačič B, Ljiljak D, Martínez-Rodero I, Parmegiani L, Shebl O, Min X, Ebner T. An annotated human blastocyst dataset to benchmark deep learning architectures for in vitro fertilization. Sci Data 2023; 10:271. [PMID: 37169791 PMCID: PMC10175281 DOI: 10.1038/s41597-023-02182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
Medical Assisted Reproduction proved its efficacy to treat the vast majority forms of infertility. One of the key procedures in this treatment is the selection and transfer of the embryo with the highest developmental potential. To assess this potential, clinical embryologists routinely work with static images (morphological assessment) or short video sequences (time-lapse annotation). Recently, Artificial Intelligence models were utilized to support the embryo selection procedure. Even though they have proven their great potential in different in vitro fertilization settings, there is still considerable room for improvement. To support the advancement of algorithms in this research field, we built a dataset consisting of static blastocyst images and additional annotations. As such, Gardner criteria annotations, depicting a morphological blastocyst rating scheme, and collected clinical parameters are provided. The presented dataset is intended to be used to train deep learning models on static morphological images to predict Gardner's criteria and clinical outcomes such as live birth. A benchmark of human expert's performance in annotating Gardner criteria is provided.
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Affiliation(s)
- Florian Kromp
- Software Competence Center Hagenberg, Data Science, Hagenberg, Austria.
| | - Raphael Wagner
- Software Competence Center Hagenberg, Data Science, Hagenberg, Austria
| | - Basak Balaban
- American Hospital of Istanbul, In vitro fertilization lab, Istanbul, Turkey
| | - Véronique Cottin
- Viollier AG, Assisted Reproduction Technologies, Basel, Switzerland
| | - Irene Cuevas-Saiz
- Hospital General Universitario de Valencia, In vitro fertilization lab, Valencia, Spain
| | - Clara Schachner
- Software Competence Center Hagenberg, Data Science, Hagenberg, Austria
| | - Peter Fancsovits
- Semmelweis University, Department of Obstetrics and Gynecology, Division of Assisted Reproduction, Budapest, Hungary
| | - Mohamed Fawzy
- IbnSina and Banon IVF Centers, In vitro fertilization lab, Sohag, Egypt
| | - Lukas Fischer
- Software Competence Center Hagenberg, Data Science, Hagenberg, Austria
| | - Necati Findikli
- Bahceci Fulya IVF Centre Istanbul, In vitro fertilization lab, Istanbul, Turkey
| | - Borut Kovačič
- University Medical Centre Maribor, Department of Reproductive Medicine and Gynecological Endocrinology, Maribor, Slovenia
| | - Dejan Ljiljak
- Sestre Milosrdnice University Hospital Center, Department of Gynecology and Obstetrics, Zagreb, Croatia
| | - Iris Martínez-Rodero
- Universitat Autònoma de Barcelona, Laboratori de Fecundació In Vitro, Barcelona, Spain
| | | | - Omar Shebl
- Kepler University Linz, Department of Gynecology, Obstetrics and Gynecological Endocrinology, Linz, Austria
| | - Xie Min
- University Hospital Zurich, Department of Reproductive Endocrinology, Zurich, Switzerland
| | - Thomas Ebner
- Kepler University Linz, Department of Gynecology, Obstetrics and Gynecological Endocrinology, Linz, Austria
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4
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Scarica C, Woodward BJ, De Santis L, Kovačič B. Training and competency assessment of Clinical Embryologists and licensing of the profession in European countries. Hum Reprod Open 2023; 2023:hoad001. [PMID: 36789007 PMCID: PMC9920573 DOI: 10.1093/hropen/hoad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Indexed: 02/13/2023] Open
Abstract
STUDY QUESTION How is the acquisition and testing of theoretical and practical knowledge in Clinical Embryology and the licensing of ART laboratory personnel carried out in European countries? SUMMARY ANSWER Twelve out of 31 European countries have established some kind of verification of laboratory competency and skills in ART: in 7 countries, this was related to licensing, but where organized education for Clinical Embryologists existed, there were vast differences in the way these processes were undertaken. WHAT IS KNOWN ALREADY In 2015, a report by the ESHRE Embryology Certification Committee concluded that regardless of the large number of people working in IVF laboratories, Clinical Embryology was only recognized as an official profession in 3 out of 27 European national health systems. In most countries, Clinical Embryologists needed to be officially registered under an alternative profession and there were limited opportunities for organized education in this specialist field. Five years after this report, the ESHRE Working Group on Embryologist Training Analysis conducted a survey to collect detailed information about how Clinical Embryologists from different European countries are acquiring their theoretical knowledge and practical skills in ART, and how their level of education and competence in Clinical Embryology is verified. STUDY DESIGN SIZE DURATION Two questionnaires about the possibilities for acquiring the education and training needed to work in ART and verification of this knowledge were prepared by the ESHRE Working Group on Embryologist Training Analysis. The first was sent in 2020 to a panel of invited lead European Embryologists who attended an Expert Meeting held in Rome, Italy. In order to have a more comprehensive and updated picture, in 2021 the same survey was also sent to the ESHRE Committee of National Representatives (CNRs). At the end of 2021, the second survey with specific questions, more focused on Clinical Embryologists' training and licencing, was sent to the CNRs who reported on verification of education in Clinical Embryology. PARTICIPANTS/MATERIALS SETTING METHODS The first survey consisted of 17 questions. It was initially submitted to 14 lead Embryologists and then resubmitted to the 34 ESHRE CNRs. Representatives from 31 countries responded. A second survey with 23 questions was sent to the 12 ESHRE CNRs who reported an established national system of verification of education in Clinical Embryology, with specific questions focused on the training of Clinical Embryologists. All 12 CNRs responded. MAIN RESULTS AND THE ROLE OF CHANCE Analysis showed that European national education programmes in Clinical Embryology could be split into 4 categories: non-existent (13 countries), recommended (5 countries), simple compulsory (9 countries), and complex compulsory (4 countries). A national document stating the minimum education requirements for staff to work in an IVF laboratory was reported by 19 respondents. The requirement to follow a prescribed theoretical and laboratory training programme in ART was compulsory in 9 and 10 countries, respectively. Some form of verification of laboratory skills, theoretical knowledge in ART, and continuing professional development was required in 12, 10, and 9 countries, respectively. A national trainee's logbook format was reported by seven respondents and a national tutorial system was available in six countries. Only seven countries had official licensing of ART laboratory staff. The title of Clinical Embryologist was not recognized in 13 countries and in 6 countries, it was used only by professional bodies, while in 12 countries the profession was at least cited in governmental regulations. The ESHRE Clinical Embryologist Certificate was officially recognized in eight countries. LIMITATIONS REASONS FOR CAUTION The survey took place in two steps and the results were then combined to provide a representative picture for most of the European countries sampled. The vast majority, but not all, of the CNRs answered the request to participate in the survey. WIDER IMPLICATIONS OF THE FINDINGS The professional recognition of Clinical Embryology within Europe is steadily evolving. However, it remains a concern that many countries continue to not recognize Clinical Embryology as a profession, with a vast difference in the reported organization of educational and training programmes and verification of skills. It is recommended that a training programme for Clinical Embryology and ART in Europe should be standardized and relevant issues should be addressed by competent authorities and European Union institutions. ESHRE is best placed to take a leading role in this educational process. STUDY FUNDING/COMPETING INTERESTS The Working Group members who are the authors of this article did not receive payments for the completion of this study. The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Catello Scarica
- European Hospital, New Fertility Group Centre for Reproductive Medicine, Rome, Italy
| | | | - Lucia De Santis
- IVF Unit, Department of Obstetrics & Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Borut Kovačič
- Correspondence address. Department of Reproductive Medicine and Gynaecological Endocrinology, University Medical Centre Maribor, SI-2000 Maribor, Slovenia. E-mail: ;
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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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Varga I, Lapides L, Brucknerová I, Gálfiová P, Visnyaiová K, Csöbönyeiová M, Klein M, Žiaran S, Sysák R, Záhumenský J. Our First Experience Implementing “Clinical Embryology and Reproductive Medicine” as a Curriculum Course of the Study Program General Medicine at the Faculty of Medicine in Bratislava, Slovakia. Physiol Res 2022. [DOI: 10.33549/physiolres.934955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There is no separate course in the medical curriculum summarizing all aspects of human reproduction in most medical school curricula. At the same time, such a course would logically connect knowledge from clinical embryology and assisted reproduction, encompassing the issue of female and male infertility, mechanisms of birth defect formation, their prenatal diagnosis and subsequent specialized neonatal care. The aim of a wide team of university teachers comprising embryologists, gynecologists, neonatologists, endocrinologists, geneticists and others was to create and implement a new course entitled "Clinical Embryology and Reproductive Medicine" into the fourth-year curriculum of the study program General Medicine at the Faculty of Medicine, Comenius University in Bratislava. There has been a great interest in the course, as evidenced by the number of medical students enrolled. The lecture syllabuses have been divided into several thematic areas: 1) Clinical embryology including a laboratory part of assisted reproduction, 2) Cause and treatment options of female and male infertility, 3) A comprehensive view of the issue of birth defects, 4) The issue of preconception education, prenatal and childbirth training, family planning, 5) Reproductive immunology and endocrinology. Despite the complexity of human reproduction being a mainstay of gynecology and obstetrics, it is underemphasized in the medical school curricula worldwide. It is often reflected in shorter hospital / practical trainings during undergraduate studies and lower requirements at the final exam. Therefore, as students almost unanimously valued, this new course is extremely helpful in preparing for the final state exam.
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Affiliation(s)
- I Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Slovakia. E-mail:
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7
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VARGA I, LAPIDES L, BRUCKNEROVÁ I, GÁLFIOVÁ P, VISNYAIOVÁ K, CSÖBÖNYEIOVÁ M, KLEIN M, ŽIARAN S, SYSÁK R, ZÁHUMENSKÝ J. Our First Experience Implementing "Clinical Embryology and Reproductive Medicine" as a Curriculum Course of the Study Program General Medicine at the Faculty of Medicine in Bratislava, Slovakia. Physiol Res 2022; 71:S59-S64. [PMID: 36592441 PMCID: PMC9854006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
There is no separate course in the medical curriculum summarizing all aspects of human reproduction in most medical school curricula. At the same time, such a course would logically connect knowledge from clinical embryology and assisted reproduction, encompassing the issue of female and male infertility, mechanisms of birth defect formation, their prenatal diagnosis and subsequent specialized neonatal care. The aim of a wide team of university teachers comprising embryologists, gynecologists, neonatologists, endocrinologists, geneticists and others was to create and implement a new course entitled "Clinical Embryology and Reproductive Medicine" into the fourth-year curriculum of the study program General Medicine at the Faculty of Medicine, Comenius University in Bratislava. There has been a great interest in the course, as evidenced by the number of medical students enrolled. The lecture syllabuses have been divided into several thematic areas: 1) Clinical embryology including a laboratory part of assisted reproduction, 2) Cause and treatment options of female and male infertility, 3) A comprehensive view of the issue of birth defects, 4) The issue of preconception education, prenatal and childbirth training, family planning, 5) Reproductive immunology and endocrinology. Despite the complexity of human reproduction being a mainstay of gynecology and obstetrics, it is underemphasized in the medical school curricula worldwide. It is often reflected in shorter hospital / practical trainings during undergraduate studies and lower requirements at the final exam. Therefore, as students almost unanimously valued, this new course is extremely helpful in preparing for the final state exam.
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Affiliation(s)
- Ivan VARGA
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Lenka LAPIDES
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia,ISCARE, Reproduction Clinic, Gynecology & Urology, Bratislava, Slovakia
| | - Ingrid BRUCKNEROVÁ
- Department of Neonatology and Intensive Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Paulína GÁLFIOVÁ
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Kristína VISNYAIOVÁ
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Mária CSÖBÖNYEIOVÁ
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Martin KLEIN
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Stanislav ŽIARAN
- Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Rastislav SYSÁK
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jozef ZÁHUMENSKÝ
- 2nd Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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D’Angelo A, Panayotidis C, Alteri A, Mcheik S, Veleva Z. Evidence and consensus on technical aspects of embryo transfer. Hum Reprod Open 2022; 2022:hoac038. [PMID: 36196080 PMCID: PMC9522404 DOI: 10.1093/hropen/hoac038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available.
OBJECTIVE AND RATIONALE
This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners’ performance.
SEARCH METHODS
A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET.
OUTCOMES
The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure, and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined.
LIMITATIONS, REASONS FOR CAUTION
Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based.
WIDER IMPLICATIONS
ET is the last procedural step in an ART treatment and is a crucial step toward achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research.
STUDY FUNDING/COMPETING INTEREST(S)
No funding. ADA has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.
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Affiliation(s)
- Arianna D’Angelo
- Wales Fertility Institute, Swansea Bay Health Board, University Hospital of Wales, Cardiff University , Cardiff, UK
| | - Costas Panayotidis
- Attiki Iatriki advanced gynaecological ultrasound and hysteroscopic centre private practice , Pallini, Athens, Greece
| | | | - Saria Mcheik
- European society of human reproduction and embryology (ESHRE) Central Office , Strombeek-Bever, Belgium
| | - Zdravka Veleva
- Helsinki University Central Hospital , Helsinki, Finland
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9
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Péloquin S, Garcia-Velasco JA, Blockeel C, Rienzi L, de Mesmaeker G, Lazure P, Beligotti F, Murray S. Educational needs of fertility healthcare professionals using ART: a multi-country mixed-methods study. Reprod Biomed Online 2021; 43:434-445. [PMID: 34384693 DOI: 10.1016/j.rbmo.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/14/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION What are the most pressing educational needs of fertility healthcare professionals using assisted reproductive technologies (ART)? DESIGN This mixed-methods study combined qualitative interviews with quantitative surveys. Participants included physicians and nurses specialized in reproductive endocrinology or in obstetrics/gynaecology, and laboratory specialists, with a minimum of 3 years of experience, practising in Australia, Brazil, Canada, China, France, Germany, India, Italy, Japan, Mexico, Spain or the UK. Maximum variation purposive sampling was used to ensure a mix of experience and settings. Interviews were transcribed and coded through thematic analysis. Quantitative data were analysed using frequency tables, cross-tabulations and chi-squared tests to compare results by reimbursement context. RESULTS A total of 535 participants were included (273 physicians, 145 nurses and 117 laboratory specialists). Knowledge gaps, skills gaps and attitude issues were identified in relation to: (i) ovarian stimulation (e.g. knowledge of treatments and instruction protocols for ovarian stimulation), (ii) embryo culture and cryopreservation/vitrification (e.g. diverging opinions on embryo freezing, (iii) embryo assessment (e.g. performing genetic testing), (iv) support of luteal phase and optimizing pregnancy outcomes (e.g. knowledge of assessment methods for endometrial receptivity), and (v) communication with patients (e.g. reluctance to address emotional distress). CONCLUSIONS This descriptive, exploratory study corroborates previously reported gaps in fertility care and identifies potential causes of these gaps. Findings provide evidence to inform educational programmes for healthcare professionals who use ART in their practice and calls for the development of case-based education and interprofessional training programmes to improve care for patients with fertility issues.
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Affiliation(s)
| | | | | | - Laura Rienzi
- Clinica Valle Giulia, GENERA Centre for Reproductive Medicine, Rome, Italy
| | - Guy de Mesmaeker
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussels, Belgium
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10
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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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