Ensuring Accuracy in the Embryology Laboratory

I am pleased again to have Drew Tortoriello, MD as a guest author on this blog. He has done a superb job outlining the steps that we take at SIRM to assure that there are no mix-ups in eggs, embryos or sperm in our embryology labs. This is a particularly timely topic, given the recent reports in the news of several clinics that have had tragic and heartbreaking embryo labeling/identification issues. Dr. Tortoriello is the Medical Director of SIRM-New York and a close friend and colleague.

- Geoff Sher
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The media has recently reported a few instances in which embryos generated through the process of IVF have been unintentionally transferred into the wrong recipients. The possibility of such errors is a nagging fear in the minds of many IVF patients, and when these very rare instances get propagated by the press it greatly augments their anxiety.

There are obviously no winners or clear solutions in such mismatch scenarios. Both the patients involved and their physicians are grief-stricken. How can we ensure that such errors never happen? The answer to this question is probably not more technology but rather to design a rigorous standard flow of operations in the embryology laboratory and adhere to it strictly.

At SIRM, all steps which require the movement of embryos from one plate to another, or to be removed and transferred into the uterus, must be witnessed by at least two people who will initial the “embryo summary sheet”. The same goes for moving vials of eggs, sperm, or embryos into or out of their respective cryotanks.

If we are to use frozen sperm, whether coming from a patient or anonymous donor, choosing the right vial is verified and witnessed by two people, as is the action of putting the collected eggs after egg retrieval onto their appropriately labeled plate and into their appropriately labeled incubator. The combining of gametes (egg and sperm) is also witnessed when the egg plate is matched to the right sperm sample before insemination or ICSI (intracytoplasmic sperm injection). After ICSI, witnessing is also done to ensure that the freshly injected eggs are transferred into their matching culture dishes.

At SIRM, even though some may consider it unnecessary, each patient’s embryos also have their own desiccator , a glass container where embryos in their culture dishes are stored, so each patient’s embryos are completely isolated from other embryos in the same incubator. At embryo transfer, two embryologists must witness that the embryos being utilized match their intended recipient. The identification of supernumerary (remaining) embryos prior to vitrification (state-of-the-art freezing) is confirmed by two embryologists, as is their placement into their appropriately labeled vials. Picking up embryos for thaw is also witnessed; two embryologists make sure that the right vial is picked up for thaw then placed into the appropriate culture dish.

There will never be a substitute for human vigilance. No matter how sophisticated the safeguarding technology may one day become, ultimately there will be human beings orchestrating and applying this technology. Because humans are imperfect, the only real solution is to have each person’s work acknowledged and verified by others at every single juncture.

- Drew Tortoriello, MD