A Web-Based Global Educational Model for Training in Semen Analysis during the COVID-19 Pandemic

Infertility affects between 2.5% and 12% of couples worldwide, with male factor infertility solely accounting for 20% to 30% and contributing to 50% of the overall infertility cases [1]. In the United States alone, infertility affects 9.5% of men [2]. The clinical evaluation of male infertility is based on the semen analysis where the results can significantly influence the diagnostic interpretation and management. While many clinicians rely on semen parameters as a surrogate marker of a man’s ability to father a child, the results of semen analysis should, however, be interpreted with caution considering its inherent limitations [3,4]. A properly performed semen analysis and an adequate clinical examination of the male along with questions regarding current medical conditions and lifestyle circumstances that could affect sample quality, can provide valuable information related to a man’s fertility potential. This information facilitates a better understanding of the physiology of the reproductive organs and the underlying causes of dysfunction [5- 7]. However, manual semen analysis has its inherent challenges associated with high subjectivity, lack of standardization, inadequate quality control and quality assurance, as well as inadequate assessment of competency, and training of laboratory personnel performing the test [7,8]. Unlike sperm concentration and motility, sperm morphology has even more subjectivity in reporting the results, with increased intra- and intervariability [8-10]. Therefore, quality control is imminent in preventing such variations and retaining uniformity in all assessments by all operators. This includes preanalytical (test requisition, correct sample collection, delivery of sample), analytical (mixing and loading of sample, correct preparation of smears or calculation of results), and post-analytical (correct reporting of results to the clinician) indicators. To minimize errors, daily, weekly, or monthly quality control of reagents and equipment is imperative

Comparison of electronic versus manual witnessing of procedures within the in vitro fertilization laboratory: impact on timing and efficiency

Objective: To evaluate the impact of an electronic witnessing system (EWS) on witnessing standard operating procedures and to assess embryologist perceptions of the EWS. Design: Prospective cohort study. Setting: Private in vitro fertilization laboratory network. Patient(s): None. Intervention(s): None Main Outcome Measure(s): The time difference between manual and electronic double-witnessing procedures, and embryologist perceptions of the EWS. Result(s): From 342 witnessing times analyzed (114 EWS, 114 manual, and 114 interruptions to witnesses), the EWS reduced mean (SD) total witnessing time (in seconds) by 91.5 (23.6) for intracytoplasmic sperm injection, 62.0 (17.9) for Day 3 embryo assessment, 58.3 (18.9) for fresh embryo transfer, and 59.4 (13.3) for frozen embryo transfer. This time reduction significantly decreased the overall time required for double-witnessing by 3.1- to 5.2-fold. A survey with 50 embryologists within the laboratory network indicated that most embryologists considered the EWS to improve sample traceability (78.3%), reduce errors in labeling issues (80.4%), and reduce the risk of sample mismatch errors by minimizing disruptions (60.9%). Furthermore, 82.6% thought that visual completion of the EWS dashboard provided peace of mind when leaving work and 84.8% were more confident knowing that all procedures were completed according to the EWS. Conclusion(s): An EWS can improve laboratory efficiency by significantly decreasing the time required for witnessing procedures and by minimizing interruptions. The EWS was well perceived by embryologists and laboratory managers and enhanced their confidence and peace of mind with regard to witnessing compliance and safety/accuracy

An expert commentary on essential equipment, supplies and culture media in the assisted reproductive technology laboratory

International audienceThe assisted reproductive technology (ART) laboratory is a complex system designed to sustain the fertilization, survival, and culture of the preimplantation embryo to the blastocyst stage. ART outcomes depend on numerous factors, among which are the equipment, supplies and culture media used. The number and type of incubators also may affect ART results. While large incubators may be more suitable for media equilibration, bench-top incubators may provide better embryo culture conditions in separate or smaller chambers and may be coupled with time-lapse systems that allow continuous embryo monitoring. Microscopes are essential for observation, assessment, and micromanipulation. Workstations provide a controlled environment for gamete and embryo handling and their quantity should be adjusted according to the number of ART cycles treated in order to provide a steady and efficient workflow. Continuous maintenance, quality control and monitoring of equipment are essential and quality control devices such as the thermometer, and pH-meter are necessary to maintain optimal culture conditions. Tracking, appropriate delivery and storage conditions, and quality control of all consumables are recommended so that adequate quantity and quality are available for use. Embryo culture media have evolved: preimplantation embryos are cultured either by sequential media or single-step media that can be used for interrupted or uninterrupted culture. There is currently no sufficient evidence that any individual commercially-available culture system is better than others in terms of embryo viability. In this review, we aim to analyze the various parameters that should be taken into account when choosing the essential equipment, consumables and culture media systems that will create optimal culture conditions and provide the most effective patient treatment

Oocyte quality and embryo selection strategies: a review for the embryologists, by the embryologists

International audienceWith the advance of assisted reproduction techniques, and the trend towards blastocyst culture and single embryo transfer, gamete and embryo assessment have gained greater importance in ART treatment. Embryo quality depends mainly on gamete quality and culture conditions. Oocyte maturity identification is necessary in order to plan fertilization timing. Mature oocytes at the metaphase II stage show a higher fertilization rate compared to immature oocytes. Morphology assessment is a critical yet challenging task that may serve as a good prognostic tool for future development and implantation potential if done effectively. Various grading systems have been suggested to assess embryos at pronuclear, cleavage, and blastocyst stages. By identifying the embryo with the highest implantation potential, it is possible to reduce the number of embryos transferred without compromising the chances of a successful pregnancy. Apart from the conventional morphology assessment, there are several invasive or non-invasive methods for embryo selection such as preimplantation genetic testing, morphokinetics, proteomics, metabolomics, oxygen consumption, and measurement of oxidative stress in culture medium. Morphokinetics is a method based on time-lapse technology and continuous monitoring of embryos. In this review, we aimed to describe and compare the most effective and widely used methods for gamete and embryo assessment as well as embryo selection

Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer

International audienceOocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction technology (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however, evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer