1. Please give an introduction about your career graph and since you have worked in USA and
New zealand you must have noticed the differences in organizational structures and
regulations based on each countries?
Although I have found many similarities between the process of IVF in the States and New
Zealand, there are some clear differences in the way that patient’s expectations are set and
the workflow of the laboratory. In the States, the embryologists tend to not be directly
involved in patient stimulation decisions as this is often decided upon by the physician. In
New Zealand, the embryologist is actively involved in the decision making with regards to
medication dosages, follicle development and trigger day assignments. Although this is
reviewed and confirmed by the physician, the embryologist is very familiar with the patient
before they present for egg collection. I have also found that by setting patient’s expectations
of their cycle outcomes can also be varied greatly. Some clinics have their embryologist call
patients daily to provide feedback of embryo progression, however, others only contact their
patients with fertilisation outcomes followed by blastocyst development on Day5. Although
this may not necessarily be a country to country difference, it stresses the point that by
setting the expectations for the patient prior to the start of their cycle, the laboratory staff can
improve workflow and efficiency.
2. What is your opinion on continuous culture and does it have advantage over sequential
culture?
I have found continuous culture to be very beneficial in the laboratory. We have identified a
greater blast utilisation rate due to the undisturbed nature of the embryo culture protocol
which has subsequently resulted in an increase in cumulative pregnancy rates. In addition,
the implementation of a single-step culture protocol in the lab reduces cost of consumables
and media and time spent preparing dishes and performing embryo changeovers (moving
embryos into sequential medium)
3. Will there be any effect of metabolic waste accumulation during continuous culture for 5-6
days without any media change.
There are published reports of low levels of ammonium detected in spent culture media
following embryo culture in a continuous culture protocol. These levels, however, were
shown not to be detrimental to embryo development. The ammonium was primarily
contributed by the media components, not from embryonic waste.
Gilbert, R.S. P-197 Ferti Stert 2012
4. There are lots of debates happening in embryo mail news on open vs closed system
vitrification!! Why so vehement opposition on closed system? In reality what could be the
survival rate with such practice? And is there any critical factors need to be controlled?
The limiting factor of a closed system for vitrification is cost of the vitrification device and the
potential decrease in the cooling rate due to increase in the thermo-insulating layers
(thickness of the wall of the sample-holding container/carrier). The expected survival rates
depend greatly on what is being vitrified. Comparable survival rates have been reported for
blastocysts vitrified in either an open or closed system. There appears to be more of debate
as to which carrier is best for oocytes. In my laboratories, we use an open system for
oocytes and a closed system for blastocysts. By being consistent with exposure times to the
cryoprotectant along with speed for vitrification and warming are essential for good outcomes.
5. Automated vitrification systems are making its way into ART labs (at least in clinical trial
phase).do you think these are going to replace the conventional vitrification process?
Automated vitrification has the potential to eliminate variables introduced into the vitrification
procedure by the technician/embryologist performing the process. Cost of the automated
device will play a big role its use across laboratories. Vitrification itself is relatively cheap as
no expensive machines / freezers are required.
6. What is your experience with lyophilized culture media from Irvine scientific?
I have no experience with lyophilized culture media as I do not use it.
7. What is your opinion about freeze all and no fresh embryo transfer policies?
Some patients benefit from avoiding a fresh embryo transfer and freezing all embryos to be
used in a future frozen embryo transfer cycle. Patients who are at risk of OHSS may benefit
from delaying their embryo transfer and freezing all embryos. Robust vitrification protocols
now allow us to achieve nearly 100% survivability post warm and because of this, in
conjunction with optimising the window of endometrial receptivity, I feel that freeze all cycles
are beneficial to patients and may be routine in the near future.
8. Time lapse systems are becoming popular in many labs. What are the advantages and
disadvantages of each commercial systems,
By minimising the disruption of the embryo culture environment through reducing the need to
assess embryos by snap-shot morphological assessments, time-lapse technology, in
conjunction with an undisturbed environment, make an ideal approach to embryo culture.
Although a recent RCT shows a 10% increase in pregnancy success when embryos are
cultured using time-lapse compared to a standard incubator, more live-birth data is required to
determine whether this technology is truly beneficial. The obvious advantage of using a non-
invasive surveillance of embryo development is the wealth of data obtained through multiple
images taken over the course of days. This data can then be used to ‘fill-in-the gaps’ from
traditional daily snap-shot assessments.
9. What is your opinion on “comfort level of embryologists” in US and Newzealand labs? like
compulsory weekend rotations, 365 days works, no leave, over time forced working hours, no
incentives etc??
Although the workload can sometimes be demanding, I find that embryologist thoroughly
enjoy their jobs and the perks that come with maintaining consistent results. In the US and
NZ, embryologist do receive incentives (bonus) based on personal performance KPIs and the
overall success of the clinic. Although holiday and weekend roster coverage is usually
mandatory, embryologist tend to manage a good ‘work-life’ balance.
10. What are the major tasks being a scientific director?
As Scientific Director, I am responsible for introducing the latest in technologies and the
implementation of such in a safe and successful way. Being involved in the overall
operations of the laboratories, making judgment calls regarding embryo culture and
stimulation protocols are daily tasks in which I assume responsibility for. In addition, making
sure that all laboratories I oversee are compliant with government regulations and protocols
is also a duty of the Scientific Director.
11. Oocyte freezing is limited in practice. What is the major factors need attention for a better
survival?
See #4 above. In addition, a large volume of the initial Thawing solution is also required.