IVF Nightmares

One of the benefits of working as a Reproductive Endocrinologist is that most patients end up with the outcome that they desired: a family. It may be accomplished with their own eggs and sperm, or donor eggs/sperm, or donor embryo or adoption or foster parenting or even on their own (GASP!). However, when a disaster occurs you can be sure that it will make all the papers and talk shows. By disasters I mean the usual parade of newsworthy events such as Octomom, lost embryos or transfer of the wrong embryos into the wrong patient.

There is no doubt that these events are too be avoided at all costs. The parents, the children, the doctors and the staff all wish to avoid this type of outcome. Octomom is the easiest to avoid. You simply follow reasonable guidelines when deciding how many embryos to transfer. There are very few individuals who believe that ET of 6 blastocysts into a single mother of six who is under 30 years old is a good idea. Case closed.

But what about the most recent IVF problems to hit the news that involve a different set of issues? There are few happy endings when the wrong embryo is transferred or cryopreserved embryos are lost or destroyed. But believe me, no doctor wants to find out after the fact that such an event has occurred. There is a level of trust that exists between RE and embryologist and when communication breaks down that is when mistakes can occur.

Working with eggs, sperm and embryos can be very stressful as there is so much riding on each treatment cycle. As a Fellow in REI, I would work weekends at the Kaiser clinic doing sonograms and IUIs. I was responsible for the whole 9 yards....prepping the sperm, doing the sonograms, doing the IUI etc. I was absolutely crazed about keeping the sperm samples separate. I labelled every tube and syringe to ensure that Mr. Johnson's sperm did not go on a little adventure into Mr. Chen's sample...and vice versa. When in doubt, I threw out the pipette and started again. You have to be meticulous or else a disaster could strike. At that time in my medical training, emergency C-sections were a piece of cake to me but keeping tabs on those sperm samples was a lot more stressful. These days neither really fazes me as I have tought one teenager how to drive so I pretty much feel that I can handle almost any stress!

So I asked our Chief Embryologist Awie Botes who has been working in Reproductive Physiology and IVF for over 30 years to give me a Top Ten list of how the laboratory staff here at Dominion (or anywhere really) ensure IVF nightmares do not come to pass.

1. Check identification of the patient
2. Never work with more than one sample at a time...one lab member per case
3. Use triple identification system for all eggs, sperm and embryos: color code, name code, number code
4. Personally identify patient for egg retrieval and embryo transfer (in case schedule has changed)
5. Team approach to fertilization as 2 members of lab team must concur before sperm and eggs are combined
6. Team approach to thawing of embryos so again 2 lab team members confirm plan to thaw embryos
7. Confirm with RE as ET transfer catheter is passed off
8. Management plan reviewed with RE in advance of treatment
9. Confirm treatment plan at time of egg collection
10. Adequate staffing to ensure a well rested team without fatigue!

Awie wanted to add providing all lab staff with new cars and a trip to Bermuda to ensure a happy lab crew....well 10/11 isn't too bad.