AN INT INTRODUCT CTION TO THE HE ART LA LABORATORY Carole Lawrence – Lab Director PCRM Edmonton
Obje jectiv ives Initial work up of couple – lab component 1 Infertility treatments that involve the lab 2 The IVF Laboratory 3 • What does it look like Embryos 4 • The gametes • how do we perform fertilization • The embryo • normal in-vitro growth • Testing the embryo • Vitrifying (freezing) the embryo 5 Safety and security 2 www.pacificfertility.ca
Androlo logy Laboratory ry 3 www.pacificfertility.ca
Se Semen ass ssessment Have a look at the semen sample There may be a male factor contributing to the infertility Current Reference Values – WHO 5 th Edition – Laboratory Manual for the examination of Human Semen - Sperm concentration > 15 million/mL - Motility > 40% - Morphology > 4% normal forms POCT – at home semen analysis kits are currently in development Advantages – removes the embarrassment factor and increase compliance to be tested Disadvantages – all methods to date are incomplete and still require laboratory analysis 4 www.pacificfertility.ca
Se Semen Analy lysis is Concentration and Motility Morphology 5 www.pacificfertility.ca
Accredit itatio ion Semen Analysis Accredited by: the Alberta College of Physicians Diagnostic Accreditation Program (DAP) 6 www.pacificfertility.ca
Addit itio ional l se servic ices – Androlo logy Lab Sperm Cryopreservation Cancer patient Gender transitioning patient Prior to fertility affecting medications Pre-vasectomy Pursuing ART treatment and travels frequently Sperm Washing for Intrauterine Inseminations (IUI) Maintain a bank of anonymous donor sperm ordered by patients 7 www.pacificfertility.ca
Lab in involv lved fert rtilit ility treatments 01 02 IUI with partner sperm IUI with donor sperm - Donor sperm sample thawed and - Semen sample washed by lab washed by lab - Success rates 10-12% per cycle with no - Success rates 20-25% per cycle obvious male factors - low invasiveness – low cost + cost - low invasiveness – low cost of donor sperm ($600-$800) 03 04 Conventional IVF IVF with ICSI - Cumulative pregnancy rate 70-75% per cycle - Very lab based treatment - Invasive and +++ cost 8 www.pacificfertility.ca
Sp Sperm rm preparatio ion for r IU IUI I and IV IVF Washing of semen sample by Density Gradient centrifugation 9 www.pacificfertility.ca
Su Surgic icall lly Retri rieved Sp Sperm 10 www.pacificfertility.ca
Embry ryolo logy Laboratory ry 11 www.pacificfertility.ca
Coll llectin ing the oocyt ytes 12 www.pacificfertility.ca
Conventio ional l IV IVF 13 www.pacificfertility.ca
ICS ICSI I Micr icromanip ipula latio ion Rig ig 14 www.pacificfertility.ca
ICS ICSI 15 www.pacificfertility.ca
Embry ryo develo lopment Good embryo development Poor embryo development 16 www.pacificfertility.ca
Embry ryo transfer to the patie ient 17 www.pacificfertility.ca
Preserv rvin ing the excess embry ryos 18 www.pacificfertility.ca
Embry ryo Bio iopsy for r Genetic ic Testin ing 19 www.pacificfertility.ca
Safety and Se Sa Securit ity All sperm preparations are double witnessed Storage Bank is monitored All oocyte and embryo with temperature probes movements are double and call out system witnessed All oocyte inseminations are double witnessed All incubators are alarmed and hooked to a call out system Lab environmental conditions are monitored by a call out system Labs are secure areas with limited access 20 www.pacificfertility.ca
Big iggest misc isconceptio ion The lab cannot make bad sperm and bad oocytes good and cannot turn bad sperm and bad oocytes into good embryos + ≠ 21 www.pacificfertility.ca
Th Thank you for r your r attentio ion! 22
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