IVF Laboratory Technology – Module 1 Lecture 1 Notes

Course Overview

  • IVF Laboratory Technology – Summer 202430, course code RCS701, Week 1, Module 1, Lecture 1 (Introduction)
  • Hosted by the Macon & Joan Brock Virginia Health Sciences Center at Old Dominion University
  • Instructor: Jacob Shuman

Lecture Objectives

  • Clarify expectations of the course
  • Explain how the Skills Course is organized
  • Identify the interdisciplinary roles that comprise an IVF facility
  • Outline the basic workflow of the embryology laboratory

Skills Development & Assessment

  • Goal: Provide opportunities to develop and certify laboratory skills
  • Certification levels
    • Expert
    • Intermediate
    • Novice
  • By course end, each student will
    • Acquire basic, intermediate, or advanced competencies (based on starting level)
    • Undergo assessment; skill level will be certified accordingly
  • Each hands-on lab graded (20 points each) on
    • Knowledge of the technique
    • Demonstrated ability to learn/perform
    • Certified level observed during residential program

Course Structure (Online + Residential)

  • Online component supports July face-to-face session
  • Weekly focus on distinct laboratory techniques
    • Andrology: Semen Analysis, Sperm Preparation
    • Embryology 101: Microscopy, manipulation of oocytes/embryos, embryo culture, media & QC ( pH, Temperature, Osmolality )
    • Oocyte & Embryo Morphology
    • Time-lapse Imaging
    • ICSI (Intracytoplasmic Sperm Injection)
    • Assisted Hatching (AH)
    • Embryo Biopsy
    • Vitrification of oocytes & embryos
  • Weekly activities
    • Lectures, assigned readings, discussion boards
    • Some weeks include non-graded self-assessment quizzes
  • Assessment timeline
    • Exam 1 (Week 5, end Module I) – 45 pts
    • Exam 2 (Week 9, pre-residential, over Module II) – 45 pts
    • Mock proficiency exam (Week 11, during residential)
    • Cumulative Final (Week 12) – 50 pts
    • Exam format: multiple-choice, true/false, short-answer essay (delivered via ExamSoft/Examplify)

Required & Supplemental Resources

  • Core Text: “Textbook of Assisted Reproductive Techniques, Vol 1: Laboratory Perspectives,” 5th ed. (Gardner et al., 2018) – PDF provided
  • EVMS RCS Lab Manual sections (PDFs)
  • Supplemental readings (PDFs) & web links will be posted per topic

Discussion Boards (Both Online Modules)

  • Two deadlines per discussion
    • Primary post: Saturday of the start week
    • Secondary responses: Monday of the same week (exception: first discussion due Sunday, May 16)
  • Topics
    • Course Expectations & Syllabus Review
    • Culture Discussion
    • Time-Lapse Imaging
    • Embryos
    • Genetics

The IVF Team – Inter-professional Roles

  • Physicians (diagnosis, treatment planning)
  • Nurse Coordinator & Nurses
  • Secretaries / Support Staff
  • Andrology Laboratory (semen analysis & preparation)
  • Endocrine Laboratory (baseline hormone assays)
  • Embryology Laboratory (gamete handling, fertilization, culture, evaluation)
  • Pre-Genetic Diagnosis/Research units (as applicable)

Diagnosis & Treatment Pathway

  • Physician diagnoses infertility → determines protocol based on
    • Patient history
    • Andrology lab results
    • Endocrine lab hormone baselines
    • Prior embryology outcomes
  • Labs provide data guiding medication dosing, stimulation length, and procedural timing

Typical IVF Laboratory Workflow (Chronological)

  1. Final oocyte maturation & hCG trigger (≈35 h pre-retrieval)
  2. Day 0 – Transvaginal ultrasound-guided oocyte retrieval
  3. Day 0 – Semen collection & assessment (count & motility)
  4. Day 0 – Insemination
    • Conventional IVF (co-incubation)
    • ICSI (direct sperm injection)
    • Option: cryopreserve unfertilized oocytes via vitrification if not inseminated
  5. Day 1 – Fertilization check (~16–19 h post-insemination)
    • Normal: 2PN (two pronuclei)
  6. Days 1–6 – Embryo culture & morphological assessment
    • Balance incubator stability vs. observation frequency
    • Time-lapse systems reduce handling
  7. Transfer (Day 1–6) – embryo returned to patient
    • IVF → uterus; alternatives: GIFT, ZIFT, TET (site & stage vary)
  8. Luteal support (progesterone) ➔ Pregnancy test
  9. Documentation, cleanup, restock; cycle repeats for next patient

Day 0 Details – Oocyte Retrieval

  • Procedure: Transvaginal probe + needle aspirates follicular fluid
  • Embryologist searches fluid for cumulus-oocyte complexes (COCs)
  • Oocyte maturity spectrum
    • Germinal Vesicle (GV) – immature
    • Metaphase II with polar body (PB) – mature
    • Intermediate
    • Atretic (degenerating)

Day 0 – Sperm Collection & Analysis

  • Parameters recorded
    • Concentration (million/mL)
    • Motility (%)
  • Determines insemination method (IVF vs. ICSI)

Day 0 – Insemination & Backup Cryopreservation

  • Co-incubation (standard) or microinjection (ICSI)
  • If insemination delayed, vitrification of oocytes possible
    • Vitrification = ultra-rapid cooling → glass-like solid without ice crystals
    • Stored in liquid nitrogen dewars (≤ -196\,^\circ\mathrm{C}) for decades

Day 1 – Fertilization Assessment

  • Confirmation of normal fertilization marked by 2PN and two polar bodies
  • Properly fertilized zygotes moved to ongoing culture media

Embryo Culture (Days 1–6)

  • Expected stages
    • Day 1: 1-cell (zygote)
    • Day 2: 2–4-cell
    • Day 3: ≈8-cell
    • Day 5–6: Blastocyst (may be hatching)
  • Morphology scoring considers
    • Blastomere number & symmetry
    • Degree of cytoplasmic fragmentation
  • Time-lapse imaging advantages
    • Continuous monitoring without incubator disturbance
    • Rich morphokinetic data for embryo selection

Embryo Transfer & Adjunct Techniques

  • Transfer timing individualized (Day 1–6)
  • Assisted Hatching (AH)
    • Zona pellucida opening prior to transfer to facilitate hatching/implantation
    • Also prerequisite for embryo biopsy (PGT-A/PGT-M)
  • Embryo biopsy
    • Trophectoderm (blastocyst stage) or cleavage-stage cell removal for genetic testing

Cryopreservation of Supernumerary Embryos

  • Usable-quality embryos not transferred are vitrified at any stage (zygote → blastocyst)
  • Cryoprotectant chemistry
    • Permeating alcohols (e.g., DMSO, ethylene glycol) protect internal structures
    • Non-permeating sugars (e.g., sucrose, trehalose) act as osmoprotectants/dehydrating agents

Ethical, Practical, & Real-World Considerations

  • Long-term storage raises questions of consent, disposition, and cost
  • Skill certification ensures patient safety and lab accreditation compliance (e.g., CAP, CLIA, ASRM, CDC)
  • Time-lapse and biopsy technologies push precision but introduce cost and data management challenges

Review & Communication

  • After lab tasks: replenish supplies, sterilize equipment, complete paperwork
  • Continuous cycle management demands preparedness for subsequent patients
  • Students encouraged to email instructors with questions for clarification

End of Lecture 1 – Key Takeaways

  • Mastery of IVF lab workflow underpins clinical success
  • Multidisciplinary collaboration is essential
  • Course integrates theory, hands-on skills, and formal assessment to develop competent embryologists