In a word. Hard.
In two words. Very hard.
In three…okay, sorry, you get the point.
When I started in embryology I took the common path. And by that I mean there was no path and I kind of just fell into it.
My background is mostly in research. I worked on lung cancer and inflammation in mouse models for a few years. Then I worked with stem cells and made brains and hearts in a lab (kind of). I was a cell culturing master. So I figured I had this embryology thing beat!
And I did, in some ways.
Technique wise, it’s not so bad. If you’re familiar with a typical biology lab and following experimental protocols, it’s basically the same thing. Freezing embryos, thawing them, even doing some steps of an embryo biopsy all had the same kind of vibe to it from when I would extract DNA or do an ELISA. Just follow the steps and you’ll be fine.
What’s challenging is that you’re constantly moving around these incredibly small eggs or embryos from one place to another. In essence that’s what embryology is. You can only see them under the microscope so all the manipulation needs to be done under a microscope. When you’re not looking at them through a microscope you have to assume they’re in there. It can be kind of scary.
The real challenge with embryology is that you CAN’T EVER MAKE A MISTAKE. And that’s in capital, and bolded, for good reason.
If you make a mistake, it’s not “oh well, I’ll just repeat it again”. Nope. There is no “repeat it again”. These eggs or embryos are all there is. To “repeat it again” means another cycle, lots of money/time/emotions. It’s not something that is taken lightly.
You can be working with a patient’s last attempt at pregnancy and if you’re not totally focused you might make a mistake.
And that is the core of what makes this job stressful. That pressure is always there.
Every embryologist makes mistakes. We’re humans. I have made mistakes and I’m very ashamed of them. The kind of shame that lasts for months. You’ve failed the patient and your team. But mistakes happen, and you do your best to learn from them and not do it again. Every embryologist has gone through this. It’s part of the job but not in the job description!
Adding to this is a common problem in IVF labs. They can be very busy and staffing can be really tight.
On a typical day there’s a few tasks that need to be done.
The “fert checks” are done first thing. The point is to check for fertilization from the previous day but we’ll also look at all the other dishes too. Embryos grow between 1 and 7 days, and on certain days we need to change the culture media, take pictures, freeze embryos that are eligible, biopsy embryos, and so on. All in all this can take one person 4 or so hours.
Embryos are thawed in the morning. This is for the patients who want to transfer their frozen embryos. Frozen embryos are placed in “warming solutions” and then put into a dish until the transfer. Each thaw takes about 30 minutes. On bad days you can have double digit thaws.
Egg retrievals are when the patient’s follicles are drained and this fluid is searched for eggs. You don’t know what you’re going to get. Maybe you’ll get 1 egg, or 6, or 85 (yes, really).
As they’re aspirating the fluid from the follicles, you’re searching for eggs. Once you’ve found them all you need to trim off the excess cumulus cells that surround the egg. A case of 10 eggs will take about 20 minutes. A case with 80 eggs will take an hour at least.
You need to be done and ready every 30 minutes for the next case. The doctor needs to keep going because everyone triggered at a certain time. The most retrievals I’ve done in a day is 16 (from 8 am to 4 pm).
Embryo transfers start in the morning and involve loading the embryo(s) into a catheter and the doctor will transfer the embryo into the uterus. Some are difficult and can take a good 30 minutes to do. But usually about 15 minutes per transfer. They do these in between the retrievals. The most transfers I’ve done in a day is 14.
Embryo biopsies are fun but very time consuming. Some patients do PGS testing on their embryos to see if they’re chromosomally normal and these might have a higher chance at implanting. It starts with taking a biopsy of an advanced stage embryo and loading this sample into a tube which is then sent to a testing lab. It can take about 20 minutes per embryo. So a case with 8 embryos will take at least 2 hours.
ICSI is where the eggs that were collected during the retrieval are injected with sperm. This involves putting the eggs into a dish and using a micromanipulator to inject the eggs. It’s kind of like a video game (there’s joysticks too!).
Easy cases with <5 eggs can be done in about 10 minutes. When there’s 20 or more it can take 20-30 minutes. When there’s 80, or the sperm is very hard to work with, I hope you brought a pillow for your butt because it’s going to start hurting after an hour. With some testicular biopsy samples we would search for sperm for 3 hours before calling it quits. Crazy times!
Embryo freezing involves taking an embryo and passing it through several different solutions so it isn’t damaged by the cold temperatures in storage. As you get more experienced you can bundle them and do a few at once but you’re still looking at around 20 minutes for about 5 embryos. The most I had was something like 50 embryos between 10 or so patients. Eggs are frozen in a similar way.
Prep for the next day
Then there’s prepping for the next day by getting the culture dishes ready. You need to look at the schedule and see who needs what kind of dish (a egg retrieval will get one set of dishes, a transfer will get another set, embryos on Day 5 will get a new dish, etc.). Then you prepare the culture media, label the incubators, and fill the plates with the media. This can take 1-2 hours.
We would also do QC on our equipment everyday to make sure everything was working okay. Embryo/egg shipments was another thing. Phone calls to people who needed to discuss things. Scheduling and making sure all the consents were in place.
Yeah, it got pretty crazy!
You would rely on each other to get through the day. Sometimes we were understaffed (correction: IVF labs are always understaffed, but when someone’s sick, or has an appointment, it can really suck). Some days I’d come home and just disappear. I couldn’t even talk to my wife. I just needed to come down from the rollercoaster that was my day.
Some days were really bad and I’d just find some place to park my car and cry for a bit. It was cathartic. I literally have nightmares to this day.
But I’m not an embryologist anymore. And I’m not sure I would be in all honesty.
There were great parts to the job. I loved interacting with the patients. There was a lot of joy in seeing the regulars finally get a positive. Making embryos and seeing that first cell divide can be pretty awe inspiring. We all started out like that and your embryologist can witness the very beginning.
But it’s hard. Very hard. It’s…You just need to be a special kind of human to do it.