In case you read FertilityIQ’s recent article, “How to Vet Your Fertility Clinic’s Lab,” we thought you’d like to know a little more about the IVF lab at Carolina Conceptions. Our Head Embryologist, Dr. Sung Tae Kim, has provided us with insight into the questions raised by FertilityIQ:
Question #1: An experienced lab does at least 200 IVF cycles/year – where does CC stand?
Answer: Cycle volume per year is not always related to the success rate. It could also be related to the lab personnel’s quality. Labs should have the appropriate number of qualified embryologists and andrologists. At CC, we have 4 embryologists, 1 andrologist, and completed 467 egg retrievals in 2016.
Question #2: Are the embryologists completing the “delicate procedures” of ICSI and PGS biopsy “skilled” and all have the appropriate practice and training?
Answer #2: These delicate procedures are referred to as micromanipulation (ICSI and PGS). The success rates of these procedures are also related to lab personnel. The embryologists at CC are all quite skilled with over 10 years of experience.
Question #3: Ensure your clinic has an ICSI fertilization rate of 70% or higher.
Answer #3: The fertilization rate of 70% should be considered a minimum level. At Carolina Conceptions, our fertilization rate is much higher. If fertilization rates fall below 70%, this can sometimes be related to low egg or sperm quality.
Question #4: “Ask the hard questions about incubators. If incubators are kept in 20% oxygen, that is a bad sign. Embryos should be cultivated in 5% oxygen.”
Answer #4: Carolina Conceptions uses low oxygen (5%) incubators.
Question #5: How good is your lab at growing embryos to the transfer or “blastocyst stage” (approximately 5-6 days post fertilization)? Incredibly difficult to do.
Answer #5: Blastocyst formation rate is also variable but average is about 45-50%. The main purpose of watching embryo growth through day 5 is to select the best quality embryo for transfer. If a patient has only one embryo, there is no reason to culture to day 5 except unless the patient is completing an embryo biopsy.
Question #6: Is the lab over or understaffed? Is the staff working 7 days a week, around your schedule or their convenience?
Answer #6: Carolina Conceptions is open 7 days a week (by appointment only on the weekends) and follows the schedule of a patient’s readiness for cycle procedures, not the convenience of their physicians. We have 4 embryologists and 1 andrologist, reasonable and stable for our clinic size.
Question #7: What is the clinic’s “Disaster Recovery Plan?” (If there was a natural disaster or significant power outtage, etc.)
Answer #7: We have generator for back-up electricity. We have an alarm system monitoring safe levels of liquid nitrogen, temperature, and gas levels of incubators 24/7.
Question #8: When consulting SART and the CDC to compare success rates of clinics, focus on the number of embryos a lab is transferring per cycle and the success rates of the clinic’s fresh cycles using donor eggs (because donor eggs are “theoretically comparable in quality across clinics”).
Answer #8: The data for Carolina Conceptions is listed with SART, the CDC, and on our website. Our policy is to transfer one embryo per cycle in women younger than 38 years old and for those using donor eggs regardless of patient age during a patient’s first IVF attempt. Failed cycles are taken into consideration and may provide a reason to transfer and additional l embryo during subsequent cycles.
Dr. Kim shared, “The MOST important number to see how an IVF lab is doing is to concentrate on egg donor cycles resulting in live birth. Non-donor patient cycles are very variable; different egg quality, age etc. But, egg donor cycles can be the standard for IVF procedure and lab quality because donor egg quality might be good and verified through cycles (so less variation for egg quality-important for fertilization rate and blastocyst formation rate). In 2015, CC was the biggest IVF clinic for fresh egg donor cycles in NC and 2nd best IVF clinic in NC for egg donation using fresh embryos (http://fertilitysuccessrates.com/report/North-Carolina/egg-donation/data.html). CC is also ranked in the top 3 clinics of NC in all age categories for 2015 fresh cycles.
[Just a reminder, 2015 data may seem “old” to be referring to- but since a pregnancy takes 9 months to determine if a live birth occurred, and also needs to be reported by the baby’s parents to their IVF lab, live birth data is usually over a year behind the present date. This is standard for all clinics -as you will see if you research rates from the CDC or on SART.]