Optimising embryo biopsy using a laser

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Presentation given by Maxine Semple, Senior Embryologist HPC, Biopsy Practitioner, Guy's and St Thomas' Hospital, ACU titled Optimising embryo biopsy using a laser. Comparison of methods

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Optimising embryo biopsy using a laser

  1. 1. Optimising Embryo Biopsy using the Saturn 5 Laser System Ms Max Semple Senior Embryologist HPC, Biopsy Practitioner Guy’s & St. Thomas Hospital, ACU
  2. 2. Current Practice • D3 biopsy (cleavage stages): Acid Biopsy/ Laser • D5/6 biopsy (Blastocysts): Laser • Predominately the practioners are acid users, but training in laser now
  3. 3. Video of Acid D3 Biopsy
  4. 4. Video of laser D3 Biopsy
  5. 5. Big Brother Watching Embryoscope is used for ALL PGD cases. “Time lapse system can monitor any effects (if any) on embryos biopsied via Laser or acid and practioners”
  6. 6. Advances in PGD programme • Guy’s shifting towards TE Bx • Laser replacing acid tyrodes • Invested in the new Saturn 5 laser system • Hands free, programmable system
  7. 7. RI Saturn (3) laser system • Manual calibration and alignment challenging • Move embryo into target position physically • Laser using single shots via mouse/foot pedal • Difficult to keep steady
  8. 8. • Calibration is quicker and simpler • Automatic alignment using PC (simple user-friendly programme) • Move the target into position for biopsy • Mouse delivers pulse • Multiple functions for biopsy – Single, multiple or biopsy mode • Easier to manipulate embryo RI Saturn (5) laser system
  9. 9. Video of Laser D5 Biopsy
  10. 10. Comparing laser with acid Effect on embryo/biopsy Acid tyrodes Laser Culture media use More Less Microneedle use More Less Microtool holder Double optimal Single sufficient Biopsy duration Longer Shorter Chemical damage Acid/pH effects None Thermal damage None Precautions to minimise the effect Precision Calibration and QC Low Difficult High Simple
  11. 11. Embryo Biopsy by Laser D5 Biopsy (Trophectoderm) D3 Biopsy Laser Ablation Hatching BC D3 Cleavage TE Bx BC Hatched BC Post TE Bx Hatching BC Hatched BC Single Cell Bx
  12. 12. QC • Trophectoderm cells can be thermally damaged and may not provide results (DNA damage). • Laser is powerful and potentially embryo lethal. Proper training and competency assessments need to be in place (Guy’s data) • Calibration and preventative maintenance • EQAS – individual practitioners to send ‘typical’ biopsy videos for external assessment. • Time-lapse analysis of all PGD cases to monitor any effects of biopsy (ongoing)
  13. 13. Cost of Change • Laser is a significant financial investment • Previously centres use to make their own acid, now commercially available • PGD consortium data (shift from acid to laser) • Long term picture – cost of laser offset against – Reduced procedure times – Reduced consumable costs – Improved outcomes?

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