How to establish an ivf center

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There are many IVF centers over the globe, but itis time to make criteria, standards and parameters for establishing an IVF center. This talk may help in this

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How to establish an ivf center

  1. 1. How to Establish a successful IVF Center
  2. 2. How to Define success! Maintain performance Grow flow Expand
  3. 3. IVF Center IVF Laboratory Viable embryos Clinical team Ob/Gyn -Ovulation induction - Monitoring - Ovum pick-upClinical team Ob/Gyn
  4. 4. How to Establish! • KnowHow Available or not • Budget (small vs large) • Team (one man show vs group) • District : central vs periphary • Target : Upper class vs middle class • Aim : finance / prestigue / adjuvant service
  5. 5. Site selection Inside a hospital: UNIT - To benefit from the infrastructure of : • Electric generator • Laundry facilities • Sterilization facilities
  6. 6. Specialised Center • Independent • Focused • Fame : rapid and easy • Much more risk taking • High running costs
  7. 7. Design - Enough space to allow equipment installation and free movement of personnel - Enough space to allow for expansion - allow enough time after construction before installing equipments and use.
  8. 8. So How to make ur decision? • Usually circumstances drive ur decision • But none of the previous factors will make it succeeds : they will help u for the setup • For success: it is all about Personnel
  9. 9. Establishing An IVF Center 1- Training of personnel. 2- Equipment selection.
  10. 10. Training of personnel I. Training the IVF laboratory practitioners • Minimum of one year (hands on) work II. Training of the IVF clinical team • Gynecologists working in infertility • Three months (hands on) work
  11. 11. Strict System • From the start • Applied to all (no exception) • Be ready for turn over • Do not forget training of nurses and workers (infertility is a special entity)
  12. 12. Essential Equipments I- Microscopes 1- ordinary light microscopes 2- sterio microscopes (inside a laminar flow) II- CO2 incubators (number & type)
  13. 13. Other equipments in the IVF lab III- centrifuges IV- refrigerators V- media preparation (H2O purification – ph meter – osmometer - balance)
  14. 14. IVF Laboratory should be backed by: 1. Cryopreservation facilities 2. Micromanipulation equipments
  15. 15. Clean Room •HEPA filters •Positive pressure •Stainless steel furniture, smooth, non-porous walls •Constant temperature •Constant UPS
  16. 16. Again this is a setup • What about success? • How to maintain it?
  17. 17. Quality Control & Quality Assurance
  18. 18. What is Quality Control (QC)? QC involves all measures undertaken to control the quality of: products equipment protocols environment to insure that the IVF Laboratory is functioning correctly
  19. 19. What is Quality Assurance (QA)? QA is a comprehensive program QC Measures of : - Equipment - Protocols - Environment - Products Results reporting Record keeping Treatment auditing and incident reporting Education of laboratory staff
  20. 20. Benefits of Employing QC & QA - Maintain the optimal laboratory performance - Detect problems before they become significant. - Evaluating personnel performance and motivating staff.
  21. 21. Micro droplet – Oil Overlay VOC’s Filtration Oil Issues Plastic Ware MediapH Temperature
  22. 22. QC Program routine monitoring 1) Equipment 2) Culture media and consumables 3) The environment 4) Protocols initial validation +
  23. 23. Equipment validation - Installed by the manufacturer - Switched on and monitored for a sufficient time to identify problems before use in clinical treatment
  24. 24. Quality Control Measures Range ± accuracy MethodFrequencyTestEquipment ± 0.5% -10 to + 50 ± 0.5ºC 0.03 EU/mL -10 to +50 ±1 ºC - 10 to + 50 ± 1 ºC Fyrite Thermometer Sperm survival assay Limulus amoebocyte test Thermometer Thermometer 3 / week Daily as required Weekly Daily Monthly CO2% Temperature Environment Endotoxin Temperature Temperature Incubator Water System Refrigerator Heated stages
  25. 25. Company-manufactured media: - QC testing of all new batches of culture media is important because of transport, and incorrect storage conditions.
  26. 26. Air pollutants Volatile organic compounds (VOCs) and chemical airborne contaminants (CACs) can significantly affect culture conditions
  27. 27. Prevention of VOCs - Consideration should be given to the site and location of the laboratories - The use of air purification units - Positive pressure airflow - Sealants, toxic glues, paint, should be avoided
  28. 28. Cleaning - Routine cleaning after every procedure during work. - Daily cleaning after work (microscopes – all surfaces – laminar flows) - Weekly cleaning Incubators - laminar flows
  29. 29. Assessment of Follicular Stimulation  Length of stimulation A. E2 level B. No. of mature oocytes C. Dosage (Type?) of gonadotrophin  Oocyte response during ICSI A. post-retrieval 1. Immediate 2. Fertilisation rate
  30. 30. What is Quality Assurance (QA)? QA is a comprehensive program QC Measures of : - Equipment - Protocols - Environment - Products Results reporting Record keeping Treatment auditing and incident reporting Education of laboratory staff
  31. 31. Keeping Records and Documentation Accurate documentation and record keeping of all aspects of the scheme is fundamental to the success of an QA program
  32. 32. Paper Work Design - Detailed information - Easy information retrieval - Security of the documents
  33. 33. Monitoring laboratory performance - Auditing fertilization and embryo cleavage rates and embryo quality - Auditing pregnancy rate, implantation rate, and birth rate.
  34. 34. Appraisal of Performance Staff evaluation Equipments evaluation
  35. 35. How to Estimate Success? • Money gain • Pregnancy rate • Growth rate
  36. 36. If it is money? • What is the acceptable percent of profit 20% 40% 50% 100% • How to reduce running costs !! • Yearly vs monthly order !!
  37. 37. How to Maximize Profit? • Cafeteria : ? Location • Auxulliary services: Lab ?? Pharmacy
  38. 38. Good Egg
  39. 39. Bad Egg
  40. 40. Fertilization •2 Pronuclei (2PN) •1 day after egg retrieval
  41. 41. Day 3 Embryo
  42. 42. Day 3 Embryo
  43. 43. Day 3 Embryo
  44. 44. Day 3 Embryo
  45. 45. Hatching Blastocyst
  46. 46. Embryo Transfer
  47. 47. Embryo Transfer

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