A failed icsi trial, who is responsible

1. A Failed ICSI Trial
Who is responsible ??
Patient ?? Clinician ?? Lab.??
By : Dr. Mohammed Walaa El Deeb
Medical Director of the Integrated
Fertility Center

2. Patient??
 Time of medication .
 How to use recent gonadotropen (pen).
 Behavior after Embryo transfer.

3. Clinician??
• Select the suitable protocol according to :
Age PCO Repeated Failure
• Don’t do OPU too early or too late.
• E.T with moke and U/S guide.

4. • Decrease cervical manipulation as much as
possible.
• Method of E.T ( Don’t push the plunger)
once but multiple push.
• Good luteul support.

7. Lab??
• Timing for identifying of oocytes retrieved .
• Handling of the dishes.
• Timing for denodation.
• Injection ( sub zonal ).
• Evaluation of the embryos.
• E.T ( loading of the embryos.
• Temperature of the lab. (24-28 )
• Humidity.
• Incubator ( ‫مراجعة‬ calibration )

9. • Oocyte pick up : long exposure of oocyte.

10. • Injection : - inexperienced embryologist.

11. • Injection : - Bad selection of sperm.

12. •Embryo transfer : if embryos are not
transferred immediately or long exposure.

13. •Heating surface are not working.

14. •Any malfunction in the microscope.

15. • It is very important to maintain the cleanliness
of the IVF laboratory:
• Washing hands with odor free soap before any
manipulation.
• Only personnel working in the Lab are allowed to
enter the lab.
• Proper clothing (scrubs), and clean crocs that are
used only inside the lab.
• Laminar flow units for cleanliness of the air.
• Coda tower (air purifier)

17. • Quality control in the IVF Laboratory:
• Indirect light, yellow NOT white
• Maintain proper temperature of the surfaces (37 degrees)
• Measuring of the incubators daily, the CO2 and
temperature.
• Measuring PH of the culture media
• Working in laminar flow units
• Cleaning of all surfaces in the lab daily by a non-toxic
odorless disinfectant.
• Cleaning of the incubators by a non-toxic odorless
disinfectant.

18. • Quality control in the IVF Laboratory (cont.)
• Do not use alcohol for cleaning. It is TOXIC.
• Ensuring Hepa filter is working properly by testing
the density of particles in the air.
• All media is kept in a refrigerator which is regularly
cleaned and its temperature maintained.
• Documentation of batch number of media and stock
numbers so that no shortage of media occurs
• Proper hand washing by all personnel before
handling of gametes.
• Gloves should be worn during preparing dishes and
handling of culture media.
• Proper filing system and labeling of gametes of
patients.

19. • Jobs in the IVF laboratory:
• Semen:
• Semen processing for IUI
• Semen processing for ICSI
• Semen analysis
• Sperm freezing
• Oocytes:
• Oocyte pick up
• Oocyte denudation
• Injection (ICSI)
• Embryos:
• Embryo grading
• Embryo transfer
• Embryo freezing

20. • Jobs in the IVF laboratory ( cont.)
• QC jobs:
• Cleaning of surfaces (daily), incubators (once per
month).
• Measuring of levels of liquid nitrogen in freezing
tanks.
• Monitoring when to change the filters of air
purifiers in the lab,
• measuring of co2 and temperature in incubators.

21. • Evaluation of results:
• Fertilization rate
• Embryo quality
• Pregnancy rate
• Multiple pregnancy rates
• Implantation rates
• Survival rate for frozen embryos