The document discusses the management of errors that can occur during the IVF process, categorizing them into clinical, administrative, and embryo lab errors. It outlines strategies to avoid such errors, including proper staffing, training, and procedural protocols, as well as the importance of transparency and disclosure to patients about any incidents. Grading of errors is provided to assess their impact on treatment cycles, emphasizing the need for a culture of truth-telling in medical practice.

1. Errors in IVF : How To
manage?

2. Outline
• Introduction
• Incidence
• Causes of IVF errors
• Grading
• How to Avoid
• Clinical errors
• Disclosure to patients

3. Introduction
• The aim of this talk is to discuss the unintended errors
that may occur during the IVF procedure
•Ricardo Asch

4. Incidence
• ART errors are fortunately a rare occurrence
• But mistakes are inevitable
(Mark P. Trolice et al., 2020)

5. Causes of IVF errors
• 1. Clinical
• 2. Administrative
• 3. Embryo Lab
(HFEA, State of the fertility sector 2019/2020)

6. Causes of IVF errors
1- Clinical
• Andrology
Semen Analysis
associated ID

7. Infertility Specialist
• Sub-optimal stimulation protocols
• Variation in skills for ovum-pick-up / Embryo Transfer
(HFEA, State of the fertility sector 2019/2020)

8. Hospitalisation
• major vessel injury (internal iliac).
• Patients starting a treatment cycle before all of their screening
results were reviewed (hepatic & anaethesia)
• Severe OHSS
(HFEA, State of the fertility sector 2019/2020)

9. As of the fertility sector 2017-2018
2- Administrative ( most common)
• Usually data protection breaches
• Overbooking , negligence, dis coordination

10. Also
• communication skills among team members.
• Daily organization, distribution, and easy visualization of
laboratory tasks.
(Maria and Amparo, 2013)

11. 3- Embryo Lab
• All procedures related to frozen embryo and egg storage.
• PGS/D including sex selection.
• Equipment failures / calibration.
• Accidents / Mix-ups.
• Power failure.

12. Human
• heavy clinical workload and distraction.
• Sakkas et al. reported error rates were significantly low where 99.9% of
procedures proceeded with no errors.
(Sakkas et al., 2018)

13. Outline
• Introduction
• Incidence
• Causes of IVF errors
• Grading
• How to Avoid
• Clinical errors
• Disclosure to patients

14. Grading
None/Minimal
Error or problem occurred, but fully correctable or
no measurable effect
Moderate
Serious error which affects a cycle, but cycle not lost
(Sakkas et al., 2014)

15. Significant
Significant compromise or loss of cycle
Major
A pregnancy or birth confirmed to have arisen from a misidentification
of gametes or embryos
(Sakkas et al., 2014)

16. How to avoid?
• Strict system
• Avoiding situations that can lead to errors
such as insufficient staffing and insufficient training.
• Avoiding the manipulation of more than one sample at
Once and shared working spaces.
(Maria and Amparo, 2013)

17. General rule
• Guidelines suggest that safe and efficient ART laboratory operation
requires one embryologist for every 150 ART cycles per year.
(Practice Committee of the ASRM, 2008)

18. Assess
• ratio of senior to junior embryologists to determine
appropriate staffing.
•1:2
(Alikani et al., 2014)

19. Cryo embryos & semen
• Some tank alert systems feature a scale underneath each tank to
monitor the liquid nitrogen.
(Mark P. Trolice et al., 2020)

20. Regarding clinical errors
• Ensure that staff are suitably trained to carry out egg collection.
• Supervision
• Have a protocol for the management of patients at risk of OHSS
(HFEA Adverse incidents in fertility clinics 2010-2012)

21. OHSS free clinic
• Lower human chorionic gonadotrophin dose
• Gonadotrophin-releasing hormone agonist in antagonist cycles
• Cryopreservation of all embryos
• Use of oral dopamine agonists after oocyte retrieval.
( El Tokhy et al, 2016)

22. Procedures for identification
• Manual double witnessing
• Electronic witnessing
– Matcher – bar codes
– RI Witness – RFID (Radiofrequency identification)
(Brison D, et al., 2004)

23. IMT International
Matcher

24. In addition
• reduce patient concerns.
• electronic tracing each procedure and the time it was
performed.
(Maria and Amparo, 2013)

25. Multichamber Incubators

26. Outline
• Introduction
• Incidence
• Causes of IVF errors
• Grading
• How to Avoid
• Clinical errors
• Disclosure to patients

27. If happened : Disclosure to patients

28. “Culture of truth-telling”
• People will trust you more if you told them the hard to say/hard to
hear things that everyone else was avoiding.

29. Disclosure: 2016 ASRM Ethics Committee Report
Ethical obligation
• • Errors that affect the number or quality of embryos should be disclosed
• • Obligatory to disclose errors where gametes or embryos are switched
• • Promote culture of truth-telling

30. Catastrophe