Podcast Review: SART Fertility Experts – Behind the scenes in the IVF lab

Speaking as someone who is firmly a layman regarding IVF clinics and their inner workings, I was interested to learn about how the labs of IVF clinics operate. This topic was recently the subject of a SART Fertility Experts podcast episode entitled 'Behind the Scenes in the IVF Lab' and featuring an IVF lab director in the USA.

I found the interview of Dr Sangita Jindal, an associate professor and laboratory director at Montefiore's Institute for Reproductive Medicine and Health, New York, by Dr Kelly Lynch to be very interesting and easy-to-follow. Dr Jindal spoke using colloquial language, which would seem to be particularly aimed at potential IVF clients. She lifted the lid on a range of issues predominantly concerning US IVF clinics, such as the labs' COVID restrictions, hierarchy, cryotechnology and lab accreditations.

Dr Jindal was first asked by Dr Lynch to explain what clients should look for when selecting an IVF clinic and what separated good labs from great labs. Dr Jindal focused on the personal qualities of the lab set-up, including the communication between the clinicians and lab staff followed by outlining the structure of clinic's labs. She elaborated that labs feature well-trained staff, usually headed by a director who would possess a medical or academic doctorate, overseeing many lab technicians who each had a science-based bachelor's degree. I was a little shocked to hear Dr Jindal refer to each of the lab technician's roles as a 'calling' which was a bit overdramatic for my taste. This sort of description is better used to describe front-line service personnel or charity workers, in my opinion.

Furthermore, throughout the interview reference was often made to lab protocol, which included an in-depth discussion on how fertility clinic labs have dealt with COVID-19, as well as the installation of witness systems to verify that the stages of IVF are carried out meticulously and correctly.

I was a little disappointed that Dr Jindal mentioned a semi-automatic artificial intelligence (AI) witness system used by many labs, but did not choose to elaborate, given the growing presence of AI within our society. However, I did admire Dr Jindal's very honest assessment of the system's capabilities, stating that it was 'not foolproof' but nevertheless more than adequate for its application.

Throughout the podcast I was really able to gauge the human side of IVF clinicians, as portrayed by Dr Jindal's passion to do right by her patients, experiencing their emotions alongside them. This was no clearer than in the regret in her voice when she lamented not being able to speak with her patients face-to-face or without the barriers of social-distancing and masks.

What was particularly interesting and frankly astonishing was Dr Jindal's revelation that babies are being born now from sperm and eggs frozen well over 20 years ago. Under the current laws in the UK, such occurrences are not possible since a woman's eggs may only be frozen for a maximum of ten years without medical exemption.

Therefore, it is very pertinent that clients of US IVF clinics can use gametes frozen over 20 years ago, a luxury not afforded to their British counterparts. Furthermore, Dr Jindal added that with the current state of cryostorage, whereby samples are kept in tanks surrounded by liquid nitrogen at -196 Celsius, samples could be kept indefinitely. This information also lends itself to the Progress Educational Trust's extend the limit petition, which calls on the UK Government to extend the ten-year storage limit for eggs frozen for non-medical (social) reasons.

In addition, further scrutiny is drawn to the discrepancy between the legislation's 55-year timespan provided for women to freeze their eggs under medical grounds compared to the ten years given to those without. It appears very little, if any, scientific reasoning was used when deciding on these separate timeframes.

The repercussions from such advances are innumerable and invaluable to many people who have lost partners or undergone damages to their fertility and can now use stored samples and receive life-changing assistance in conceiving. When pressed further by Dr Lynch, Dr Jindal provided numerous control procedures in place to prevent or counter the failure of the cryostorage, such as weekly checks of the equipment, back-up power supplies and alarms which notify staff.

As a scientist, I was particularly interested to hear about the lab's day-to-day workings, with Dr Jindal taking the listener through the various stages of IVF from egg and sperm retrieval to fertilisation into embryos. I had not previously grasped the fragility of these samples, in particular the growing embryos and their vulnerability to any interference from human contact used to test their growth and morphology.

I enjoyed hearing about the development of ICSI (intracytoplasmic sperm injection), which has now become the dominant technique of fertilising eggs with sperm, by injecting sperm directly into an egg prior to normal IVF embryo transfer. This method is particularly used in male infertility where sperm feature a low count or irregular morphology or motility. It is interesting that many US IVF clinics use ICSI to such a large extent, given the opinions of many fertility specialists who have questioned its efficacy (see BioNews 1100). Experts have found that ICSI is only an effective treatment for couples suffering with male infertility, representing 40 percent of couples who struggle to get pregnant. However, as shown by Dr Jindal, the use of ICSI is far more common than the prevalence of male infertility and in fact, it has been shown that using ICSI actually lowers the chances of conception in couples who do not suffer from male infertility.

Nevertheless, such descriptions of techniques like ICSI really do return one to a state of child-like wonder, amazed at the power of scientific advances enabling humans to artificially recreate a pivotal process vital for new life. These moments were unfortunately punctuated with the odd advert delivered in a typical corny tone which reminds you that both this podcast and IVF clinics themselves are nevertheless businesses and rely upon the unsentimental arts of marketing.

This podcast episode was a worthwhile listen to any couple or person who is thinking about undergoing IVF treatment and wants to know more about the general scientific process and the personnel who carry it out behind the scenes. I found both Dr Lynch and Dr Jindal to be very open and personable. Dr Jindal clearly demonstrated her heartfelt interest in helping people to understand the motives of IVF clinics and the lab personnel.