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IVF Lab

Experts agree that a high quality laboratory can improve your chances of success by two fold. Naturally, clinics will tell you their laboratory is superb. Here we run-down the issues that help patients make the distinction between a world-class, mediocre, or poorly-run laboratory.

An Overview of the IVF Laboratory

Choosing a clinic that has a superb lab may be the most important step you can take to ensure that you have a healthy child through IVF. Most embryologists freely admit there is a wide variation in quality when it comes to laboratories, and that a good laboratory can double your chances of success.

Laboratories typically have a singular goal: take eggs and sperm and grow healthy embryos. This is enormously difficult and some labs are better at it than others. Below you can see the variance in success rates between two highly regarded clinics using donor eggs (which are presumably of good quality):

As patients, it is incredibly hard for us to distinguish between an excellent, mediocre and poor laboratory. First, according to our data, only 26% of clinics make it easy to get your questions answered by an embryologist (but many relent if you insist). Second, most of us simply don't know what to look for.

First, make sure that the clinic is doing a sufficient number of cycles to be experienced (roughly more than 200 per year) and that they have the right number of embryologists staffed. Each clinic should have two embryologists and you typically do not want the ratio of cycles-to-embryologists to reach above 150 - 200.

Second, zero in on the laboratory's key performance indicators. They should be able to succesffuly fertliize more than 70% of the eggs they inseminate with ICSI over a given time period, and then be able to turn 40 - 50% of those into blostocyst-stage embryos by the fifth or six day of culturing.

Third, ensure this laboratory has great culture conditions. You want your embryos in an incubator that is kept at 5% oxygen (not 20%), as 5% drives higher success rates. Many clinics still keep their incubators at 20% oxygen levels and this should be considered a red flag. Also, you want to ensure your embryos are kept in an incubator with as few other samples as possible, or within their own chamber. This reduces the risk your embryos will be disturbed when other samples are being tended to, and reduces the likelihood your sample could be mistaken for someone else's.

Finally, consult publicly-reported data to get a sense for how many embryos the clinic is transferring in a fresh cycle (fewer embryos means more confidence in the lab's work), and how well they do with donor egg cycles (since donor eggs are almost always good, this is a decent leveler between clinics).

You may come to realize that your clinic doesn't have its own laboratory. We estimate 15 - 20% of clinics use another laboratory. This isn't necessarily a problem, but it may be harder to get concrete answers on how that laboratory operates. Below we compare the success rates of a major clinic, and the outsourced laboratory the clinic uses for half of its patients.

Unfortunately, there is no meaningful oversight for laboratories in the US. College of American Pathology (CAP) accredition and FDA clearance amount more to "check the box" benchmarks than signifiers of excellence. New York State inspectors are more rigorous, but few laboratories outside of the tri-state area are ever inspected.

Ultimately, patients are very much on their own to determine if they are putting their faith in a laboratory that will diminish their chances of success or give them a meaningful advantage.

Expert's Perspective
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IVF treatment is a relatively new treatment, and egg and embryo freezing are newer still. So do we know how long these gametes can be safely stored and still work?
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Is it safe to ship cryopreserved eggs (and embryos)?
Patients are increasingly eager to ship their eggs and embryos to clinics out of town, out of state and out of the country. Vitrification has made that a far more delicate process. Peter Nagy, Ph.D helps explain the outcomes, steps and costs associated with shipping gametes from one clinic to another.
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Egg Freezing, Vitrification & Judging Your Lab’s Track Record
With every passing year, fertility treatment relies more and more upon the laboratory's ability to freeze and thaw gametes. Vitrification has forever changed how we store eggs and embryos, and yet the process requires a fair amount of experience, specifically when it comes to egg freezing. Peter Nagy, one of the fathers of vitrification, helps patients ascertain whether their lab is experienced enough to trust.
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Improving IVF Success Rates: Using Low Oxygen in the Lab
Selecting a clinic is as much about selecting their laboratory as anything else. A key determinant of lab quality is the conditions they use to culture embryos. Using low oxygen in the incubator is preferable, yet a third of laboratories don't do this.
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The Problem of Mosaic Embryos in IVF
While clinicians are adopting PGS at a rapid rate (now 35% of all IVF procedures), it's now become clear that the results we get from such a test are not as black-and-white as we originally presumed. What is now unclear is how often we are dismissing good embryos, and what we do from here.
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