Behind the scenes: The critical role of embryologists in fertility clinics

Embryologists are the unsung heroes of fertility treatment and the embryology team are among the most important people in your ability to achieve the success of having a baby through IVF. So what does an embryologist do and how do they help?

A little bit of IVF history

Lets start with a little bit of history. In 1978, the world's first IVF baby was born on the 25th of July. Her name is Louise Brown and to this day she is actively involved in the world of raising fertility awareness. For years the world thought that her existence was due to two men – I know, shocker! Although both Robert Edwards and Patrick Steptoe played a massive role in IVF becoming a reality there are many that came before them. There was a woman who made this all a reality. Her name was Jean Purdy and she was trained as a nurse. Her contribution led her to becoming the worlds first embryologist even though such a thing didn't exist back then.

The development of embryology as a sole job took many years, but it became apparent that to succeed in creating embryos you had to have a strong scientific background and an ability to be dextrous with your hands. This coupled with empathy and compassion, and we are where we are today.

An embryologist's work is hard work

Becoming employed as an embryologist has never been an easy task, it's a competitive and sought after role. And equally it is not a role that is suited to everyone, no matter how much they wish to do it. There's a lot of stress and anxiety involved and its takes a certain type of personality to cope with that every day. Embryologists are holding peoples lives, dreams, and futures in their hands. Thats a lot of pressure. They work long hours, weekends, and are regularly doing incredibly stressful tasks that require immense levels of concentration, for very long periods of time.

There is no natural light in the labs themselves, and so we can, somedays, go to work in the dark and leave in the dark. It's hard, the anxiety is the reason that many don't stay in this job forever. But make no mistake, it is also one of the most rewarding and soul lifting jobs on this planet. I'm deeply moved by the privilege of helping people achieve their dream of having a child. It's a truly humbling experience.

What does an embryologist do?

Embryologists are trained to handle gametes (eggs and sperm) and embryos for the following purposes:

• Performing IVF and all associated treatments, to create, and grow embryos until they are ready to be transferred back to the body to create a pregnancy.
• Understanding embryo health with visual assessment, knowing what development markers are good and bad.
• Cryopreservation: Placing eggs, sperm and embryos, that are viable, through specific solutions to preserve them for the future.
• Genetic testing: Conducting biopsy on the embryos to enable identification of genetic health.
• Discussion: Talk patients through what will happen and when, whilst being able to deliver bad news.
• Research and development: Some embryologists work in the support sector in companies that supply technology and consumables to the IVF sector.

Our day to day involves a lot of microscope work with incredibly fine motor skills. Our days also involve a lot of administrative work, and depending on where you work, will also depend on how much patient contact you get. I work at The Evewell where patient care is at the centre of everything we do and so we are very involved with the patients. I mean, who better than an embryologist to be discussing the embryos. It has always astounded me that doctors take these conversations on when they are not the experts. I won't discuss your uterus with you, as I am not the expert there, but your embryos, yes – that's all us!

How important are embryologists to outcomes?

So how important are embryologists to your outcomes.... well much more important than anyone thinks. We all obsess over the doctor we are going to see, and yes they are important, really important. They need to get your body to do what it needs to do and at the right time for us, as embryologists, to even be given eggs and sperm to work with.

Doctors also need to be brilliant craftsmen to make sure that those eggs and sperm are at the best quality that they can be to create to ultimate possibilities. Their advice and timings and protocols are the starting point for all the blocks that need to be built and all the hurdles that need to be jumped.

But for that job to be done there are heaps of other people involved to make it all run like clockwork: Admin staff, reception staff, Health care assistants, phlebotomists, blood testing services, sonographers, nurses, accountants, the list is endless. Until it's not. Because at the end of all of this process is one team. one team that stands in the way of making this all come together. Your embryology team!

The funnel of IVF influence

I created a visual to show all of this and I have called it "The funnel of IVF influence" depicting who has 'what' effect 'where'. There are more people influencing the outcome at the start of the funnel. There are so many people and disciplines involved in you getting there. But once it's all done, once the eggs are harvested and the sperm given over/donated, it ends up with one group of professionals.

So lets work through the visual. Before you even get to a clinic you are faced with a lot of individuals, both professionals and not, that are playing a role in your progress, and navigation towards the next stage of the process. Most people are well meaning and only want good things for you. Others are, unfortunately, trying to make money out of the fertility situation you find yourself in. Navigating your way through this is hard. I'm hoping this information will make it easier for you.

1. Before the clinic

The amount of people that play a role in the stage before you seek active help is huge. Many of them are involved in helping you know, and come to terms with, the fact that you may need medical intervention on your road to parenthood. GP's sending hospital referrals, friends with well meaning advice, holistic therapists, with needles and candles, that maybe you have been seeing whist trying to conceive. There's social media and of course, lets not forget Google!

By the time you enter your chosen clinic there has already been, without you even realising it, a lot of influence over your path. This is also the most vulnerable stage, this is the stage people will try and take advantage of. The stage where you feel so overwhelmed and desperate that you will try anything. Please take care at this part in your journey. If something doesn't feel right, it probably isn't. The fertility industry is worth billions, and there will always be unqualified persons trying to take a slice of the action.

2. Fertility consultation/tests

For you to be able to walk into a fertility clinic and have an appointment, for whatever reason, there have already been multiple people involved to get you there. All of these people are important in making sure that the doctor you are seeing not only knows what they need to know about you to make for an efficient consultation but also to make sure the time allocated is enough for your needs. Medical Private Assistants (PA's) and patient services have a very important role in a clinic in organising appointments and establishing what, if any, tests will need to be carried out.

During these initial appointments there are other people that you will need to see too, that will help inform on your situation. The person doing the scan is handing over crucial information to the doctor to help them make a plan for you. You are also very important in this stage as this is the part where your medical history should help make an overall treatment plan. You'll be asked to complete a medical history form – make the form as detailed as you can. You might not think that having a pelvic infection when you were in your 20's is that informative, we may very well think the exact opposite. We'd rather you tell us everything and let us work it all out with more pieces of the puzzle present.

3. Stimulation/treatment phase

The doctor may come up with the plan to enable you to have the necessary treatment protocol you need to get you to where you need to be but this is facilitated by all other departments to make sure their vision is a successful one. The nurses have to show you how to do all the injections to make sure its correct, the phlebotomists take blood at times allocated by the Medical PA's. The nurses/ ultrasonographers need to scan you so that the doctor can accurately see the response and make adjustments if needed.

All of these professions have to be good at their job to carry out these tasks to ensure nothing is missed. It's also important that you are closely monitored. I personally think that anything less than four scans and bloods in the stimulation phase is too little, and could impact your outcome.

4. Egg & sperm collection

I think you might be starting to get the picture, this is a massive team effort to get you to this point. But once you're at the point of egg collection, the teams involved in your treatment get smaller as the process gets more clinical and tightly controlled. By the time you are at the stage where eggs and sperm are being taken to the lab, on that day, very few people are involved.

The nursing team will be there with the doctors to carry out the procedure. The anaesthetist is there to make sure you are asleep and safe. The embryologist is there to find and collect the eggs, and take them into the lab safely. As for the sperm sample, well, unless its already frozen, that part is down to the person providing it, and then it too is handed over to the embryology team for processing. By the end of this day – what we call day zero– everything is in the hands of the embryology team.

5. Embryo creation

Everyone has worked so hard to get these eggs and sperm in the lab. But now the door to the lab is shut, and what happens next is partly down to the quality of what has been collected, and partly down to the skill of one team. The embryology team are solely responsible at this point for adjusting decisions to make sure you get the best results.

The embryology team work under some of the highest pressure. Day in and day out they make human lives become a reality in petri dishes. What they do has the potential to have the most profound effect on your lives. I find it baffling that they are not known more and not thought of as important as they are when choosing a clinic to go to. Their skill, and the leadership they are supported by, can completely change the success rates at any give clinic. They are the persons deciding which sperm goes into the egg, which embryos should be transferred, frozen, PGT-A tested, or let go. They have a lot to decide for you and not all of these decisions come easily.

As embryologists we work under the Vienna consensus list of key performance indicators, and if you would like to understand this more listen to my podcast where we broke down what it all means for you.

🩷 Always in your corner

So there we have it, what an embryologist does and how important they are. The unsung heroes in your treatment cycle, unfortunately, and potentially, one of the people you will never get to meet (don't get me started on that nonsense!).

Please know that this is a job that is full of anxiety, stress and can be incredibly life consuming. So we don't get into this profession lightly, or easily for that matter. It is not a career for the faint hearted. But it is a career that is driven by passion and belief that we can help you achieve the ultimate outcome.

And whether you meet us or not, please know we are always in your corner willing you to have the best outcome that we can possibly achieve for you!