What to expect from the Scientist?
Today we actually attended our second Lomi Lomi Couples Massage. This ancient Hawaiian therapy is used to reduce, stress, anxiety, muscle tension and eliminate toxins. Each person has a 2 hour full body massage and afterwards you are left feeling completely rejuvenated, it is an incredible experience and very different from the traditional massage therapies that I have attended previously. The strokes in the Lomi Lomi massage are very long and from the heart and are said to awaken the Aloha spirit within you! Much gratitude goes to Luke Mollica from the Lomi Heart Centre at Long Jetty, thank you for your healing today.
The most favourite part of my job as a Scientist in a Fertility clinic was talking with the patients. I have trained in all aspects of clinical practice, Embryology, Andrology and the Biochemistry. The most conversation and connection with patients that I would experience would be during my time in the Embryology Laboratory.
In the Biochemistry laboratory, also known as the Assay Laboratory or Pathology Laboratory, this is where the blood testing happens, there is no patient contact here at all. The Nurses take the blood samples from patients and then send them down to the laboratory. When they arrive here the tubes of blood are spun in a centrifuge to obtain the serum and separate this from the red blood cells. The serum is tested for Estrogen, Progesterone, Lutenizing Hormone, Follicle Stimulating Hormone and HCG (the pregnancy hormone). Generally the Rubella, Hepatitis B & C and HIV testing is performed in bigger Pathology Laboratories. Based on these results, you can see whether or not the stimulation regime of injections is working by the levels or estrogen observed. At this point the specialist may increase your dose for injections, looking at these levels and your corresponding ultrasound results.
In the Andrology Laboratory where the sperm samples are prepared there is minimal conversation with patients. The conversation is to ask a few questions about abstinence, checking patient identification and any other relevant factors regarding the health of the male currently, flus or illness and lastly whether or not any of the sample was spilt during collection. The conversation here is very brief.
When the samples are received in this laboratory they are examined for sperm numbers (density), sperm motility (swimming factor) and morphology (the shape of the sperm). Sometimes the tests are the preliminary ones for determining the best course of treatment, these are called Seminal Fluid Analysis or SFA’s, depending on the results here, you may be able to have lower intervention treatment such as IUI’s initially.
This laboratory also prepares the samples for the IVF and ICSI cycles, on the day when the oocytes are being collected, the scientist will be preparing the sperm sample to give the optimal numbers of swimming/alive sperm required for each treatment.
However in the Embryology Laboratory, this is where the most contact and connection happens. You will get the opportunity to meet your Scientist prior to oocyte collection and potentially immediately after oocyte collection, however many patients are still too sleepy after sedation to remember this contact.
In one of the clinics where I worked, we routinely performed post OPU (oocyte pick up) talks, where both partners would return to the clinic to have a quick rundown on what happened next, including when and how we would communicate results. It was the perfect time to ask questions and the men especially benefited from this one on one question and answer time. The best part of having this type of conversation was the ability to show diagrams, medical models and equipment that was used for the next stages, thereby allaying any fears regarding the upcoming transfer.
Transfer catheters are very small and explaining the procedure to patients puts them at ease, they know exactly what to expect.
So what do you expect at the time of Embryo Transfer? You will get changed prior to the transfer. Generally whoever is going into the transfer room will wear a gown, cap and shoe covers. The reason for all the protective gear is to try and keep the room as clean as possible, not sterile, as you would need to remove all your clothes and put on theatre scrubs! Some clinics perform their transfers in hospitals, so depending on where the procedure is performed will determine exactly what you will wear.
Scientists will generally have a conversation at this time with you about the quality of embryo chosen for transfer and if any of the remaining embryos were suitable for freezing.
You will get to see the embryo prior to transfer and be able to take a picture of it. Your fertility specialist will perform the ET procedure. The transfer procedure is very similar to having a Pap smear test. Positioning is the same, knees bent and speculum inserted into the vagina to view the cervix. At this time the Doctor will clean the cervix and let the scientist know they are ready. Often times an ultrasound machine is use to show exactly where the embryo is being transferred.
The scientist will then prepare the embryo for transfer allowing you to view it prior to loading it into the transfer catheter. The whole procedure is less than 10 minutes most of the time. At the time of the transfer both partners have the opportunity to speak with both the Doctor and the Scientist.
Although text messages, screen shots and live video images are available now for some patients undergoing treatment, I still find value in the conversation with people, otherwise it is all too clinical and sterile. These conversations will allow you to find out specific information about your embryo quality which will not be available in the electronic communications.
In summary what does the scientist do for you?
Looking in the individual specialty areas for example with the blood testing – here the hormone levels and pregnancy tests are performed. Although these tests are performed in isolation without any patient contact, the good news and positive beta tests starts in this laboratory, they are the first to know! The dosage of your stimulation injections will be determined by the results from the blood tests in this laboratory.
With the encouragement of urine testing and the tendency to test too early for most women when at home, clinics still prefer to have a blood test and confirm the rising level of BHCG to ensure everything is progressing normally.
The Andrology Laboratory does have limited conversation with the males at the time of sample collection. This busy laboratory is preparing sperm samples to give the best/optimal sample for the IVF and or ICSI procedures. They are also performing routine semen analysis which is used to determine the best course of treatment for your cycle. In this Laboratory though the less contact with the scientist the better, it means that the sperm sample is sufficient, so not being called back is a fantastic sign!
In the case of PESA/TESA, these procedures are often performed in the same room as the embryo transfer. Under local anaesthetic with the scientist in the next room. The high powered microscopes are used to find sperm. When the doctors are performing the procedure there is generally not too much conversation with the patient. Often times when a good PESA sample is obtained this can be shown to the patient at the time by the scientist.
At the time of the egg collection, after the egg collection, at the post opu talks, fertilisation checks and embryo transfer, all provide multiple points of contact to discuss your questions with your scientist.
Of course behind the scenes the scientists are working tirelessly to ensure the best possible outcome for the sperm sample, oocytes and embryos, during the various stages of your treatment cycle.
It is always a good idea to have your questions written down for the scientist. They have the hands on information about your gametes (sperm and eggs) they have been detailing accurately all the stages and developmental steps reached by your embryos. They are the ones who are carefully choosing the best embryo to return to you at transfer time and making the decision to freeze any surplus embryos.
I saw a post recently on Instagram with a baby wearing a jumpsuit with the words on the front, “My first babysitter was an Embryologist” which is funny and ever so true!
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Kind Regards, Sophia