How do I know that’s MY embryo?
Because we implant RFID chips in each embryo. Kidding. But seriously, what are clinics doing to ensure your embryo is actually your embryo? While every clinic is different, there are a few basic guidelines that everyone should be following. Here are some of the ways embryologists “keep track of shit”:
ID/Witnessing
Chain of Custody
Labeling
What does ID/witnessing entail? Everything that may contain your gametes or embryos in the lab will be labeled with your personal identifying information. This includes your full name, date of birth, sometimes the last four of your social or the entire social, and sometimes other information like a clinic generated medical record number, a barcode, a QR code, or procedure date. This means that every time a specimen is moved from one place to another, the labels or codes are compared against each other to ensure a match. Here are some examples of how embryologists may keep track of your specimens:
Sperm accessioning: when a patient arrives at andrology to produce a specimen, aka, ejaculate semen into a specimen cup, he will likely need to verify his identity via driver’s license, verifying DOB and/or social, etc… Then he will be shown a sheet of labels with his and his partner’s information, and once verified for accuracy, he will initial every label on the sheet. A label will then be placed on the specimen cup he’ll ejaculate into. Once that specimen cup is given to the andrologist or embryologist, the sample will be processed in any variety of ways, depending on the procedure for which the semen is intended. Let’s say it’s going to the embryology lab to be processed for ICSI. An embryologist will have all of their supplies set up for this patient in their own area, with no other specimens sharing the work space. All of the items in which the specimen will move through, will have redundant labels (remember the ones initialed at the beginning?). Once the embryologist has their supplies and setup all labeled, they will have a different person look at all of the labels to ensure they’re all matching, and sign off on the setup. It’s common to see redundancy in these steps. For example, a printed and initialed label may be attached to the tube which will contain the sperm after it’s processed for ICSI, but the tube may also have the patient’s name physically written onto it in sharpie, just in case the printed label were to come off or become damaged. At no point in this process will the sperm be in an unlabeled container that hasn’t been matched to all other containers/cups/devices and their labels with the patient.
Embryo freezing and thawing: Patients will occasionally make a comment during the transfer procedure, where they may sound like they’re joking, but it’s coming from a very real place of concern (anyone read the IVF clinic horror story headlines in the news?). “Is that really mine?” “How do you know that one is MY embryo?” “Are you sure that’s mine? HOW can you be sure?” Well, there are no unique identifiers to eggs or embryos that an embryologist could ever point to and say “oh that’s for sure Barbara’s eggs”. That’s simply not possible. But, in the process of freezing and thawing, embryologists will label and verify everything at every step, along with additional sets of eyes to guard against mix ups. Embryos are frozen individually on devices that have patient labels, dates, and unique embryo identification numbers. These labels are compared against hard copy printouts with this information, which are compared against labels on dishes containing the embryos. At no point in the freezing or thawing process, will an embryo ever be thawed, moved, or handled without at least two sets of eyes identifying and verifying label matching. This may also be done electronically with barcoded devices and labels. But with or without the use of electronic identification systems, adherence to a strong protocol and procedure program is hands down the strongest insurance against errors.
Chain of custody: As exemplified in sperm accessioning and embryo freezing/thawing, chain of custody refers to the steps of the process in which specimens will never be without accompanying identification or in the possession of a medical professional. What would a break in the chain of custody look like? Let’s say a patient produces a semen sample, goes to the bathroom to clean up, but forgets the specimen cup on top of the toilet paper dispenser in the bathroom stall. For the time that cup sat in the bathroom before being retrieved by either him or a staff member, there’s absolutely no way to guarantee it wasn’t handled, contaminated, or tampered with. This is a break in the chain of custody. Or let’s say, an embryologist brings the specimen cup to a lab hood for processing, transfers it into a centrifuge tube to spin down, but once they take the tube out realize they forgot to label it, this is a break in the chain of custody, because there’s no way to guarantee what’s contained in that tube. It could be a ballast tube, or it could be another tube mistakenly left there unlabeled. When a situation like this occurs, the process is halted and a patient may be asked to return to provide a fresh sample. And when things like this do happen, we understand it may be disconcerting to a patient who’s asking themselves “Well wtf happened to the first sample? Don’t these people know what they’re doing? Were they just not careful?” but in reality it’s more likely a strong indicator that they’re following best practices and making sure they feel 100% sure about the identification of your specimens.
So while we’re not writing your initials on your embryos under a microscope or implanting RFID chips, we are using long established methods to safeguard as strongly as possible against errors or contamination. And any system, old or new, high-tech or manual, is only ever as good as the degree of adherence to which the embryologists are following their protocols and procedures. And any specimen an embryologist handles, is at the mercy, trust, skill, of every person and procedure upstream of that embryologist.
for your bros.