The handling of eggs and sperm in the culturing of embryos is delicate and complex and is performed by highly-trained embryology and andrology specialists. RMA of New York has a large and experienced lab team that is committed to upholding the highest standards of safety and precision to achieve superior success rates and healthy pregnancy outcomes for our patients. In this episode we talk to Senior Embryologist at RMA of New York, Donna Dowling, about what exactly an embryologist does, the process of making an embryo, ICSI explained, and what happens to your eggs post-retrieval.
The handling of eggs and sperm in the culturing of embryos is delicate and complex and is performed by highly-trained embryology and andrology specialists. RMA of New York has a large and experienced lab team that is committed to upholding the highest standards of safety and precision to achieve superior success rates and healthy pregnancy outcomes for our patients. In this episode we talk to Senior Embryologist at RMA of New York, Donna Dowling, about what exactly an embryologist does, the process of making an embryo, ICSI explained, and what happens to your eggs post-retrieval.
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Speaker 2:Hi everyone. We are Rena and Dara, and welcome to fertility forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai hospital in New York city. Our fertility Ford podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate. RMA of New York state of the art laboratory is one of the crucial components in our ability to achieve high success rates for our patients. Over the past decade, the majority of advances in assisted reproductive medicine have occurred at the laboratory and at the genomic level RMI New York has been at the forefront of these innovations and as a recognized leader in the scientific and technological advancements in the field, the handling of eggs and sperm and the culturing of embryos is delicate and complex. And it's performed by highly trained embryology andrology specialists. RMA of New York has a large inexperienced laboratory team that is committed to upholding the highest standards of safety and precision to achieve superior success rates and healthy pregnancy outcomes for our patients. In this episode, we talk with RMA embryologist, Donna Dallin, Lacey, about what exactly an embryologist does the process of making an embryo exi explained and what happens to your eggs post retrieval. We are so excited to welcome to fertility for today. Donna darling from RMAs embryology lab. Thank you so much for coming on done. Oh, great. No problem. Thanks for walking up two flights of stairs and coming out of the lab, it's always great to come out to the lab. We were just saying that, um, you know, there's a bunch of levels at work at RMA and how we don't always cross paths. So it's so nice that we finally get to see you in the office area so often. Well, so tell us, where are you usually in a lab all day? It depends on what I'm doing sometimes because the lab is like a long alley in the middle of the bat in the afternoons. I'm usually all the way in the back because in my mind, the embryologists are kind of standing in a line, looking at a microscope all day at things on a little slide. Is that the reality or that's just my addiction part of the time where we're staring at things, but it's a lot of moving around, like back and forth. Uh, so I guess, so tell us really, what do you do all day in the morning? We focus more on doing thawing and checking the eggs that have been fertilized and retrievals and checking embryos for biopsies. So there's a lot of movement back and forth going from the incubator to a working station in the morning. It's very busy. And then in the afternoon, it's a little bit quieter. It's more freezing where you're in one place for a little bit more of a longer time. So it's not as much hustle and bustle and there's a lot of transfers. So that usually that one person is doing transfers is doing a lot of back and forth because the transfers it's a very quick, very quick. So is that person, that's usually the one that's going back and forth a lot, but usually the afternoon sitting in a corner and someone just feeds me dishes, sitting there curious, my presumption is that a lot of the retrievals are done in the morning and is that why it's extra busy? So what happens to that? So they go and they retrieved the eggs and then they come to you. The, or staff brings us tubes with the fluid and the fluid has the eggs in them. And then they pour it out in the dish, the embryologist, and does the search for the eggs. It puts it in another holding dish. And then at the end of that, you just kind of rinse them off and you put them in the dish that goes to the incubator. So it's just takes about maybe 12 or 15 minutes. And then what happens in the incubator? It just sits and it kind of gets happy. Happy place just kind of gets used to its new environment because, you know, you just took it out of the human body as well. Are they separate or is it individual eggs on a dish or they're still together in a group, but they're groups at that time, the groups. So there's like maybe three or four in a drought. We have like little drops along the edge of the dish. And so they could put in those and then they go into, and then they sit for maybe about three, four hours and then they get two and a half or so. And then depending on what the procedure is, then we take the eggs. Cause they're at the time of retrieval their trend of all the excess Cumulus cells around them. So they're like the little package, so they're easier to work with. And so we take that and then we do a procedure where we strip the eggs of the Cumulus cells that you want to keep the cells around the eggs during that little incubation time, just to kind of help the eggs. If they're not sure at the time of retrieval, it kinda like talk to the eggs. It's like a little communication thing, get into chore. So at the time of the hire on a days when I will not try and spell that enzyme, the enzyme breaks down the cells around the eggs. So you can clearly see the pullet body, which is beside maturity for the egg. So basically two and a half to three hours is the time that really helps those enzymes work on the egg after the two and a half, three hours. Does that mean it's, there's not as much. There's still potential that if they're immature at the time of pile, that they will mature, but the Cumulus cells like really like with there's still like residual hormones and stuff like that. So think of them as the helper cells. Okay. So then, okay. So then after today, as you do the high Ronna days, and then if you're doing exceed, that's when you went, Indeck the sperm. If there's another incubation period after that, because it's complicated, want to keep the eggs happy? So, so are you doing like a song and dance for them back in the incubator? They let it be, let them rest for a little bit. And then you do the injections. I was like a knife. Have their buddies, the enzyme music playing in the lab. There's this everything's happy. What, what type of music is it like the Beatles? Like is there sometimes the Beatles? Sometimes some eighties we did research on the music at the time. Yeah. If it helps the eggs really? Yeah. It just depends on who's in charge of the music. Okay. So then, okay. So then after that, if they're doing XC, then can you explain, well, there's a person, that's an injection person. And then there's an assistant and the assistant gets the dishes and we have little dishes and like a Petri dish, a little Petri dish and flat dish. And they have, there's a PDP dish in the middle. This is another big word. If I can remember it, PPP is little donor or something like that. It slows the spoon down so we can catch it. So kind of take the needles, there's needles on this verdict microscope. And you just kind of wait and wait until you want to slow them down. When this is my ignorance. You would want you to think that the ones that are fast they'll be the ones that you would want, because those would be the survival ones. Right. And why do we slow them down? Is it to make sure that they move so fast, that you can't catch them? And for XC though, you're then injecting them into the egg, correct individually. So that's what the assistant's job is to put the sperm into the drop. And then the eggs go into separate drops, like kind of like a little mini triangle like that PVP. And then the micro manipulation drops the eggs, go in there and then hands the dish to me, or to whoever is doing the procedure. And then the needles are used to hold the egg and inject. And how long does that take? Beginning from once the eggs are removed, it's about two and a half hours. And then from that, until the injection, that's another, maybe after the procedure takes about five minutes per dish, maybe 12 eggs per patient around about maybe 15, 20 minutes for a patient to do a full procedure. If you are going the route of making embryos, once you have, then what happens? The embryos fertilize overnight. And so we check those in the morning and then they get separated again into individual drops and they're numbered individually. And then on day three, they're checked to see their, I guess, cleavage stage. So they have to at least be a poor cell to proceed to date and either they're hatched or usually they're hatched because most of our patients are going to have biopsies done. So we take the divided embryo like little cells and they have like little they're like little cells. They're like, look like a little cluster of grapes. And so there's little spaces in between the cells and you take a laser and you just put a little hole in that little space. And so when the embryo grows to the blastocyst stage, they kind of escape. Some of the trifecta themselves will skate from that hole. And on the day of biopsy, just take the laser and you just cut off some of those cells and put them in a PCR tube who send it for testing. Is that, so you're doing that process. So you can then send that through. Yeah. At this time for all embryos, just for the ones that are requesting a biopsy PGD testing. So that's how you prep them for the genetic testing. Yeah. So then I guess a lot of people also, you know, often have questions about what to do three of our state's five day, six day seven and the grading system. Can you, can you tell us about that? And what's preferred typically do here, right? The best embryo on date three, it would be like a six to eight. And then on day five, you want it to be a blast three. What does that mean? It is the expansion of the Emmerdale. So as it grows, the inner cell mass starts to grow and then to dome cells on the outside part of the blastocyst, excuse me, they start to expand. So the blast to seal grows, it becomes filled with fluid. And so you have the inner cell mass, you have the dome. And so as it grows, it starts to expand. It gets bigger and bigger and bigger. And so eventually it will escape from the zonal Pollicita, which is the protective, like an eggshell. And so it will break that open and it will escape. That's what it does normally. And that's the normal process, but because we put the hole in, it will escape through that little hole and then we just kind of cut Donna for the late person. Um, I believe it's does that mean that they want the cells to divide? You also want each cell to have, as time goes on. So those two components are critical for good quality. And then if someone comes because you know, a lot of times people get a picture of their blastocyst and they say, okay, you know, mine was, it was all kind of compact. And the zone implicit, right? The circle or the picture could show a lot of cells escaping now is one better or worse. And that scenario, the more compaction early the stage of the embryo is doesn't mean it's bad. It just means it's early. And sometimes they take a little bit longer to get to that fully expanded blastocyst stage. But it doesn't mean that it's cause we wouldn't transfer it. So there's day three day five. Do we hold off further than that now? Or is it usually a day five transfer? What's the typical or is there a typical I know back way back in 2009 time and I was a patient here day threes were somewhat more typical, but I thought, and I could be wrong that day five is something that we want to strive towards day five day, six day, six optimal days for transfer and freezer. And is there a reason any longer is because longer just because it's divided doesn't necessarily mean the quality will stay in tact? No, it's just the longer that it stays in the culture, the longer it needs to be in the human body, that's what it's supposed to be. That's because it's human cells that the longer it stays and culture, the longer it's the more likely it's going to lose. Tegrity okay, great. Yeah. So day seven is like the maximum time that we keep the embryos in culture and it's not necessarily a day. Seven is not an ideal day, but it's, that's our cut off time. And then also, I guess, can you explain to say someone goes through a transfer of an embryo and then, you know, they walk out and your pregnancy test is approximately nine, 10 days after that, but then you think, okay, well I was only pregnant since my trans, but really your timeline is actually longer. Is that because the embryo was in the dish for a certain amount of time before grow. And it's a good question. I think with the transfers, because they don't have the transfers right after they retrieval. It's more like if they have them frozen and then they come back. So everything is kind of times. So according to the day of the embryo turns, the uterus is wrapped for the embryo. So in the ideal environment for the embryo and do we freeze most of them nowadays because I don't, again, back in 2009, none of them were not frozen. Both of my cycles, 2009, 2011. I believe now they all are frozen prior to the transfer. Jordan of our embryos are frozen to help a woman's body kind of normalize post transference posts. And also we're waiting for the test results from the biopsy. So everything that's biopsy gets frozen, no matter what. So if you do choose to have a biopsy, it's frozen, what are the, that, that the school, if that now in a fresh versus frozen transfer, a different than an embryo with either, it just depends on the patient's genetic history, how young they are. And also if the patient wants to have the genetic testing, if they don't want it, like prefer to have a fresh transfer, that's their prerogative, but you don't see that too often anymore. No, not really. Let's say by the internet 10%, 10, 15. It's just great. That there's that option now. And then for me, this is the other component, which I wasn't so familiar with. I didn't know. I know a little bit more about, can we talk a little bit about grading and I believe there's different types of grading depending on what place you go to. And everyone does it a little bit differently, but we do it here at RMA. We use the gardener system where each stage of the unreal, the expansion that determines whether it's one, two, three, four, five, or six, is when it's just starting to form like a little cavity, a little bit more expansion, but you can't really tell the differentiation between the blessed, the inner cell mass. And then three is when you have a full, like, almost more of an expansion of the blast to sail, you can see the inner cell mass in which you don't want to see. You do want it. So the higher, the number the better. So you want to see a higher number, the higher, the number, the more the state of the inner cell mass in, cause I always thought more expanded. I wonder if they changed it. We used to be graded again when I was a patient who was like a BDA, is that still used? But that's different. That's a different type of grading. The first aid is the grade for the inner cell mass. And the second letter, the ABCD is for the trifecta. So you want them ideally both to be, but in a higher number, right? Like a whore I never paid attention to, but I was like, who doesn't want it to any class AA, but it's more complex than that. It's the grade. And the number are two important factors. So it could be a four, but it could be a four AC DC, super complicated, but interesting. So what would you say if you're a patient kind of the ideal embryo grading is we lived for eight days, four A's. I like the 40 days because they have that the best potential as far as implantation. And even though it appears that a five or six, a, B or AA would be better because it's more expanded and that the four eight is more potential. They have more better implantation and pregnancy rates because I guess maybe the zoner protects it during the freezing process. So it's more, more, the cells are inside of the zona. So interesting when it's frozen. Well, okay. So then, so you have the grading system, which I find a lot of patients put so much stock into that, you know, so, you know, say a patient comes back and they don't get a positive pregnancy result. And they say, well, I don't understand, you know, I had a four AA, you know, embryo, this should have worked. And I always say, well, you know, there are other factors besides that, you know, the embryo is just one part of getting pregnant, you know? So what could be other reasons? Did you have a foray embryo or whatever, great graded embryo that it doesn't take. It could depend on what day it could be on day seven. It could also depend on the patient's patients if it's not properly prepared or if it's not an ideal place for implantation. So once you implant the embryo, what has to happen for a pregnancy to occur? The embryo has to find that ideal spot so it can implant, but it also could be an abnormality in the embryo that it grows to a certain point and then it will just kinda grow anymore. Yeah. So, and also I'm assuming also the a woman's environment probably plays a role to hormones perhaps at that time. So it's much more complexity. I think that's great to read. I mentioned that that it may not be, we shouldn't necessarily focus just on that number. There could be so much more to it. I think it's perfect on paper embryo. And I say, well, that's only one part of this. You know, there's some other things that have to happen in your body, even though you do everything absolutely perfect. And you follow all instructions. It's all about how your body accepts everything. So it's very complicated, all these different facts and you wear a lot of hats. You do a lot to different things during the day. I didn't realize that it's, there's so many different stages. You have to work with the team, which is probably you get to probably do different things on different days. So it doesn't become as routine. I do a lot of different things every day. It's just, I have like a little schedule. I look at the different colors. It's like a little hourly block. And I look for the colors to see exactly what I'm supposed to be doing. So everybody has their tasks for the day. So depending on the caseload, I could be doing one thing all morning and one thing all afternoon, or I could be doing like five different things in the morning and six different things in the afternoon. It just depends on what's going on. And do you ever see your patients or are you really, it was through, there only transfers your tables. That's usually the only time I see it, if the is wide open, that's the only time I saw any embryologist is when the embryologist don't see anybody at their, not my embryologist who made, you know, my daughters, they think, yeah, we see pictures and sometimes we'll see a baby in the elevator. I remember that. Yes, exactly. Like[inaudible]. Yeah. So of all the things that you do, which seems like a lot, do you have a favorite part of your job? Because it's just so really quick. And I get that, that little instant kind of satisfaction seeing like the life that's going to go to the patient. It's like, Oh, I did that. I thought that, Oh, it's great. I think I thought, I think if I could put it in, you know, I watched a lot of baking shows and you know, you're cooking your hair short for time. Okay. I want to put it in the freight freezer for a couple of minutes just to like it and set. I mean, that's what I picture. And then it comes out a little bit in the new, well, yeah, a thought, what do you do? You put on the microwave on the difference, what you thought it's a little small dish and we have it at 37 degrees Celsius, which is body temperature. And then we just kind of take the little device that the embryos on and just kind of dive right into it. I'm Canadian. So I wonder why, I think it's just the international scientific as I think you made it a thermometer or a British, and then anything in terms of work wise, that you can find the most challenging. You don't have to dislike it, but challenging, challenging usually are the sperm samples, the difficult ones, the Tessie's segmentations, and that can take sometimes hours to do searches, tedious work. So that's the worst thing, but it's not my favorite thing says that you sit there and you have to be very dedicated to find that sperm, you have to be in the right mental place, mental place, meditate beforehand, prayer, just get it done. And how do you become an embryologist? How did you get into the scale? This is really random. I applied for a research assistant position. I didn't get it and they put my resume on and then something popped up another research position in a embryo research lab with dr. Susan Lanzendorf at Eastern Virginia medical school. She gave me my first job. I worked there for maybe about three years and a position opened in the Jones Institute, which was basically like downstairs and across the quad in the hospital. And they offered me a position. And then I jumped at the chance. I knew what I was doing, the research lab prep to me because I was doing the research end of the clinical. I learned a lot working with her or like basic media and patching and how to make my own pipettes dissecting. Very cool. I could just do whatever I wanted. And then I went to the lab and it was just so structured. And this is like, what? This is totally, it was fun. Then I, you know, I got to meet all the people in the lab because she was their advisors. They were all getting a PhD or masters. So I got kind of in and like, Oh, Hey, why don't you come over here and work? Cause I it's like, Oh, okay, cool. I'll come over. I loved it for 19 years.[inaudible] so do you do any research now? I know that sounds like that was kind of your heart in the beginning because it was part of my job was doing research. So I was writing grants and papers and I was collecting data, not just for myself, but for the research fellows. And it became like almost consumed my life. So as to just breathe and then when I took the position here, I didn't have to do that unless I wanted to, I could do it if I want to eventually I'll get back to it and trying to like wiggle my way back into research, but it was a lot. And this way you're dealing with more people and don't have a lot of time to do research because there's so many other things that have to do because I also not just the lab, but I deal with the discard, the embryos, where I help patients clear their accounts. So I have a lot of emails and they don't want their embryos anymore. They have to sign a consent. I have to create the consent and send it to them. And then I have to, or keep that paperwork organized. And we also have to keep track of our inventory of our embryos. So it's like when the test results come in, some of them are abnormal and because they signed the consent that says that we can automatically discard. Those have to keep track of all those breaks. And it's a lot of paperwork that actually my question, my patients ask a lot. Okay. Because they get, they want to know the nuances. Okay. So say you elect to discard your embryos. What does that mean? Where do they go? How is it done? Well, it depends on what they want us to do with them. We can just,[inaudible] went to the where, because of the biohazard. Well, no, my patients want to know. They say, well, is it, where is it going? They really, they would like to know. So it goes into the red biohazard. That's where they go. They can donate those to research. It's definitely difficult to figure out, right? Most of them go. And I'm assuming that the, um, you know, when you freeze embryos, longterm, is it a different freezing area? Is it in our office? Is it somewhere else? All of our embryos are stored in one place. They just, we have these huge tanks and we put them at the bottom of the tanks because we're not really going down in there. So those are for the longterm storage longer term, longer term yet. Or they can opt to have them sent to another longterm facility. There's many options. They have options. It's what we're here for a whole nother team that takes care of transferring stuff out. They're busy too. And it's a lot more complex than even the people that have been working here at Reno myself than we even realize anything else that you want to add in terms of what you do or comments, just love to make people happy. And like making people happy is their joys just to have children. So this is just a pleasure to help so many families and, you know, helped make a lot of babies for almost 20 years. A lot of babies, friends, relatives, it's just a pleasure to do that. You know, they see them and I don't, you know,[inaudible] try to flip it. It's okay. It's so interesting to hear that. Cause I bet, Oh, my OB GYN loved, you know, working with me when I was pregnant. But as soon as I had my baby and I brought my daughter to see him, he was kind of awkward. Didn't really know what to do. It's like, it's so funny with, depending on each stage, that's what, you're the expert in. It doesn't necessarily mean that that's for not looking after that, showing your baby, see the joy, the happiness of these. When I do the transfers, I get the tears, I get the smiles. And it's just great that we have such an important job. I mean, you're doing such important work. I mean, you're changing people's lives. They're rewarding. The gift. We try to get the guests. That's the most important thing. Well, thank you so much for taking the time.[inaudible] nobody really sees me. I know. Well, we like to end our sessions by talking about one thing we're grateful for. So gratitude. So what is your gratitude for today? Just being helpful, trying my best, being helpful, being patient, looking forward to the final results, lots of babies. You're in the right field. It's like, where else am I going to go to make people happy like this? And they love that lots to be grateful for, but I'm actually grateful for you, Donna, and for the embryology team, really, I feel like you guys are helped so much and we don't really get to see you. I feel like we need to put you guys in the forefront pictures when you walk in really for a big part of
Speaker 1:[inaudible].
Speaker 2:My doctor was my doctor here. And like, I go, thanks for helping me make my baby. But really you guys are also a huge part of it. And you know, this is one opportunity to acknowledge the great work that you do, but so much gratitude for that. Of course I'm grateful for people like Donna and embryology, they're doing such important work. And you know, I wish, like I said, I wish I knew who made my daughter's embryos. So I could say thank you. I mean, what an amazing thing. They that's my life right there. So, you know, I wish I knew who it was. So, you know, I'm so grateful for you for all the work you do, you know, for helping the patients and doing such important work. Thanks for being here. Come visit us whenever you have a break. Thanks. Thank you so much for listening today and always remember practice gratitude, give a little love to someone else and yourself. And remember you are not alone. Find us on Instagram at fertility underscore forward. And if you're looking for more support, visit us@wwwdotrmaandy.com and tune in next week for more fertility forward.