Timelines in An IVF Laboratory
Working in an IVF laboratory could be stressful and exciting, both at the same time. Exciting because you are about to fulfil someone’s dream of parenthood and stressful because an important part of fulfilling this dream is to do with how good your laboratory is. Thus, it is important to ensure that every laboratory has set SOPs and QA/QC parameters, which are followed meticulously and routinely.
The difference between a good laboratory and an average laboratory is about having standardisation across all members of the team. Every laboratory or chain of clinics will have their own way of conducting a process, depending upon what type of consumables are being used and which media is being used. However, there are some timelines that have no influence on different SOPs at different laboratories and have to be adhered to as a least standard process. Let us understand what IVF lab setup processes are.
1. Dish Preparation: The right manner of dish preparation is the cornerstone of any embryological process. The design and method of preparation may vary from laboratory to laboratory, but basic time of preparation should be followed. As per good practice, in our experience, all dishes made should be incubated at 37 degrees in a CO2 incubator for a minimum of 8 to 12 hours and is a mix of pre-made sides and dispensed tubes.
2. Fertilization or Day 1 check: Fertilization check is dependent on the manner in which you have handled the cycle on Day 0, typically called the ‘ovum pick up day’. In our experience, it is important to incubate the retrieved oocytes for up to 4 hours before performing conventional IVF or ICSI. Documentation of the time at which these processes are done is extremely important, since an ideal time to perform fertilization checks is 16 to 19 hours post injection/insemination, also referred to as HPI.
3. Day 2/Day3 Checks: Once we have separated the fertilized zygotes from the non-fertilized oocytes, it is important that fertilized zygotes are cultured in a new dish. It is essential to document the time at which you performed the fertilization checks, as this would define the time at which you should check the embryos over the next few days. It is important to note that, from Day 2 onwards the zygote has now developed into an embryo and thus, it is important to start grading the embryos. If your laboratory does perform Day 2 checks, it is important to do so 44 to 71 hours post injection or in simple terms 24 hours after fertilization checks. A similar process needs to be followed when you perform Day 3 checks, which is exactly 24 hours after your Day 2 check. In laboratory terminology, it would indicate 67 to 71 hours post injection. Going forward from here, embryo development to Day 5 or 6 will be based on your laboratory’s and/ or clinic’s practice.
4. Day 5/6 or Blastocyst Checks: So, if your laboratory practices Day 5 culturing, it is important to calculate 48 hours post your Day 3 checks, as we skipped a day in between. Thus, for Day 5, a good range would be 116 to 120 hours post injection. Sometimes, the embryos might be slow and you may have to keep them for another day, i.e Day 6 or some laboratories across the world also have a routine to check up to Day 7. In either of these scenarios, it is important to document the Day and time of check.
No laboratory can do away with these timelines, as they define the outcome of a cycle.