When patients talk about their health care experiences, they often talk primarily about their doctor, their nurses, and their coordinators. And that makes sense; those are the people they see in the office, day in and day out, who walk them through each step. But in the case of fertility medicine, there’s a whole lot going on behind the scenes—or in this case, behind the double doors that lead to the lab—that can have a significant impact on the success of your egg freezing treatment. You’re not just picking a doctor; you’re also picking the lab that will handle your eggs.
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As seen in a recent FertilityIQ video, experts agree that the quality of your clinic’s laboratory (and the experience and care of its laboratory team) makes a huge difference in your chance of success with an in vitro fertilization procedure, with a high-quality lab improving chances by up to twofold. Though in vitro fertilization is a technique used to create embryos, not to freeze eggs, it uses many of the same steps used in egg freezing (learn about the difference between IVF and egg freezing). So it follows that the quality of the lab can significantly affect success rates for egg freezing, as well.
Here are four things to consider when choosing an egg freezing clinic to ensure maximum success:
1. The experience of the laboratory team
Once your eggs are retrieved from your ovaries, they’re handed over to the embryology team for cryopreservation. An embryologist is a scientist who specializes in the study of reproduction, and these experts will be handling your precious reproductive cells during the cryopreservation process. If you’re considering egg freezing, you’re probably already doing lots of research on your physician and his or her team. It’s also a great idea to do some research on your embryologist and the lab team to make sure you’re comfortable with their level of experience and expertise.
Our embryology team is led by Dr. Leslie Ramirez, a highly skilled scientist who earned her Masters and her Ph.D in embryology. Previously, Dr. Ramirez worked as an embryologist and researcher at Brigham and Women’s Hospital at Harvard University, where she was part of a team doing groundbreaking research work in embryo selection. She also trained with acclaimed cryopreservation expert Dr. Kuwayama to perfect his advanced freezing technique, called the Cryotec method (more on that later)—and now, our lab is the Cryotec representative for the eastern United States. If any embryologist in this region wants to practice the Cryotec method, they need to study with Dr. Ramirez first.
And our lab team is reinforced by the vast experience of embryologist Alexis Adler—yes, the very same Alexis Adler you saw in that FertilityIQ video we linked to earlier! With over 30 years of experience in human reproduction starting at Cornell University, Alexis helped devise the early lab protocols that became the foundation of the field of embryology.
So, what do these experts do? Once your eggs are handed over to the lab, an embryologist isolates each egg and carefully removes the extra cells surrounding the eggs so they can be evaluated under a high-magnification microscope for maturity (only mature eggs can be fertilized after they’re thawed, so they’re the only ones frozen). Finally, the embryologist treats the eggs with a cryoprotectant to prevent harmful ice crystals from forming during freezing, carefully places them onto a small straw, and plunges them into liquid nitrogen to freeze them. The skill, knowledge, experience, and attention of the embryology team makes all the difference to the success of this process.
2. How many cycles the lab performs
In addition to knowing your embryology team is knowledgeable, you want to know that they have many hours of experience with egg freezing, specifically. In the IVF world, labs that perform 200 or more cycles per year are considered “seasoned,” and are more likely to result in higher success rates according to FertilityIQ data.
In the world of egg freezing, Extend Fertility does more egg freezing than any other clinic in the country. We’ll perform about 750 cycles this year alone. According to SART data, there were about 7,500 egg freezing cycles done across the country in 2015—so the egg freezing cycles done here at Extend Fertility represent about 10% of all egg freezing cycles done in the country!
But too many cycles—with too few embryologists—could mean that a lab is understaffed and each case isn’t getting the attention it needs. As FertilityIQ notes, there’s a “sweet spot” for embryologists—between 100 and 150 cycles per year—in which they’re getting enough lab practice, but they’re not being stretched too thin. We agree, which is why we’ve built a lab team with five experienced embryologists that falls right into the ideal range. Sweet.
3. The techniques used in the lab
Equally important to the expertise of the lab team is the lab techniques they use. Extend Fertility uses the most advanced and successful egg freezing method, created to ensure a near 100% egg survival rate. But what does that really mean?
There are two methods used for egg cryopreservation, or freezing: slow freezing and vitrification. The latter is a much more effective form of “flash freezing” that reduces the chance that damaging ice crystals will form inside the egg. Vitrification is undoubtedly a superior method, with studies indicating egg survival rates (meaning the percentage of eggs that are still viable after they’re thawed) increase from 61% with slow freezing to 91% or more with vitrification.
And even within vitrification, there are differences in protocol—the exact procedure that the lab team uses to freeze the eggs—that can affect success rates. In the Extend Fertility lab, for example, we use the Cryotec method, a specific set of strict protocols developed by Dr. Masashige Kuwayama, long considered the foremost authority on vitrification. Dr. Kuwayama’s method is the most advanced form of vitrification available, with egg survival rates close to 100%.
When choosing an egg freezing clinic, don’t be afraid to ask them about the techniques they use in the lab and their survival rates—as that could make an enormous difference in your egg freezing success.
4. The lab’s equipment and environment
Egg freezing has improved in leaps and bounds over the past decade, thanks primarily to new technology. And because the research behind fertility technology is constantly advancing, it’s really important that fertility labs stay up-to-date and use cutting-edge technology to optimize their patients’ success. At Extend Fertility, we use the most modern, state-of-the-art equipment available in cryopreservation today.
The incubator is just one example. An incubator creates a maximally optimal environment for eggs, with the correct pH, temperature, and oxygen levels—all matched to the natural environment inside the female body. It’s really important for the viability of the eggs that this environment stay as stable as possible and avoid temperature or atmospheric fluctuations. At some labs, they use a large “box incubator” that contains many patients’ eggs; the problem is that, every time the incubator is opened to access a patient’s eggs, the environment inside changes—and because box incubators are larger, it takes longer for their interiors to return to the optimal temperature and pH.
A superior piece of equipment is a benchtop incubator, like we use in our lab. The six small chambers of the benchtop incubator each contain only one patient’s eggs, allowing precise control and stability of the incubator environment. (Another really cool note: in our lab, every surface is warmed to body temperature—a cozy 37ºC—to maintain egg quality no matter where the eggs are in the lab.)
Another important factor is lab air quality. Within the past few years, it’s been confirmed by research that air quality within the fertility lab is a major determinant of success. In a lab that’s not using a highly efficient air filtration system, particles in the air can attach to microorganisms that could potentially damage the delicate cells the embryologists are handling. In our lab, we’ve installed a unique air handling system to remove potentially harmful particulates. Thanks to this system, our lab is a “class 1000” room, which means that there are fewer than 1,000 particles per cubic foot. For reference, the air in an average office building contains between 500,000 and 1 million particles per cubic foot. (Yikes!)
Our lab was, in fact, purpose-built to support effective egg freezing in the cleanest, safest environment possible. We worked directly with our lead embryologist to create a workspace that’s perfect for egg freezing. Think of it as a chef’s mise-en-place—Dr. Ramirez designed the lab to accommodate the workflow she and our other embryologists undertake everyday.
When considering a clinic, inquire about its equipment and lab environment. When was the lab last updated? Does it use a box incubator, or a superior small chamber incubator? How does it ensure air quality? At some facilities—ours included—the embryology team can take interested patients on a lab tour, so they can see this highly specialized equipment and environment with their own eyes.