P–161 Is enough the staff in your lab?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Olmed. Illueca ◽  
E Veiga ◽  
E Ferrer ◽  
M Fernández ◽  
A Mauri ◽  
...  

Abstract Study question Must be all the activity made in in vitro fertilization (IVF) laboratories keep in mind to size its staff? Summary answer To create a staff calculator based on number of cycles carry on, assisted reproduction techniques, quality controls, administration management, weekend duties, labour regulations and holidays. What is known already In a bibliographic search about staff in human reproduction labs there is no mention about de number of embryologists recommended for every cycle done. Only that it will be according to the workload. Other guidelines establish that every embryologist could assume 150 IVF cycles/year. However, here is a downward tendency in the work that an embryologist can assume. Alikani established a maximum of 100 cycles/year for every embryologist (Alikani et al, 2014). Study design, size, duration Seven senior embryologists working in different IVF centres, three public and 4 privates, take part lead in this Multicentre study during 2019 and 2020. We made a survey to create a calculator for staff using the mean time spent in every lab by each embryologist of the centre to do any IVF procedure and measured three times each one. Participants/materials, setting, methods Different lab procedures and activities related with quality control, time spent to do them, and witnessing were included in the survey. For the calculations it was considered an embryologist with a full-time contract working 1744 hours / year according to current labour agreement in Spain. The times included in the calculations for each task were those corresponding to the 95th percentile. For the calculation, the program used was Microsoft Office Excel. Main results and the role of chance In the IVF laboratory many gametes and embryos from different couples are manipulated daily. The maintenance of traceability could be affected by not having the right staff and lead to dramatic consequences for the patients and the centre. Workload or overload caused by non-suitable staff number also affects the embryologist having a direct impact on his health. The results of the survey carried out showed the time needed by embryologist to perform the different procedures necessary for an IVF treatment, being a classic IVF cycle (8.11 hours), also taking into account the time spent in managing documentation, preparing the cycle and databases. An ICSI with Time lapse needs 10.27 hours and an ICSI-PGD cycle 13.91 hours. To all off this, 1.81 hours should be added for every vitrification support needed and the time to control more than 200 critical steps, including equipment control and culture parameters. The time spent in semen analysis (including managing documentation, cycle preparation and databases) or intrauterine insemination with a partner sperm was 2.7 hours. For donor sperm an additional hour for the management involved is required. The time required to perform and cryopreserve a testicular biopsy and seminal cryopreservation was 4 and 3.7 hours, respectively. Limitations, reasons for caution The study was made taking account of Spanish regulations, quality standards and recommendations and should be adapted to the foreigner’s regulations. Wider implications of the findings: New advance staff calculator allows laboratories estimate minimum number of embryologist necessary for a particular public or private laboratory without compromise neither security nor success in their results. Nevertheless, we recommended a minimum of two qualified embryologists in every lab, whatever it was the workload. Trial registration number none

2019 ◽  
Author(s):  
Vanessa L. Dudley ◽  
Marc Goldstein

Male factor infertility contributes to at least half of all cases of infertility in couples. The most common causes of male factor infertility are impaired sperm production due to varicoceles, obstruction of the ductal system, and genetic defects causing nonobstructive azoospermia. A majority of these underlying conditions are treatable. Even when in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) is necessary, treatment of men has been shown to improve the outcomes of IVF-ICSI and potentially increase the chances of finding sperm with microdissection sperm extraction in some cases of nonobstructive azoospermia. Important advances in the field include abundant evidence now supporting microsurgical repair of varicocele in varicocele-associated nonobstructive azoospermia prior to IVF-ICSI or attempted surgical sperm retrieval. Advances in techniques for reconstruction of obstruction is dependent on the surgeon’s skill in creating a tension-free and leak-proof mucosa-to-mucosa accurate approximation with a good blood supply and healthy mucosa and muscularis and can result in higher patency rates. Treating the men often allows upgrading men from being solely candidates for donor sperm or adoption to candidates for ICF-ICSI with surgically retrieved testicular sperm to allowing IVF-ICSI with ejaculated sperm and from IVF-ICSI with ejaculated sperm to allowing the simpler intrauterine insemination and, finally, the possibility of a naturally conceived pregnancy. This review contains 27 figures, 1 table, and 69 references. Key Words: microsurgery, obstructive azoospermia, transurethral resection of the ejaculatory duct, varicocele, vasectomy reversal, vasoepididymostomy, vasography, vasovasostomy


2020 ◽  
Vol 13 (5) ◽  
pp. e233100
Author(s):  
Amelle Geurim Ra ◽  
Paul Jeffrey Evans ◽  
Anshu Awasthi ◽  
Upendram Srinivas-Shankar

We report the case history of a 32-year-old man with no phenotypical abnormalities who presented with infertility. Semen analysis revealed azoospermia and testicular biopsy confirmed Sertoli cell-only (SCO) syndrome. Karyotyping revealed 47,XYY and pituitary hyperplasia was found on MRI pituitary. In our patient, 47,XYY karyotype is likely to have given rise to SCO syndrome that in turn resulted in pituitary hyperplasia. The patient was evaluated by various members of the multidisciplinary team including the pituitary surgeon, endocrinologist and andrologist. The patient’s partner successfully delivered a healthy baby via in vitro fertilisation with donor sperm. This triad of diagnoses (SCO syndrome, 47,XYY karyotype and pituitary hyperplasia) has not been reported previously. SCO syndrome should be considered in the presence of azoospermia, elevated follicle-stimulating hormone, low inhibin-B and normal testosterone levels. Our case report also highlights the importance of excluding genetic causes of infertility even when the patient has no phenotypical abnormalities.


2017 ◽  
Vol 63 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Leonardo de Souza Alves ◽  
Francisco Batista de Oliveira

Summary Introduction: Varicocele disease is well-known cause of infertility in men. The presence of spermatic varices veins create a hostile environment to spermatogenesis. It results in reduced quality of the sperm production and in some cases can determine a total absence of sperm. The varicocelectomy procedure in patients with non-obstructive azoospermia (NOA) can raise the rates of sperm in the semen analysis. A positive rate for sperm, even if very low, may be sufficient to enable the capture of sperm intended for in-vitro fertilization without the use of donor sperm. Objetive: To evaluate the raise of sperm in NOA patients with varicocele disease who were submitted to a bilateral procedure to recovery sperm production. Method: We analized the sperm results of 25 NOA patients who undergone to a bilateral varicocelectomy procedure. Results: From a total of 25 patients, three (12%) recovered sperm count four months after procedure. One year after the procedure, five (20%) patients recovered sperm production. Conclusion: Patients with varicocele disease and azoospermia, without genetic changes or obstruction of the spermatic tract, should undergo surgical procedure to recover sperm.


2018 ◽  
Vol 13 (3) ◽  
Author(s):  
Thomas A. Masterson ◽  
Aubrey B. Greer ◽  
Ranjith Ramasamy

Introduction: We aimed to determine the time and predictive factors of semen quality improvement in men with severe oligospermia after microsurgical varicocelectomy. Methods: Men with total motile sperm count (TMSC) <5 million on two semen analyses were identified from May 2015 to August 2017. Postoperative semen analysis was collected at 3–6 months and >6 months. We evaluated preoperative factors for successful semen quality upgrading based on assisted reproductive technology (ART) eligibility: in vitro fertilization [IVF] (<5 million), intrauterine insemination (IUI) (5–9 million), and natural pregnancy (>9 million). We compared men with TMSC <5 million to those with TMSC 5–9 million. Data are reported as means and standard error of the mean (SEM). Pregnancy data was collected by phone interview at >6 months postoperatively. Results: A total of 33 men were included. TMSC improved from 1.5±0.2 to 7.3±1.8 million at 3–6 months (p<0.05) and 12.2±3.6 million at >6 months (p<0.05). There was no statistical difference in TMSC between 3–6 months and >6 months. Sixteen (48.5%) men upgraded semen quality into the range of natural pregnancy. Preoperative TMSC from 2–5 million was predictive of upgrading semen quality. Twenty-four couples were contacted by phone; 20 were attempting pregnancy in the postoperative period and five (25%) of them had achieved natural pregnancy. Conclusions: Men with TMSC <5 million can expect the largest improvement in TMSC from 3–6 months postoperatively with minimal improvement thereafter. Preoperative TMSC >2 million was most predictive of semen quality upgrading.


2020 ◽  
Vol 38 (01) ◽  
pp. 029-035
Author(s):  
Mohan S. Kamath ◽  
Judith F.W. Rikken ◽  
Jan Bosteels

AbstractThe standard fertility workup includes assessment of ovulation, semen analysis, and evaluation of tubal patency. If the fertility workup is found to be normal, a diagnosis of unexplained infertility is made. The role of laparoscopy in fertility workup has been a matter of debate. The current review presents the evidence for and against laparoscopy and hysteroscopy during fertility workup and subsequently prior to fertility treatment. After appraising the literature, we found the role of diagnostic laparoscopy in fertility workup is limited and is dependent on factors like prevalence of pelvic infection, setting, and availability of expertise. Moreover, whenever a laparoscopy is planned as a part of the fertility workup, the preparation should include ability to carry out simultaneous therapeutic intervention to maximize the benefit. Similarly, the routine use of hysteroscopy in women with unexplained infertility cannot be recommended. There is a need to investigate the impact of choice of tubal test on chances of spontaneous conception and treatment outcomes in women with unexplained infertility. Our future research agenda should also include high-quality multicenter randomized trials assessing the cost-effectiveness of screening and operative hysteroscopy prior to intrauterine insemination or in vitro fertilization.


Anthropology ◽  
2019 ◽  
Author(s):  
Amy Speier ◽  
Caridad Zamarripa

Reproductive technologies are those technologies that aid in animal and human reproduction. Assisted reproductive technologies (ARTs) are more narrowly defined as those technologies that help people suffering from social or bodily infertility create a family. Socially infertile includes single women and men as well as homosexual couples who rely on donated gametes for the creation of a future child. Intrauterine Insemination (IUI) is usually the first step taken by couples having trouble conceiving. The most general type of reproduction technology is in vitro fertilization (IVF), which means that the egg is retrieved from a woman’s uterus and sperm is introduced to these eggs in a petri dish. In the case of male infertility, intracytoplasmic sperm injections (ICSI) may be employed, which means that sperm are injected directly into the egg. IVF may include the use of donated sperm, oocytes, and embryos. In addition to gamete donation, surrogacy may be employed in cases where an intended mother or intended gay fathers cannot carry a pregnancy to term. In addition to being used to create families, contraception is also considered a reproductive technology. Anthropologists have been conducting ethnographic analyses of reproductive technologies by studying the people intimately engaged with these varying technologies. Scholarship revolves around major questions about markets and gift exchange, kinship, and how our understandings of family have shifted with the advent of reproductive technologies, as well as globalization and the ways in which bodies, people, and technologies traverse the globe.


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