Recent news of a woman becoming pregnant with another woman’s embryos has heightened awareness of a common question shared by many IVF patients – how do I know the embryos being transferred are really mine?
At Shady Grove Fertility, making sure the right sperm end up with the right egg or that the right embryo is transferred to the right patient is the absolute, most important thing to our practice. We are proud to report that in our 20-year history there has never been a mix-up in our IVF laboratories. An examination of the inner workings of our embryology laboratories demonstrates a combination of well-designed methods and well-trained personnel ensure the continuation of Shady Grove Fertility’s unblemished record.
Identity Protocol is Multi-Faceted
Imagine if your job required you to keep hundreds of items organized and even the slightest mistake could be catastrophic. Now, imagine if those items were invisible to the naked eye and even when you could see them, under a microscope, they all looked the same. That’s the challenge facing embryologists at fertility centers everywhere.
At Shady Grove Fertility, this challenge is managed with a detailed IVF laboratory protocol. This protocol provides a specific set of steps that embryologists follow every time they come into contact with a patient’s sperm, eggs or embryos. Jim Graham, Shady Grove Fertility’s Laboratories Director, says a key element of the protocol is redundancy.
First, redundancy means that there are always two staff members who verify a patient’s identity at every stage of collecting or processing a specimen. Focusing on every letter and number on printed documents, wristbands, and labels can be tedious when done day after day. Jim Graham says, “Having that second person there to check everything you do keeps you from getting too comfortable. It’s not only a safeguard but a reminder to stay alert to every detail.”
Redundancy also means using multiple identifiers for each patient. Shady Grove Fertility uses a patient’s name and date of birth and social security number to identify her but also matches those items to what they call a Master-Patient Index Number or MPI. This unique number eliminates the possibility, however rare, of there being a mix-up between two patients with the same name and birthday. In addition, if there are two patients with similar names, their charts are flagged to alert all personnel.
Check, Re-check, and Check Again
Another important method used at Shady Grove Fertility, in addition to the written and signed documents, is called Active ID. This means that patients are asked to say, and sometimes write out, their names and birthdates for verification. Jim Graham explains why, “When patients come in, they are often nervous, thinking about the procedure they are about to have. If we just hand them a piece of paper with a name on it, they might just glance at it and say, ‘This looks fine’ without really reading the important details on it. But when we do an Active ID, then the patient has to generate the information him or herself and it gives us additional confirmation and better verification.”
Amy, a current patient undergoing IVF at Shady Grove Fertility, said of the multiple checks, “When I came in for my embryo transfer, I almost had to laugh at how many times they asked me to verify my identity. But the truth of the matter is, I was really relieved they were doing it. There was no way they could make a mistake with that many checks in place.”
Nowhere are these procedures more evident than in the embryo transfer room. Besides doing multiple written and verbal identifications, newly installed video monitors provide an additional level of confidence for the patient. These monitors are linked to microscopes inside the IVF laboratory so both the doctor and the patient can read the label with the patient’s name and MPI number on the correct petri dish and confirm, once again, that these are the correct patient’s embryo. And even after all that, the embryologist and the doctor doing the transfer verbally confirm the patient’s name and number of embryos for transfer immediately before placing the catheter with the embryos into the uterus.
While patients experience some of the protocol first-hand, there are many protective measures that happen behind the lab door. Embryologists always work sequentially. This means that there is never more than one specimen being processed in the laboratory at a time. Also, each of Shady Grove Fertility’s laboratories are inspected and accredited by The Joint Commission and the Accreditation Association for Ambulatory Health Care. Finally, Shady Grove Fertility voluntarily reports the results of all its procedures to the Society for Assisted Reproductive Technology (SART), which acts as a governmental watchdog for the field.
Staff are Extensively Trained
“There’s no room for error here, so having a highly capable, well-trained staff is just as important as having a well-designed protocol,” says Jim Graham. All of Shady Grove Fertility’s andrologists and embryologists receive extensive training before they ever work on a patient’s case. In fact, it takes four years to become a Senior Embryologist.
Having a larger staff than some other fertility centers also helps improve embryologists’ effectiveness.Robert Stillman, MD, Shady Grove Fertility’s Medical Director explains, “The size of our staff allows us to limit the number of procedures any one person does each day.”
The Patient is More Than a Number
At Shady Grove Fertility, photographs of patients are attached to their charts. Jim Graham believes that these pictures are a great motivator to embryologists. “We’re very results-driven, but the patient is the first priority. I always tell staff members to take a moment to remember that the data they’re looking at – the ultrasound, the specimen – belongs to a particular patient.” Having success for the person – those patients – is the reason embryologists follow the detailed, and sometimes tedious, laboratory procedures.
Dr. Stillman adds, “We want patients to know that there is nothing more important to us than safety and quality. If there were a choice between a patient getting pregnant and following patient safety protocols in the lab, the protocol would win out. That is our pledge to them. These are human endeavors, so there is always risk, but our mission is to have quality control and best practices so that that risk is as close to zero as humanly possible.”