I consider Andrology as the foundation to firmly stand before you set your foot on IVF or Embryology. Efficiency, precision, and skills are important in IVF and the lack of many courses in this field has added as a disadvantage. Individuals join as trainees in fertility clinics but fail to get the necessary exposure owing to no organized training environment coupled with the intense haste in wanting to proceed in the lab work. In whichever way you embark, ethics needs to be on our side as we try immersing ourselves into ‘on the job’ learning exercise.

Andrology training can be sustained as the sperm requirement for Handling and processing is done with ease as there will be samples collected for semen analysis. The samples provide some platform for the trainees or juniors to learn the craft. But when it comes to embryology, resources in hand are not really in plenty. If the IVF cycles or cases are low, it is difficult to progress and a systematic procedure to upgrade you tends to be an arduous task. In embryology, techniques need to be practiced innumerable times before we finally apply it to the patient live and even here, the application has to be initially subtle followed by a full-scale exposure.

Of all the procedures including ICSI, freezing and embryo transfer, the most basic part is to learn ‘handling human oocytes’. Unless proficiency is not gained in the same, the embryology techniques will be quite impossible to master. Hence, Oocyte Handling (which also will make you handle embryos) needs to be worked upon diligently and is quintessential to be a successful Embryologist.

Oocyte handling is based on the use of an instrument called the ‘Denupet handle’ which can be a miniature version of your micropipette. On the contrary, a Denupet handle exhibits similar characteristics as compared to a micropipette including the frontier to attach disposable tips, the rear designed like a handle to hold and a standard volume gradation embedded in it for aspiration. The Denupet tips are disposable tips used for the actual handling of oocytes or embryos and come in different sizes depending upon oocyte, embryos or the blastocysts. For example, if I am using Denupet tips from RI, you will have a size of 145 um for handling oocytes, 175um for managing cleavage stage embryos and 275um for the blastocysts respectively. Initial handling will be concerned with transporting them which will be followed by practicing Vitrification, etc. The principle applied in using the Denupet handle is that we need to fix a volume, aspirate and draw some fluid in which we have the necessary gametes or embryos and that column of fluid will continue to remain. As we aspirate oocytes and release then at a new location, there will be an interplay of positive and negative pressures.

The training should comprise the transportation of oocytes from one dish to another followed by movement from one drop to another and gradually shifting towards attempting Vitrification or denudation. If the resources in the IVF lab are few owing to less number of cases or otherwise, microbeads can be a good alternative or a substitute to help you in that situation. After working on the beads which do not float, discarded unfertilized or even degenerated oocytes can then be used to practice as they will give you a hang of features such as buoyancy, floating nature and its ability to get entangled into the bubbles. The formation of bubbles and the loss of oocytes are some of the hurdles you need to overcome. A self-assessment program can be applied where a prescribed number of oocytes will be taken and an account of how many of them you lose in the end will be regarded as a learning measure. Some of the precautions in oocyte handling include not pressing too much as the end of the handle to aspirate the media during operation as this may spoil the spring and render it not functional or requiring servicing.

In the past, pulled pipettes were used to handle and work around the human oocytes which had tremendous disadvantages such as lack of sterility, pointed edges and loss of oocytes permanently if you lose control of the rubber bulb. Thankfully, the introduction of the Denupet handle has helped to overcome these aspects and now these handles are an inseparable part of your IVF lab equipment. Nevertheless, that does not take away the fact that learning oocyte handling systematically is essential in giving yourself the necessary foothold to grow.

Read more on The importance of embryo grading and selection