The medical profession in other branches unilaterally places the onus on the Clinicians. The skills of a doctor drive a medical branch, for example, say cardiology. Undoubtedly, supporting roles played by the assistants and the staff is critical but clinicians are the nucleus and their role is monopolized. When we talk about IVF and infertility, the Clinician continues to play the essential role but here clinical domain is only one part of the ART cycle. IVF incorporates a duopoly where the clinical side has to be supported by the lab part which is assigned to an embryologist. The success of an ART clinic depends upon both the players where oocytes obtained by stimulation protocols of the clinician need the able hands of an embryologist to make them into embryos. Both the embryologist and a clinician are capable enough to handle their respective forts effectively. However, diffusion of basic knows how on both sides is useful. Nevertheless, the success or a failure in an ART cycle is more borne by the clinician considering they counsel and face the patients. Given the same, is it not essential for the clinicians to be abreast of what’s happening in the IVF or an Andrology lab?

Primarily, clinicians need to be completely aware of the basics which can certainly alter the course of the treatment. I remember visiting a clinic where after denuding all the oocytes, I realized not even one of them was mature. When I informed the clinician, he first asked me if an IVM cycle as possible. Fair enough, considering he may not be acquainted with the ensuing technicalities and different approaches needed to do an IVM cycle. His next question was if we can do conventional IVF! The query was shocking considering it is fundamental to know once the cumulus is denuded, we cannot use the IVF approach! This experience highlighted the necessity of why the IVF clinicians ought to know a few basic aspects. When I fast forward to embryo transfer, the responsibility of the clinician will increase to know more from the lab side. If as an embryologist, I am transferring two good day 3 embryos and if I show it to the clinicians before the transfer, they should understand the details I furnish it to them. If it is an 8 cell, grade A embryo, the clinicians should be aware of how such an embryo appears at that stage. Aspects such as temperature fluctuations during oocyte handling or filling the test tubes with follicular fluid during the ovum pick up only up to the brim and maintenance of sterility in the IVF lab are some of the examples. These are basics that need to come naturally and knowing them is a must.

A slightly higher stage for the clinicians concerning embryology might be to know about the components of the lab such as the media, the instruments, and the techniques. For example, if I inform that the time required to inject ten oocytes is an hour, a clinician who is not aware may assume it to be the truth not realizing its an overexposure. Many clinicians enroll to get trained at EART not becoz they will be doing the techniques themselves but to imbibe the minimal know-how which can help them steer cycles. The decisions are taken such as the number of embryos to be transferred, if we need to do fresh or frozen ET, the means and methods of all the techniques, the documentation and knowledge about filters and air quality together are important for the clinician to be in the loop.

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And then there is the highest stage of a clinician hobnobbing with the lab side and that is when the clinician has to participate in the proceedings on account of a freelancer embryologist. At many clinics located in the remote corners and locations of the country, full time in house embryologist is impossible or not economical to find. In such a scenario, freelancers rule the roost but the problem is they mostly come for only doing ovum pickups, ICSI, embryo transfers, and vitrification. There is a great deal of embryology too in between these main procedures which include preparation, embryo checking and QA/QC. Especially in case of preparations, the clinician should know the basics as I have seen some not labeling tubes aliquoted, keeping the media tight lid even if it is a CO2 based media like single-step media for example. Many are not aware of the principle where the infusion of CO2 is necessary to maintain the pH of the media and a loose lid is a must. Fertilization check, embryo development, handling oocytes and embryos with a Denupet handle and stock check may be a requirement of some clinics if they have a paucity of in house lab personnel. A step above may also result where the embryologist will strictly come for ICSI only and in that case, a clinician may have to upgrade themselves to do techniques like embryo transfer and freezing. One of the most neglected tasks in an IVF lab in the absence of an in house embryologist is topping of cryo tanks with liquid nitrogen.

Interestingly, I was able to do all the procedures as an embryologist under the able guidance of a clinician. ART will scale newer heights in terms of success, quality, and pregnancies if the association between the clinician and the lab side is smooth and cooperative. The clinician must understand embryology and the lab better as finally, they have to answer the patients when the results come negative!

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