We should be very careful in handling gametes and embryos . There should be regulations or system that ensures minimizing errors during IVF cycle

1. Errors in IVF : How To
manage?

2. Outline
• Introduction
• Incidence
• Causes of IVF errors
• Grading
• How to Avoid
• Clinical errors
• Disclosure to patients

3. Introduction
• The aim of this talk is to discuss the unintended errors
that may occur during the IVF procedure
•Ricardo Asch

4. Incidence
• ART errors are fortunately a rare occurrence
• But mistakes are inevitable
(Mark P. Trolice et al., 2020)

5. Causes of IVF errors
• 1. Clinical
• 2. Administrative
• 3. Embryo Lab
(HFEA, State of the fertility sector 2019/2020)

6. Causes of IVF errors
1- Clinical
• Andrology
Semen Analysis
associated ID

7. Infertility Specialist
• Sub-optimal stimulation protocols
• Variation in skills for ovum-pick-up / Embryo Transfer
(HFEA, State of the fertility sector 2019/2020)

8. Hospitalisation
• major vessel injury (internal iliac).
• Patients starting a treatment cycle before all of their screening
results were reviewed (hepatic & anaethesia)
• Severe OHSS
(HFEA, State of the fertility sector 2019/2020)

9. As of the fertility sector 2017-2018
2- Administrative ( most common)
• Usually data protection breaches
• Overbooking , negligence, dis coordination

10. Also
• communication skills among team members.
• Daily organization, distribution, and easy visualization of
laboratory tasks.
(Maria and Amparo, 2013)

11. 3- Embryo Lab
• All procedures related to frozen embryo and egg storage.
• PGS/D including sex selection.
• Equipment failures / calibration.
• Accidents / Mix-ups.
• Power failure.

12. Human
• heavy clinical workload and distraction.
• Sakkas et al. reported error rates were significantly low where 99.9% of
procedures proceeded with no errors.
(Sakkas et al., 2018)

13. Outline
• Introduction
• Incidence
• Causes of IVF errors
• Grading
• How to Avoid
• Clinical errors
• Disclosure to patients

14. Grading
None/Minimal
Error or problem occurred, but fully correctable or
no measurable effect
Moderate
Serious error which affects a cycle, but cycle not lost
(Sakkas et al., 2014)

15. Significant
Significant compromise or loss of cycle
Major
A pregnancy or birth confirmed to have arisen from a misidentification
of gametes or embryos
(Sakkas et al., 2014)

16. How to avoid?
• Strict system
• Avoiding situations that can lead to errors
such as insufficient staffing and insufficient training.
• Avoiding the manipulation of more than one sample at
Once and shared working spaces.
(Maria and Amparo, 2013)

17. General rule
• Guidelines suggest that safe and efficient ART laboratory operation
requires one embryologist for every 150 ART cycles per year.
(Practice Committee of the ASRM, 2008)

18. Assess
• ratio of senior to junior embryologists to determine
appropriate staffing.
•1:2
(Alikani et al., 2014)

19. Cryo embryos & semen
• Some tank alert systems feature a scale underneath each tank to
monitor the liquid nitrogen.
(Mark P. Trolice et al., 2020)

20. Regarding clinical errors
• Ensure that staff are suitably trained to carry out egg collection.
• Supervision
• Have a protocol for the management of patients at risk of OHSS
(HFEA Adverse incidents in fertility clinics 2010-2012)

21. OHSS free clinic
• Lower human chorionic gonadotrophin dose
• Gonadotrophin-releasing hormone agonist in antagonist cycles
• Cryopreservation of all embryos
• Use of oral dopamine agonists after oocyte retrieval.
( El Tokhy et al, 2016)

22. Procedures for identification
• Manual double witnessing
• Electronic witnessing
– Matcher – bar codes
– RI Witness – RFID (Radiofrequency identification)
(Brison D, et al., 2004)

23. IMT International
Matcher

24. In addition
• reduce patient concerns.
• electronic tracing each procedure and the time it was
performed.
(Maria and Amparo, 2013)

25. Multichamber Incubators

26. Outline
• Introduction
• Incidence
• Causes of IVF errors
• Grading
• How to Avoid
• Clinical errors
• Disclosure to patients

27. If happened : Disclosure to patients

28. “Culture of truth-telling”
• People will trust you more if you told them the hard to say/hard to
hear things that everyone else was avoiding.

29. Disclosure: 2016 ASRM Ethics Committee Report
Ethical obligation
• • Errors that affect the number or quality of embryos should be disclosed
• • Obligatory to disclose errors where gametes or embryos are switched
• • Promote culture of truth-telling

30. Catastrophe