Training in the embryology lab: validation is the key

ICSI, the introduction of a sperm into the cytoplasm of oocyte using a micropipette, is a widespread assisted technology of growing popularity worldwide; in Europe, ICSI was reportedly used in 271,711 ART cycles initiated during 2010, which corresponds to 68.40% of all ART cycles reported in the region. Much like other laboratory procedures, ICSI is operator-dependent and requires training to be performed successfully. Most laboratories establish internal training schemes for junior embryologists in order to learn ICSI. Nevertheless, painfully few ICSI training protocols have been reported in the scientific literature. Moreover, commonly used training schemes are not tailored to the trainee and do not allow for individualized assessment of proficiency, and are not validated against clinical results. Finally, the difficulties encountered by clinics and hospitals to procure and operate with gametes and embryos of animal origin, both from the legal and practical point of view, might push ICSI to be learned on viable human gametes, opening ethical issues of great relevance.

A recent work by our research team addresses some of these issues, specifically we wanted to know how we could make sure that when we send an embryologist to treat patients by ICSI, the embryologist is really trained (http://www.ncbi.nlm.nih.gov/pubmed/26979744). We have used the Learning Curve-CUmulatine SUMmation (LC-CUSUM), a statistical method which allows to monitor in real time whether a proces (in this case, the ICSI outcome) is “in control” or “out of control” according to pre-established standard. We have found that while some trainees were able to learn ICSI in as little as 35 trials, and to be as proficient as expert embryologists afterwards, others could not learn properly even after 80 trails. This large gap indicates that ICSi should not be taught and practiced a fixed number of times, since a standar training protocol will result in two outcomes. On one hand, trainees that are fast learners will use more resources and be overtrained, and on the other hand, and most importantly, trainees that are slow learners might begin to treat patients before they are ready to do so. All ART centers have the responsibility and the duty to make sure that their personell is fully trained and proficient before they are placed in charge of patients, and we think that ART facilities should adopt individualized training for ICSI, and allow for sufficient time to adjust to different trainees training paces.

Rita Vassena
Scientific Director, Clinica EUGIN