Melanie Cole, MS (Host): Did you ever wonder what happens during egg retrieval from the lab and embryology perspective? Well, we're here today to give you a behind the scenes look at the science of egg retrieval.

Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. And joining me today is Casey Pagnotta. She's an embryologist with RSCNJ.

Intro: The Reproductive Science Center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's Melanie Cole.

Melanie Cole, MS: Casey, welcome. I'm so glad that you could join us today. I'd like you to start by telling us a little bit about yourself. And what is an embryologist? What do you do every day?

Casey Pagnotta: Hi, Melanie. Thank you for having me today. So, an embryologist, a day in the life of an embryologist, we're in the lab for the most part. We do some paperwork outside of the lab, but our daily routine is in the lab. We will start by doing quality control in the morning, and we look over our instruments and equipment to make sure that everything is properly working. We also do egg retrievals where we see the patient. We do embryo transfers where we see the patient. But most of the time, we are behind the scenes working with the eggs and the sperm and the embryos, as everybody likes to say where the magic happens in the lab.

Melanie Cole, MS: How cool is that? You have such a cool job, helping people to start families. So Casey, walk us through a typical process of egg retrieval day from your perspective. You said you get to actually meet with the patients. So, tell us how all of this works.

Casey Pagnotta: Sure. So, a normal egg retrieval day for us, we could have one egg retrieval or several. Our lab door is connected to the procedure room where the doctor will knock on the door. And we will all start out by doing a timeout, which is just a name check with the patient and date of birth to make sure that we're all working on the correct person at the time. Then, we will go back into the lab and the doctor will aspirate the follicles into tubes and they hand them to us where we look through the follicular fluid for the eggs. So once we collect all the eggs, we will put them into a dish and place them into the incubator.

Melanie Cole, MS: What about preparations? You mentioned in your intro that you go check your instruments for quality control, and then you do the name check with the patient. And then, do you go back to your lab while the doctor does the egg retrieval? Speak about the preparations you are doing in the lab to get ready for when the eggs arrive to you.

Casey Pagnotta: All of our prep for the egg retrieval actually starts the day before. We will start by making a variety of dishes and we write the patient's name and date of birth on all of those dishes. From there, we fill them with culture media. And then, we place them in the incubator to equilibrate overnight. That way, by the morning everything is ready to the correct pH and temperature. And another thing, like I mentioned, is we do our QC in the morning just to make sure all the equipment is working properly, that the refrigerator and the freezers are the right temperature and things like that.

Melanie Cole, MS: So, tell us some of the main steps that are involved in processing those retrieved eggs once they get to you in the lab.

Casey Pagnotta: Sure. So once we collect the eggs, we place them into a dish with culture media, and they go into the incubator. Until we use them again, which for a standard insemination case would be four hours. That's when we would add the sperm to the eggs and just let them do their thing in the dish overnight.

For an ICSI case, which I know my coworker, Amanda, talked about on one of these before, for that one, we will do stripping of the eggs two hours after the egg retrieval and stripping the eggs means we remove the cumulus cells, which allows us to visualize the maturity of the egg because we will only inseminate the mature eggs. So once we do that, another two hours later, we will fertilize the eggs.

Melanie Cole, MS: Isn't that fascinating, what you get to do every day? How does the lab ensure quality and viability of the retrieved eggs during handling and processing? I mean, Casey, are these things very delicate?

Casey Pagnotta: Yes, everything with embryology is delicate. You have to have very steady hands. No sudden movements. We make sure that we know where the other people in the lab are at all times, so we're not knocking into anybody or anything like that. We have a double witnessing system, which just means that another embryologist will witness everything we're doing. Every time, we take a dish out of the incubator, we will make the other person check the name and the date of birth to make sure that it's the correct person. We also will work efficiently when we take the dishes out of the incubator to avoid shifting pH or temperature change.

Melanie Cole, MS: Wow. It's certainly a lot of responsibility. How do you determine, and the lab, the number of eggs to fertilize and the best timing of that fertilization you mentioned, that it sits overnight depending on the type that you're doing? How do you know how many to do?

Casey Pagnotta: We will always inseminate all mature eggs in an ICSI case and all eggs in a standard insemination case unless otherwise told by the patient. So, that would just be a special type of plan that the patient and the doctor would work out if they didn't want all of them to be inseminated.

Melanie Cole, MS: I'm sure this is a question, Casey, that you get every day when somebody finds out what you do for a living, what happens to the eggs that are not immediately used after retrieval? Are they frozen? Are they stored? What happens to those?

Casey Pagnotta: So usually, we will just all mature eggs, and we will either freeze them or inseminate them.

Melanie Cole, MS: So, does the patient decide that, and they let you know either to freeze some? Does the patient even know how many eggs were taken?

Casey Pagnotta: After the egg retrieval, we will let the doctor know how many eggs we have collected and the doctor will usually call whoever is dropping the patient off and picking them up, usually their partner. But these plans are all made ahead of time so that everybody knows what's going on. Usually, the patient will decide if they would like to only inseminate a certain amount. Then maybe, they'll freeze the rest of them and use them at a later time. But for the most part, we always use all of the eggs.

Melanie Cole, MS: Casey, really, really interesting what you do, and you're so lovely. Please let the listeners and viewers know what you would like them to know because you work in the lab. This is your perspective about helping families to start families. And it's such an exciting career. I just want you to summarize what you would like the best advice to be for people that are looking to start a family and kind of want to know what goes on behind the scenes in the lab. Just wrap it up for us.

Casey Pagnotta: I would say not to be so nervous about what's going on behind the scenes because all of us embryologists are highly trained on all the techniques. And like I said, we have a double witnessing system, so there's nothing to be worried about. There's already so much stress as it is going through IVF. So if we can just let them not be as stressed about what's going on behind the scenes, that would be good.

Melanie Cole, MS: I love that you said that because I think that's so important for couples to hear is don't worry about what's going on behind the scenes. We've got you. We've got this taken care of, and so highly trained. And thank you so much, Casey, for joining us today. For more information, you can always visit fertilitynj.com to get connected with one of our providers. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. Thanks so much for joining us today.