Effective management matters! Factoring time and lab workload in the assessment of embryological outcomes across 8 years. Real-life experience of a large IVF practice

• Published in: Reproductive biomedicine online Vol. 48; p. 104035
• Main Authors: Maggiulli, R., Innocenti, F., Papini, L., Taggi, M., Cermisoni, G.C., Casciani, V., Soscia, D.M., Albricci, L., Fabozzi, G., Alfano, S., Alviggi, E., Vaiarelli, A., Ubaldi, F.M., Rienzi, L., Cimadomo, D.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-05-2024
• ISSN: 1472-6483
• DOI: 10.1016/j.rbmo.2024.104035

Effective IVF lab management is pivotal. Achieving this requires balancing operator training, monitoring key performance indicators (KPIs), workload, and timings. However, current evidence is contradictory. This study aimed to evaluate the impact of lab management factors, including operators, workload, year (2015 to 2022), retrieval-to-denuding timings, specific sequential oocyte-retrieval of the day, culture media, and incubators, on embryological outcomes in 7986 ICSI cycles conducted by 5204 couples across 2114 working days with ≥1 oocyte-retrieval.
Data on operators and timings were collected automatically using an electronic witnessing system (EWS). Associations with embryological outcomes were analyzed using multivariate linear regressions and generalized estimating equations (GEE), considering repeated measures for couples undergoing multiple retrievals.
On average, 6.6±4.5 (range:1-32) MII-oocytes were inseminated in 38.5±3.8 (24-48) years-old women, whose partners’ Severe Male Factor (SMF) prevalence was 18.9%.
Overall 27.7±15.9 (1-94) procedures were conducted by 8.2±2.4 (3-12) operators per day. Oocyte-retrievals plus ICSI (4.4±2.6 per day, 1-15) represented 7-24% of the daily procedures. These figures increased across the years and were unevenly distributed across the week. The procedures per operator on Fridays, Saturdays and Sundays were 0.6X, 1.4X and 2.4X than the average of 3.6±2.2 (0.1-21). Differences in fertilization-rates appeared among years, days of the week, specific sequential number of oocyte-retrieval, and denuding/ICSI operators. However, the only significant association after adjusting for maternal age and SMF was the time retrieval-to-denuding (unstandardized-B:-1.5%, 95%CI:-2% to -1%,p<0.001). Denudings conducted beyond 3 hours showed fertilization rates >75% that decreased until falling below the clinic average (73%±26%) for denudings beyond 5 hours. Similar trends were observed for blastulation-rates (unstandardized-B:-1.3%,95%CI:-1.9% to -0.6%,p<0.001) that decreased from ≥50% to ≥45% for denudings conducted beyond 3 hours from retrieval. Continuous media performed better than sequential (unstandardized-B:-2.6%,95%CI:-3.9% to -1.2%,p<0.001) and undisturbed incubators than disturbed (unstandardized-B:-1.6%, 95%CI:-2.2% to -0.9%,p<0.001). No association was reported for euploidy-rates among the 5262 PGT-A cycles.
These findings suggest that balancing daily/weekly workload - even when substantial - with the number of well-trained and controlled operators can maintain or even improve the overall IVF performance, carefully monitored through lab KPIs. Notably, the time retrieval-to-denuding should not exceed 3-4 hours.