Optimising embryo biopsy using laser (saturn5) guys

Optimising Embryo Biopsy using the Saturn 5 Laser System

Ms Max SempleSenior Embryologist HPC, Biopsy Practitioner

Guy’s & St. Thomas Hospital, ACU

Current Practice

• D3 biopsy (cleavage stages): Acid Biopsy/ Laser

• D5/6 biopsy (Blastocysts): Laser

• Predominately the practioners are acid users, but training in laser now

Video of Acid D3 Biopsy

Video of laser D3 Biopsy

Big Brother Watching

Embryoscope is used for ALL PGD cases.

“Time lapse system can monitor any effects

(if any) on embryos biopsied via Laser or acid and practioners”

Advances in PGD programme

• Guy’s shifting towards TE Bx

• Laser replacing acid tyrodes

• Invested in the new Saturn 5 laser system

• Hands free, programmable system

RI Saturn (3) laser system

• Manual calibration and alignment challenging• Move embryo into target position physically• Laser using single shots via mouse/foot pedal• Difficult to keep steady

• Calibration is quicker and simpler

• Automatic alignment using PC (simple user-friendly programme)

• Move the target into position for biopsy

• Mouse delivers pulse

• Multiple functions for biopsy– Single, multiple or biopsy mode

• Easier to manipulate embryo

RI Saturn (5) laser system

Video of Laser D5 Biopsy

Embryo Biopsy by Laser

D5 Biopsy (Trophectoderm)

D3 Biopsy

Laser Ablation Hatching BC

D3 Cleavage

TE Bx BC

Hatched BC Post TE Bx

Hatching BC Hatched BC

Single Cell Bx

Comparing laser with acidEffect on embryo/biopsy

Acid tyrodes Laser

Culture media use More Less

Microneedle use More Less

Microtool holder Double optimal Single sufficient

Biopsy duration Longer Shorter

Chemical damage Acid/pH effects None

Thermal damage None Precautions to minimise the effect

PrecisionCalibration and QC

Low Difficult

HighSimple

QC

• Trophectoderm cells can be thermally damaged and may not provide results (DNA damage).

• Laser is powerful and potentially embryo lethal. Proper training and competency assessments need to be in place (Guy’s data)

• Calibration and preventative maintenance • EQAS – individual practitioners to send ‘typical’

biopsy videos for external assessment.• Time-lapse analysis of all PGD cases to monitor

any effects of biopsy (ongoing)

Cost of Change• Laser is a significant financial investment• Previously centres use to make their own acid,

now commercially available• PGD consortium data (shift from acid to laser) • Long term picture – cost of laser offset against

– Reduced procedure times– Reduced consumable costs– Improved outcomes?