She's 'made' about 700 IVF babies in 18 years: This embryologist tells us what it takes to do her job
Melinda Chan was 27 when she first joined KKIVF Centre as an embryologist. She tells CNA Women her secret to convincing trying-to-conceive couples not to give up, and how rigorous and intense her role can be, in this first instalment of our National Day series on women with unusual jobs.
After Melinda Chan graduated with a Biotechnology degree from an Australian university in 1999, she dived straight into research work in Singapore where she worked on a bio-artificial liver device to help patients with liver failure. Think of it as a dialysis machine for the liver, she said.
Just as her two-year contract was ending, she came across a job advertisement for an embryologist. What stood out for her was the job description: The hospital needed someone with experience in cell culture (or growing cells in a dish), which was right up her alley.
“I wanted to work away from research and animal trials, which was something I wasn’t really comfortable with,” Chan told CNA Women. “I thought it was time for me to move to healthcare instead.”
Chan joined KKIVF Centre in April 2002 as an embryologist, whose daily scope involves using assisted reproductive technology such as in-vitro-fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) to help couples conceive. ICSI is the process of injecting the man’s sperm directly into the egg to fertilise it.
She was 27 then. Two decades later, she is KK Women’s and Children’s Hospital’s chief embryologist, leading a team of 15 embryologists at the largest fertility centre in Singapore.
She is among 60 or so embryologists in the country, and in her 18 years as a trained embryologist, has helped make babies happen for couples struggling with infertility – nearly 700 successful pregnancies, she said.
“IT TAKES A CERTAIN KIND OF CHARACTER TO FIT THIS ROLE”
Chan’s day begins before 8am, after the gynaecologist has extracted the eggs from a patient in the operating theatre. When the eggs are transferred to the adjacent IVF lab, the embryologist first ensures that the fluid they come in is kept warm, at a constant body temperature of 37 degrees Celsius.
Using a microscope, the embryologist scans the fluid for eggs before transferring them to a solution designed to give eggs and sperm a conducive environment for growth.
You need to have a bit of OCD because every process involved in IVF requires double checking.
Typically, 10 to 15 eggs are extracted from a patient. “Ample time is allowed for eggs to ‘rest’ before fertilisation takes place,” said Chan.
A trained embryologist then injects the man’s sperm directly into the egg to fertilise it. This is done in a petri dish under a microscope.
The embryos will be left to grow in the lab for up to five to six days before they are ready for implantation. Depending on the history of the patient, the gynaecologist typically implants one or two embryos into the woman’s uterus.
As an embryologist, Chan said the hours spent on microscopic work in the IVF laboratory can be long and intense, with little room for error or any form of distraction.
Stellar hand-eye coordination is crucial. “You can’t keep looking at your left hand and right hand while looking through the microscope,” she explained.
This is particularly so during ICSI where the embryologist has to coordinate between two joysticks, one in each hand, to inject the sperm into the egg.
“It takes a certain kind of character to fit this role,” Chan smiled. You also need to be tidy and meticulous, what she describes as “a bit of OCD”, referring to obsessive compulsive disorder, a term often used to reflect one’s tendency to repeat certain behaviours.
“Some people think an embryologist’s job is very glamorous, but I always tell people that we’re like a kitchen: We are creating a recipe, cooking the broth, then later we put it in the oven before the final product is ready,” said Chan.
RIGOROUS TRAINING ON THE JOB
All embryologists come from biology backgrounds and the minimum qualification is a degree in science – there isn’t a basic degree course in embryology, said Chan. The embryologists in Singapore are trained in-house, in the laboratory. Depending on how long one takes to master specific technical expertise for certain tasks, training could range from three to five years, she said.
“It’s a very strict training environment – you’ll be under close supervision by the licensed embryologist and it’s a very steep learning curve,” she added. Grading the embryos, for instance, requires a high level of training and a yearly internal audit among the team to ensure consistency of their skills.
Chan explained that “top quality embryos” come in uniform size and shape along with the right number of cells; an average-looking embryo appears slightly irregular, with fewer cells.
When it comes to recruiting fresh graduates, Chan has specific eligibility criteria in place to pick out those suited to the job.
“You need to have a bit of OCD because every process involved in IVF requires double checking. We actually carry out a number of aptitude tests to test one’s character; otherwise, you will probably drop out by yourself within the first year,” she said.
"Do you play any music instruments? Do you play video games? Do you drive?”
Chan often asks such questions to aspiring embryologists. “Excellent hand eye coordination and dexterity is one of the main criteria required for this profession,” she explained.
Chan herself indulges in Zumba and cardio dance during her spare time, and even toyed with the idea of a full-time career in music. “I play the organ and used to play the trumpet in a band. I thought of joining the Singapore Symphony Orchestra after I graduated, but I never quite made it.”
The laboratory is also a high-stress environment so embryologists need to be able to perform under pressure. “Once the eggs and sperm are out, everything goes on clockwork. We need to follow a fixed timetable on which procedure needs to be done. We cannot have delays as eggs and sperm age with time,” she said.
HELPING COUPLES TO CONCEIVE: “MY GOAL IS TO PUT THINGS INTO PERSPECTIVE”
While embryologists usually don’t have direct contact with couples, a brief conversation takes place after an embryo transfer, as well as another detailed one at the end of the IVF cycle.
While most of these interactions are short and quick, Chan has, at times, had to address more complex cases, including patients who face multiple embryo transfer failures. In IVF, a successful outcome would mean that the embryo has implanted in the woman’s body; a failure means the body has failed to accept the embryo.
The pressure can come from family, friends or even the workplace. Some of them are able to talk about it very openly, but there are some who can’t even share it with anyone.
In such cases, the couple would usually have more questions about the outcome, such as the grading of their embryos.
“Sometimes there’s this essence of self-blame; they think there’s something wrong with them. They will ask: What is Grade A, B or C? Once they start talking about numbers and grades, the body itself is already very stressed. They put a very high expectation on the quality (of the embryos).”
Chan further explained that it may not be because of the embryo or the health of the womb. It could be that the couple’s stress levels during each cycle have a huge impact on the body, resulting in implantation failure.
“My goal is to talk to them and put things into perspective. The pressure can come from family, friends or even the workplace. Some of them are able to talk about it very openly, but there are some who can’t even share it with anyone. The stress builds up and it affects the entire body,” said Chan.
She makes it a point to ask the patient’s husband to be around during these conversations as it’s important for the couples to understand they are contributing equally to the success of each cycle.
“Producing a sperm sample on demand is a very stressful time for the men as well,” she added.
EVERY EMBRYO COUNTS: “NEVER JUDGE A BOOK BY ITS COVER”
Chan recalled numerous scenarios where her patients were down to their last embryo: “At that point, they’ve already resigned themselves to fate – that it’s probably not going to work out,” the mum of three said.
“But that is actually the one that implants and becomes a baby,” she added excitedly.
Some patients even want to throw away their last embryo, Chan told CNA Women. “They think that if the first two didn’t make it, the last one won’t make it at all.”
“Remember that a grading score is not key to the success of each IVF cycle. It is just used as a guide, and is certainly not absolute because success is dependent on many factors.”
What’s her secret to convincing couples to give their last embryo a shot? An analogy which, she said, works most of the time.
“If you have two kids of the same age – one kid is 1.4 metres tall and the other is 1.2 metres tall – is the shorter kid any inferior to the taller one? Their answer is no. And will the 1.2 metre-tall kid always be the shorter one? No, right?
“For an embryologist to grade the embryos, we can only judge them by its shape, size and appearance – but no one can tell the innate quality of it.
“Likewise for embryos. They can be slightly slower at this point of time but that doesn’t mean they can’t catch up. In the laboratory, as long as we can grade them, they are usable. And as long as they are usable, they deserve a chance. The moral of the story is never judge a book by its cover,” she said.
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