What Does an Embryologist Do?

Find Dr. Michael Baker and Denver Fertility Albrecht Women’s Care at the links below

https://www.facebook.com/AlbrechtWomensCare

https://www.instagram.com/denverfertilityawc/

https://www.albrechtwomenscare.com/

September Burton: Good morning, everyone. This is September Burton from the Colorado Fertility Conference Podcast. Today I have with me Dr. Michael Baker, who works at the Albrecht women’s care center. Dr. Baker’s top priorities revolve around exceptional laboratory communication with patients and persistent quality improvement. IVF Patients at Denver Fertility can expect multiple opportunities to discuss their lab journey with Dr. Baker, both before and after treatment. Nothing makes his day more than a visit from a baby he once cared for as an embryo. Michael, thank you so much for coming on the show today.

[00:00:32] Dr. Michael Baker: Well, thanks for reading all of that. Happy to be here.

[00:00:36]September Burton: What was intriguing to me in your bio is how you talk about keeping patients front and center keeping their mental health and their emotions in the forefront of everything that you do. I love that.

[00:00:47]Dr. Michael Baker: Yeah. I think that’s really a great point for Denver Fertility.  Were really trying to maintain the boutique fertility care center atmosphere. We want to be able to give that personalized care and attention to each of our patients. And though sometimes it’s a very busy day in the lab I do try to make time for patient phone calls. We also do an IVF orientation seminar for new patients or possible prospective patients. That way they get to interact with the lab. I know I hear time and time again on social media and in different forums that a lot of patients don’t get to talk with their embryologist ever. And we want to make that accessible. We want to be available for our patients to fully understand the process and have complete confidence in the laboratory that they’ve chosen and the clinic as a whole so that they can rest assured that they feel that their embryos are in the best hands possible.

[00:01:50] September Burton: I like that. I think that’s really admirable. So one of my first questions was what made you decide that you wanted to be an embryologist?  You saw sperm fertilize an egg and loved that. But what was it?

[00:02:03]Dr. Michael Baker: That was the day I made the commitment to changing my education and my career path, but truly I started having interests in reproduction even I can think back as far as high school biology classes, where I just had an increased interest in the lectures on meiosis and reproduction and how do sperm and eggs develop? How does an embryo grow? And I took that  to heart, but during my first few years of college I was soul searching and truly I was in a comfortable path to become an artist. I was working in ceramics and sculpture and had aspirations of glassblowing. But I took another biology class in college and got reminded of my love for science and genetics specifically. And that got me to Texas A&M working on my bachelor’s in genetics. They were the best genetics major in the state. And so I, took off to college station. and then through those years, I started asking myself “well, what do I want to do with genetics?” And I looked at a few different career paths, one of them being genetic counseling. And I realized after spending a day with a genetic counselor that that’s 95% counseling and 5% science. And that wasn’t quite the weight that I was looking for. And then I discovered IVF and the role of an embryologist, but I was relatively young, I hadn’t even finished my bachelor’s degree. And when I reached out to an embryology lab I really kind of hit a brick wall and I didn’t get to spend a day with an embryologist, like I did genetic counselors. And so I wasn’t able to slip into that path at that time. But it was rather fortuitous because I did decide to go off to graduate school and begin my PhD. And about halfway through my PhD I finally got to meet an embryologist and spend a day in the lab, and I got to witness ICSI intracytoplasmic sperm injection, where they select one sperm and inject it into the egg. And that was the day that I decided I was going to complete my PhD in reproductive biology and work my way eventually to laboratory director. And I graduated from U.T. Southwestern in 2013. And I was very fortunate to get my foot in the door in a clinic in Texas where I was able to really start at the bottom and work my way up. The PhD gives you a lot of scientific know-how of the why we do things in the lab, but it didn’t teach any of the how. And that’s one of the challenges in training embryologists is the how, how to gain those hands-on skills is really an apprenticeship and you have to find a senior embryologist who’s willing to take you under their wing and work you all the way from andrologist with the washing and processing of sperm. Once you’ve proven your attention to detail, your multitasking skills, your ability to function under pressure. Then you work your way into the embryology lab where you again, with perhaps preparation of culture dishes to the handling of discarded eggs or embryos, just to make sure that your hands are steady and you’re able to work on that microscopic level. And then it gets worked one by one you learn your technical protocols as you learn to catch eggs for retrieval and strip eggs and get them ready for the ICSI procedure, fertilize eggs, grade embryos, all the way to freezing and warming of embryos, embryo transfers, and usually the grand finale of training is the PGT embryo biopsy for genetic testing.

[00:06:07]September Burton: Very fascinating. Everything you just said, I’m just in awe. So I guess my question is, can you kind of walk us through a process of egg retrieval, sperm retrieval, and then when the egg and the sperm get back to the lab what happens?

[00:06:19]Dr. Michael Baker: So the guys will collect their semen sample on the day of the egg retrieval. If they have any need to cryopreserve sperm in advance, that’s certainly a possibility. But that’s a relatively straightforward process. We’re able to wash that sperm and concentrate it. We’re able to separate the dead sperm from the modal sperm. And while it’s not natural selection, there is many, many levels of selecting for the best sperm possible for the day of egg retrieval. That process is proceeding in parallel with the oocyte retrieval. The egg retrieval is of course , rather invasive and requires general anesthesia. And the physician is there as well to aspirate the follicles on the ovary. And hopefully we’re able to obtain as many eggs as possible using the variety of stimulation protocols available at the hands of the physicians. But as they’re aspirating the many follicles that are available that day, we in the lab are searching through a sea of follicular fluid, blood, and flesh media, where we’re looking for that oocyte complex. It takes a trained eye to be able to find those accurately and efficiently. We don’t want to delay the procedure because the embryologists are taking too much time. So we really train to do that quickly, and again, very accurately. Once those eggs are collected in the laboratory, we’ll wash them out of all of that fluid into clean culture media. And in order to do a conventional insemination we can use that oocyte that’s surrounded by Cumulus cells. we’ll put tens of thousands of sperm in a drop of culture media, and allow that to fertilize naturally in quotations. But that is a potential for patients with optimal sperm conditions. And that will then be apparent the following morning. For the ICSI procedure we want to strip off all of the exterior cells, the Cumulus cells and get it down to just the oocyte itself, where we can observe the maturity of that egg and ensure that it’s expelled the polar body that contains the excess chromosomes and that it’s at the right stage to accept a sperm. If it’s mature, then we’ll be able to inject one sperm into each egg. And then again, we’ll wash that back into the culture dish, where it will stay for 16 to 18 hours before we’ll check it the following morning, in order to observe for pronuclei formation. And so with one pronuclei from the egg and one from the sperm they’re easily apparent to a trained eye under the microscope. We’re able to tell our patients how many of their eggs fertilized normally. Some, at that time we may not see any pronuclei or they may have three or four, one . If they have too many pronuclei, those are abnormally fertilized perhaps with a conventional insemination, more than one sperm made it into the egg or with an ICSI, perhaps that the oocyte was unable to expel the excess chromosomes that it needed to. But starting with the total number of fertilized oocytes that’s one of the important phone calls that I make to the patients where we then set expectations for blastocyst development, perhaps depending on age, a third to a half of those pronuclei 2PN embryos will go on to form blastocysts that it will be of sufficient quality for transfer or cryopreservation. And then we just get to watch those embryos grow over the next five to seven days as we allow the biology to take over and hopefully we’re able to achieve success for that cycle.

[00:10:20] September Burton: So I can imagine that you’re growing these embryos and then you implant this embryo into the mother and then nine months later, they bring in this little baby. And I can, I can only imagine what that feels like for you on your end, how gratifying that would be.

[00:10:34] Dr. Michael Baker: That’s a very special day. And to be honest, sometimes the embryologists are forgotten on that day and the clinical side of everybody getting to ooh and aah over the babies is always fun. But the days that somebody remembers, Hey “can we see the embryologists we’d like to meet our first babysitter”, if you will. That’s really special to get to see the final results of all of our hard work in the laboratory.

[00:10:59] September Burton: I love that. And you personally make those phone calls to the patients to let them know how the embryo is doing?

[00:11:05] Dr. Michael Baker: I am. Again, we’re very fortunate that our patient volume is kept to a manageable size so that I can give that personal fertilization call as well as a final call to go over the end results of an IVF cycle. How many embryos were successfully grown to blastocysts and cryo preserved and discuss some of the expectations for their upcoming cycles or their genetic reports. Those sorts of topics are very frequently brought up in those conversations.

[00:11:36] September Burton: So what’s your favorite part of being an embryologist?

[00:11:40] Dr. Michael Baker: That’s a really tough question. And of course, knowing that we’re helping people reach their goals of building their families, that’s the underlying motivation for everything we do. But on a day-to-day basis I really enjoy that I’m able to be accessible to patients. If they have a question for the lab that I can provide that confidence in who they’ve chosen to take care of their embryos. But then you get to the scientific part of me and I just really enjoy the technical challenges of being in the lab, working hands-on with the embryos. Some directors reach the point where there’s too much office work to be able to really care for the embryos and throughout my career I’ve gone from training in embryology, which is where I learned to make embryos and care for embryos, to supervisor, where my job really evolved into how to make a good embryologist. And now, at the director level it’s a big picture sort of view of how to maintain a successful laboratory with staff and equipment and relationships with patients and the clinical and all the other departments. But it’s very fortunate that I still have time to be in the lab, working hands-on with embryos, always trying to improve my success rates at a very small level. Being fertilization rates or my blast growth rates, and ultimately the take home live births per retrieval or per transfer rate. It’s always exciting when I can make improvements in that. And I enjoy keeping up to date with the latest technologies and tests and trying to better our clinic every day. That’s my goal–come in to work every day and do my best.

[00:13:30] September Burton: I like that.  I’m really curious when I was reading through your bio, it says that your dissertation research focused on the identification of genes which contribute to optimal sperm and egg formation. Do you mind talking about that just a little bit?

[00:13:43] Dr. Michael Baker: Absolutely. So  after discovering my love for embryology, I joined the lab of Diego Kasriel at U.T. Southwestern and he’s still there. He found a gene called FOXO3 that in mice, when we knocked out that gene , resulted in a massive development of all of the follicles in a mouse ovary within the first few months of that mouse’s life. So, their ovaries just blow up like balloons to many times the size of a normal mouse ovary and all of the follicles get activated. And then after that, there’s no more follicles remaining. So it was a really fascinating phenotype of a genetic knockout. And I really wanted to get involved with that genetic pathway and see if I could identify another gene that perhaps had similar responses. I worked on a gene called Reb. And when I knocked that out the ovary didn’t really have that same function and that’s part of science. Negative datas is true, but also frustrating. But when I looked at the male mice, they were infertile . they had small testicles. And while I initially started off in egg development, I was also able to turn that into a dissertation on sperm development and how that particular gene affected the spermatogenic STEM cells and just that whole sperm development process. And that was a great introduction to both sides of development of human gametes.

[00:15:14] September Burton: That is absolutely fascinating. Very cool. So what are some of the biggest changes that you’ve seen in the field of embryology since you’ve  been an embryologist?

[00:15:24] Dr. Michael Baker: I’d say I first got introduced to embryology nearly 10 years ago. And I mean, 10 years in the changing of technology can be fast and slow at the same time. But some of the new technology that’s coming out involving artificial intelligence and lapse microscopy, all of that’s very fascinating. Someday we’ll be able to have a computer analyze video of an embryo as it grows and divides. There’s different timings associated with different stages of development and artificial intelligence will be able to take all of that into account and add that to the final , sort of, the beauty contest of embryo grading, and give you a good, a better, more improved score on which embryos have the greatest potential for a successful pregnancy. I’d say stuff that I’ve already been able to witness is the rapid improvement of cryopreservation technology for freezing of embryos and eggs. When I first got into the field, egg freezing was considered experimental by the FDA and it’s since been released as a more accessible option for patients to cryopreserve eggs for fertility preservation and the success of embryo cryopreservation has gone from maybe 90% success to over 99% success in most cases. And that’s just been really reassuring to our patients that instead of one out of 10 embryos failing to survive a thaw now we’re seeing less than a one out of a hundred. We’re really getting great improvements from commercially available products to enable the embryologist to have greater success while reducing the chances of human error. And that’s something we’re always trying to avoid in the embryology lab.

[00:17:16] September Burton: Yeah, for sure. So when you guys there at Denver Fertility, when you do a transfer, do you do a frozen transfer or fresh?

[00:17:23] Dr. Michael Baker: So whether it’s frozen or fresh transfers is really a decision for the physician and their patients. I can tell you vast majority of our patients are prescribed to have frozen embryo transfers. Whether that’s to allow their body to reset from all of their stimulation medications, or to provide time for genetic testing of those embryos, a significant portion of our patients do have frozen embryo transfers and with great success because of those reasons.

[00:17:54] September Burton: Yeah, I always ask our guests before we sign off–do you have any words of wisdom or nuggets of knowledge that you would like to leave our listeners with?

[00:18:02] Dr. Michael Baker: I’d suggest that if you can talk with your embryologists and make sure that you’re comfortable with what’s going on behind the curtain. It’s just really, it doesn’t need to be a secret and hopefully the laboratories that you choose will be open and honest and helpful and reassuring. So that’s just one of my core values and I want to provide that to all of our patients and also there’s a lot of different reasons to choose a clinic or a lab, but I think communication is a big part of that. How well you’re interacting with the lab and the staff as a whole.

[00:18:36] September Burton: Absolutely. I agree with that a hundred percent. Well, thank you again so much for coming on Dr. Michael Baker from Denver Fertility, Albrecht Women’s Care. You have a great day. Thank you so much.

[00:18:47] Dr. Michael Baker: Thank you.

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