Gametes and Fertilisation —
Training activity: 4

Details

Perform oocyte denudation and correctly identify the different stages of oocyte maturity

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Culture conditions, including media selection
• Troubleshooting
• Risks to oocytes
• Witnessing requirements
• In-house standard operating procedures
• Aseptic technique
• Infection control
• Record keeping and traceability
• Implications of immature oocytes for the patient treatment cycle

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to ensuring complete removal of cumulus cells without damaging the oocyte.
• Consider how the learning outcomes apply, specifically in relation to identifying the morphological criteria for correctly identifying different stages of oocyte maturity (GV, MI, MII).
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to accurately recording the maturity results.

What is your prior experience of this activity?

• Think about what you already know about microscopy techniques (e.g., bright field, phase contrast) and identifying oocyte maturity stages.
• Consider possible challenges you might face during the activity, such as overly sticky cumulus cells or difficulty distinguishing maturity stages.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example, if a denuded oocyte shows ambiguous characteristics that make definitive maturity grading difficult.
• Acknowledge how you feel about performing delicate procedures and critical morphological assessment.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as practical denudation skills and refining maturity assessment.
• Identify the specific insights you hope to gain into the link between oocyte maturity and subsequent fertilisation success.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of challenging cases of maturity assessment.
• Identify important information you need to consider before embarking on the activity, such as the protocols for denudation and maturity assessment and the relevant HFEA regulations regarding oocyte handling.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing oocyte denudation and identifying maturity?
• Are you encountering situations such as:
  • Some oocytes being more resistant to denudation than others?
  • Maturity assessment being ambiguous (e.g., difficulty visualising the polar body)?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Did you adjust the denudation method or duration?
• Consider the steps you are taking in the moment, such as seeking a second opinion on maturity assessment from a colleague.
• How are you feeling in that moment? For instance, are you feeling unsure about the maturity stage of a particular oocyte? Is it affecting your confidence in assigning a maturity stage?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to successfully denude the oocytes and assign a maturity stage to each? Or are you needing support because an oocyte shows ambiguous characteristics that make definitive maturity grading difficult?
• What are you learning as a result of the unexpected development? For example, are you refining your denudation technique or improving your confidence in maturity grading?

On action

What happened?

• Begin by summarising the key steps you took when performing the oocyte denudation and the techniques you used. What stages of oocyte maturity did you identify (e.g., GV, MI, MII)?
• Consider specific events, actions, or interactions which felt important, such as the care taken to avoid damaging the oocyte during removal of cumulus cells.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adjusting the pipetting pressure or switching to a different sized pipette when encountering overly sticky cumulus cells.
• How did you feel during this experience, e.g., did you feel stressed by the need for precision or confident in your manual dexterity?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding denuding oocytes and assessing maturity. What strengths did you demonstrate, e.g., effective denudation without damaging the oocyte?
• What skills and/or knowledge gaps were evident, e.g., difficulty distinguishing between MI and MII stages based on polar body morphology?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in performing delicate procedures and critical morphological assessment?
• Identify any challenges you experienced, such as unclear morphology or intermediate stages during maturity assessment, and how you reacted to this. This might include needing to seek advice or clarification on scope of practice regarding the definitive classification of ambiguous maturity stages.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to refining your morphological assessment criteria.
• What will you do differently next time you approach denuding oocytes and assessing maturity, for instance, by proactively reviewing reference imagery for ambiguous maturity stages immediately beforehand?
• Do you need to practise any aspect of the activity further, such as practical denudation skills or key learning outcomes related to identifying maturity stages according to morphological criteria?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of performing oocyte denudation and correctly identifying maturity stages since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent batch had overly sticky cumulus cells requiring modified mechanical or enzymatic denudation forced you to re-evaluate the gentle handling and technique applied during your first attempt at this training activity.
• Considering what you understand about oocyte maturity markers (e.g., GV, MI, MII), precision micro-manipulation, and accurate grading now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your denudation technique and morphological assessment based on further learning and experiences? For example, how you proactively integrated accurate grading and speed into your routine assessment based on further learning.
• Has discussing challenging maturity assessments or best practices for handling delicate oocytes with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a difficult maturity distinction refined your understanding of the critical nature of detailed microscopic assessment.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent oocyte denudation experiences, contributed to your overall confidence and ability in microscopic assessment and manipulation, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills in fine manipulation and microscopic assessment now enable you to confidently perform oocyte denudation and maturity identification during a DOPS assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to oocyte denudation and maturity identification? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from your Training Officer immediately if a denuded oocyte shows ambiguous characteristics that make definitive maturity grading difficult, ensuring diagnostic accuracy is maintained.
• Looking holistically at your training journey, how has this initial oocyte denudation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to identifying the morphological criteria for correctly identifying different stages of oocyte maturity?

Relevant learning outcomes

#	Outcome
# 4	Outcome Assess the maturity of oocytes.
# 7	Outcome Practice in accordance with HFEA regulations.