Gametes and Fertilisation —
Training activity: 8

Details

Perform fertilisation assessment on both IVF and ICSI inseminated oocytes and record the results

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

• Normal and abnormally fertilised oocytes
• Timing of assessment
• Witnessing requirements
• In-house standard operating procedures
• Aseptic technique
• Infection control
• Record keeping and traceability
• Chain of custody
• Timescale

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 performing fertilisation assessment on both IVF and ICSI oocytes.
• Consider how the learning outcomes apply, specifically in relation to accurately identifying normal fertilisation (e.g., presence of two pronuclei and two polar bodies) and categorising abnormally fertilised oocytes.
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to meticulously recording the results for each oocyte.

What is your prior experience of this activity?

• Think about what you already know about fertilisation assessment criteria and using microscopy (e.g., bright field, phase contrast).
• Consider possible challenges you might face during the activity, such as difficulty visualising pronuclei or atypical appearance of fertilisation signs.
• 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, to ask for a second opinion on an oocyte with an atypical number of pronuclei.
• Acknowledge how you feel about performing this critical, time-sensitive assessment.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as improving identification of fertilisation outcomes (normal vs. abnormal).
• Identify the specific insights you hope to gain into the reasons for abnormal fertilisation and the implications for embryo development.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reviewing image sets or reference materials for normal and abnormal fertilisation.
• Identify important information you need to consider before embarking on the activity, such as the specific timing considerations for when the assessment must be performed and the criteria outlined in laboratory SOPs.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing the assessment of fertilisation on oocytes?
• Are you encountering situations such as:
  • Observing unexpected fertilisation patterns (e.g., high incidence of abnormal fertilisation, low fertilisation rate)?
  • Some oocytes being difficult to assess due to morphology or visibility?

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 double-check your assessment criteria or technique for classifying fertilisation?
• Consider the steps you are taking in the moment, such as seeking confirmation from a senior embryologist for challenging assessments.
• How are you feeling in that moment? For instance, are you feeling unsure when encountering ambiguous or unusual fertilisation outcomes? Is it affecting your confidence in accurately recording the results?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to complete the fertilisation assessment and accurately record the results? Or are you needing support because you needed a second opinion on an oocyte with an atypical number of pronuclei?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into identifying nuances in fertilisation morphology or handling unexpected results?

On action

What happened?

• Begin by summarising the key steps you took when performing the fertilisation assessment, including the criteria you used to identify normal fertilisation (e.g., 2 pronuclei and 2 polar bodies). What results did you record for the IVF and ICSI oocytes?
• Consider specific events, actions, or interactions which felt important, such as the meticulous recording of results or the careful handling of dishes.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, spending extra time reviewing an oocyte before definitively classifying it as abnormally fertilised due to atypical pronuclei numbers.
• How did you feel during this experience, e.g., did you feel focused on morphology identification or stressed by the critical nature of the assessment?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing fertilisation assessment. What strengths did you demonstrate, e.g., accurate classification of outcomes?
• What skills and/or knowledge gaps were evident, e.g., distinguishing between specific abnormal fertilisation patterns or maintaining efficiency when assessing a large batch of oocytes?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development related to identifying fertilised oocytes achieved? Has your practice improved in accurately identifying normal and abnormal fertilisation?
• Identify any challenges you experienced, such as unclear morphology or poor visibility. This might include needing to seek advice or clarification on scope of practice regarding asking for a second opinion on an oocyte with an atypical number of pronuclei.

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 improving the accuracy and speed of your morphological classification.
• What will you do differently next time you approach performing fertilisation assessment, for instance, by proactively starting fertilisation checks early to avoid PN fade prior to detection?
• Do you need to practise any aspect of the activity further, such as reviewing reference images of complex abnormal fertilisation or key learning outcomes related to identifying normally and abnormally fertilised oocytes?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of performing fertilisation assessment on IVF and ICSI inseminated oocytes 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 assessment required complex differentiation between vacuoles and atypical pronuclei forced you to re-evaluate the accuracy of your microscopic observation during your first attempt at this training activity.
• Considering what you understand about normal and abnormal fertilisation criteria, morphological markers (e.g., pronuclei and polar bodies), and the required timing of assessment 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 microscopic assessment and meticulous recording techniques based on further learning and experiences? For example, how you proactively integrated specific criteria for classifying abnormal fertilisation events based on further learning.
• Has discussing challenging fertilisation assessments or unusual observations (e.g., three pronuclei or a vacuole?) 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 embryologist about a borderline fertilisation outcome refined your understanding of the critical importance of diagnostic accuracy and documentation.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent fertilisation assessment experiences, contributed to your overall confidence and ability in microscopic diagnosis and documentation, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills developed in microscopic observation and meticulous recording now enable you to confidently perform fertilisation assessment and interpret outcomes 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 performing fertilisation assessment? 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 to ask for a second opinion on an oocyte with an atypical number of pronuclei, ensuring diagnostic accuracy and the correct recording of results.
• Looking holistically at your training journey, how has this initial fertilisation assessment experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to identifying normally and abnormally fertilised oocytes? For example, how this foundational experience has supported your development in detailed morphological assessment and diagnostic accuracy, which informs subsequent embryo grading and selection.

Relevant learning outcomes

#	Outcome
# 4	Outcome Assess the maturity of oocytes.
# 6	Outcome Identify normally and abnormally fertilised oocytes.
# 7	Outcome Practice in accordance with HFEA regulations.
# 8	Outcome Apply and adapt skills to communicate effectively with patients and the multidisciplinary team.