Embryo Development, Grading and Selection Copy —
Training activity: 5

Details

Select and record the fate of embryos for:

• Transfer
• Cryopreservation
• Training
• Research
• Disposal

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

• Local SOPs/protocols
• HFEA traceability and record keeping regulations
• Informed consent
• Multiple births minimisation strategy
• Factors influencing embryo selection decision making and prioritisation
• Suitability of embryos for cryopreservation and potential effects on embryo quality
• When not to do an embryo transfer
• Informing patients of the fate of individual embryos

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 selecting and recording the fate of embryos accurately and according to regulatory standards.
• Consider how the learning outcomes apply, specifically in relation to evaluating embryo quality, interpreting and reporting results, communicating effectively, and practicing in accordance with regulatory and safety standards, including keeping accurate records of the fates of embryos.
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to the precise criteria for assigning fate (e.g., which specific grades qualify for cryopreservation) and the required regulatory documentation.

What is your prior experience of this activity?

• Think about what you already know about the legal and ethical frameworks governing the fate of embryos (e.g., consent for training).
• Consider possible challenges you might face during the activity, such as dealing with poor quality embryos that do not meet standard criteria for cryopreservation or managing complex patient consent forms for disposal/research.
• 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 the patient consent forms regarding embryo disposal or training are ambiguous or incomplete.
• Acknowledge how you feel about the legal and ethical weight of assigning the final fate of embryos.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as applying legal and quality criteria simultaneously to assign embryo fate and accurate documentation.
• Identify the specific insights you hope to gain into the comprehensive regulatory requirements governing embryo discard.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of documentation or consent review activities.
• Identify important information you need to consider before embarking on the activity, such as patient consent forms regarding all fates (transfer, storage, disposal, research), current storage limits, and detailed SOPs for cryopreservation/disposal.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst assigning and recording the final fate of embryos?
• Are you encountering situations such as:
• Ambiguity in patient consent forms (e.g., conflicting instructions or missing signatures for cryopreservation), preventing immediate fate assignment.
• An unexpected lack of available witness for regulatory compliance purposes.

How are you reacting to the unexpected development?

• Consider the steps you are taking in the moment, such as immediately halting the fate assignment process to verify consent documentation against regulatory checklists, or seeking advice on safe temporary holding procedures.
• How are you feeling in that moment? For instance, are you finding it difficult to maintain focus amidst legal/ethical pressure? Is it affecting your confidence in adhering strictly to regulatory protocols?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving minor consent ambiguities via internal verification? Or are you needing support because the complexity of the consent issue requires legal or senior management review before the fate can be finalised?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the critical importance of comprehensive patient consent documentation across all possible embryo fates?

On action

What happened?

• Begin by summarising the key steps you took when selecting and recording the fate of embryos for transfer, cryopreservation, training, research, or disposal.
• Consider specific events, actions, or interactions which felt important, such as how you verified patient consent for non-transfer fates or how you applied the criteria to determine suitability for cryopreservation.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately halting the process when a potential discrepancy in the consent form was identified.
• How did you feel during this experience, e.g., aware of the critical legal and ethical obligations or focused on meticulous documentation?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding regulatory compliance and ethical documentation. What strengths did you demonstrate, e.g., meticulous adherence to regulatory requirements and consent verification?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific consent form for research or training?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in practicing in accordance with regulatory and safety standards, including keeping accurate records of the fates of embryos?
• Identify any challenges you experienced, such as ambiguity in patient instructions regarding the fate of lower-grade surplus embryos for training, and how you reacted to this. This might include needing to seek advice or clarification on scope of practice regarding interpretation of complex legal consent documents, and how you reacted to this.

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 consent documentation verification processes.
• What will you do differently next time you approach selecting and recording embryo fate, for instance, by proactively checking a detailed regulatory compliance checklist against patient consent forms?
• Do you need to practise any aspect of the activity further, such as reviewing legal guidelines for embryo disposal/training or key learning outcomes related to applying statutory and regulatory requirements?

Beyond action

Have you revisited the experiences?

• Considering what you understand about HFEA regulations, ethical considerations for discard, and meticulous record-keeping 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 protocol adherence and documentation accuracy based on further learning and experiences? For example, how you proactively implemented a mandatory double-check system for patient consent signatures regarding training fates.
• Has discussing ambiguities in storage consent or the impact of documentation errors on compliance 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 scenario where incorrect documentation risked a compliance breach refined your understanding of the criticality of legal adherence.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent regulatory compliance and record-keeping experiences, contributed to your overall confidence and ability in accurately assigning and documenting embryo fate, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated rigour in regulatory adherence and meticulous documentation now enables you to confidently dispose of embryos using appropriate witnessing 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 documentation and adherence to legal requirements for embryo disposal? 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 the Training Officer or Clinical Governance Lead immediately when consent forms for disposal or training are legally ambiguous or missing key signatures, recognising this requires senior authorisation to maintain legal compliance.
• Looking holistically at your training journey, how has this initial embryo fate documentation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to practicing in accordance with regulatory and safety standards, including keeping accurate records of the fates of embryos? For example, how this foundational experience has supported your development in understanding the legal and ethical framework surrounding selecting the fate of an embryo.

Relevant learning outcomes

#	Outcome
# 1	Outcome Evaluate embryo quality and development to inform clinical decision.
# 3	Outcome Interpret and report embryology results.
# 4	Outcome Communicate embryo grade and clinical decisions effectively with patients and the multidisciplinary team to enhance the overall patient experience.
# 5	Outcome Practice in accordance with regulatory and safety standards, including keeping accurate records of the fates of embryos.