Gametes and Fertilisation

Module details

Title

Gametes and Fertilisation

Type

Specialist

Module code

SLS325

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the knowledge and understanding of the development of male and female gametes and the process of fertilisation. They will understand and gain experience in egg collection, sperm preparation and insemination methodologies, and identify normally and abnormally fertilised oocytes. The trainee will also learn how to report results from insemination/fertilisation.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 6	Competency Discuss insemination methods used in treatment based on semen quality with patients.	Action View
# 2	Learning outcome 5	Competency Make a clinical decision regarding the method of insemination with respect to semen quality.	Action View
# 3	Learning outcome 1	Competency Label and witness samples used for insemination.	Action View
# 4	Learning outcome 4	Competency Prepare epididymal and testicular samples for use with ICSI.	Action View
# 5	Learning outcome 1,2,4,5	Competency Perform and interpret swim-up techniques and density gradient separation of sperm samples of different quality, including: antisperm antibody-positive samples retrograde samples severe oligoasthenozoospermic samples frozen samples, including donor samples.	Action View
# 6	Learning outcome 3	Competency Identify granulosa cells, cumulus cells and oocytes during egg collection.	Action View
# 7	Learning outcome 3	Competency Identify cysts during an oocyte collection.	Action View
# 8	Learning outcome 1,2	Competency Handle and manipulate oocytes to maintain viability.	Action View
# 9	Learning outcome 1,2	Competency Perform the identification and witnessing checks carried out at the time of insemination for IVF and ICSI.	Action View
# 10	Learning outcome 1,2	Competency Perform insemination for IVF.	Action View
# 11	Learning outcome 1,2	Competency Perform cumulus removal before ICSI and categorise the state of maturity of denuded oocytes.	Action View
# 12	Learning outcome 1,2,7,8	Competency Perform fertilisation checks.	Action View
# 13	Learning outcome 8	Competency Communicate bad news to patients in the event of low or failed fertilisation.	Action View
# 14	Learning outcome 8	Competency Discuss fertilisation results with patients and the multidisciplinary team.	Action View
# 15	Learning outcome 1,2,7	Competency Correctly identify and record normal and abnormally fertilised oocytes.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform an egg collection correctly identifying oocytes, cumulus cells, granuolosa cells and cysts	DOPS
Perform IVF insemination of oocytes giving reasons why the sample is suitable for IVF	DOPS
Perform cumulus removal prior to ICSI and identify the stage of oocyte maturity	DOPS
Discuss fertilisation outcome MDT	DOPS
Perform and interpret swim up techniques and density gradient separation of sperm samples of different quality	DOPS
Handle and manipulate oocytes to maintain viability	DOPS
Perform the identification and witnessing checks carried out at the time of insemination for IVF and ICSI	DOPS
Prepare surgically retrieved sperm samples	DOPS
Label and witness samples used for insemination	DOPS
On the day of egg collection explain the laboratory pathway to the patient including the stages of relevant embryology eg insemination, cleavage, embryo development, embryo transfer and cryopreservation.	OCE
In the case of unexpected poor semen quality discuss with a patient the rationale of converting the treatment from IVF to ICSI.	OCE
Inform and discuss with a patient normal fertilisation results Inform and discuss with a patient abnormal fertilisation	OCE
Inform a patient of failed fertilisation and discuss the reasons why this may have occurred and implications for future treatment	OCE
Present a discuss sperm quality and suitability of insemination method with patients to clinical collegues	OCE
Communicate bad news to patients in the event of low or failed fertilisation	OCE
Discuss insemination methods with patients used in treatment based on semen quality	OCE

Learning outcomes

1. Follow correct witnessing procedures to comply with HFEA regulations.
2. Handle gametes correctly to maintain viability.
3. Undertake an egg recovery procedure and identify oocytes.
4. Perform the different methods of sperm preparation techniques.
5. Identify patients who, based on clinical parameters, require either in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
6. Advise patients on their treatment pathway through discussion of the different insemination methods. Perform the different methods of routine (not ICSI) insemination.
7. Identify stages of oocyte maturity and normally and abnormally fertilised oocytes.
8. Record and report accurately patients’ fertilisation results.

Learning outcomes

1. Explain spermatogenesis and spermiogenesis.
2. Explain oogenesis and oocyte maturation.
3. Discuss the cellular and molecular basis of fertilisation.
4. Describe relevant techniques for gamete preparation and handling.
5. Describe methods of insemination and be able to identify normal and abnormally fertilised oocytes.
6. Discuss the linkages between the reproductive science laboratory and other clinical specialisms in the selection and management of patients who will undergo insemination/fertilisation.

Indicative content

• Developmental and genetic control of spermatogenesis and spermiogenesis, including cytology of spermatogenesis, spermatocytes and spermatids
• Physiology of mature sperm
• Acrosome reaction
• Sperm capacitation and zona pellucida binding
• Follicle growth in the human ovary
• Oocyte growth and maturation, including genetic and cellular regulation of meiosis and mitosis
• Structure and properties of the zona pellucida
• Cellular and molecular basis of fertilisation
• The pronuclear oocyte, including completion of the second meiotic division and pronuclear formation
• Syngamy
• Basic laboratory skills and aseptic technique for semen preparation and oocyte collection and handling
• Normal and abnormally fertilisation (polyspermy and parthenogenesis), including failed to fertilise oocytes, theories of origin and implications for patient treatment
• Insemination methodologies
• Risks of loss of viability associated with the handling of gametes and relevant control measures
• Reporting outcomes from insemination/fertilisation

Activities

• Review patient notes where the course of treatment has been changed with regard to method of insemination. Reflect on the reasons for change and the intended/actual improvements in treatment outcomes for the patient. Discuss with your supervisor.
• Attend multidisciplinary team meetings to review and discuss cases of failed fertilisation to recommend further treatment options. Reflect on the reasons for failure, the recommendations and potential outcomes, and the impact of failure on the patient experience. Discuss with your supervisor.
• Review presenting cases and prepare to discuss with clinical colleagues the presenting infertility causes that would indicate the methods of insemination. Prepare your own recommendations, with rationale for discussion, and reflect on the outcomes of review with colleagues.
• Review cases where insemination has not taken place post egg recovery and discuss the reasons for this with your colleagues and supervisor. Reflect and review the discussion and implications for your own future practice.
• Review patients’ notes where donated gametes have been used. Review and discuss the patient pathway, including why donor gametes were required, the counselling and consent process. Consider from both the specialist and patient perspectives.