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The second emybroscope with a time-lapse system has arrived in Austria – to be precise, at the Kinderwunsch Institut in Dobl! The embryoscope, manufactured by FertiliTech in Denmark, is a high-end device that increases the likelihood of a successful pregnancy to 89%. Until now, it was not possible to constantly monitor the fertilised eggs, which meant that no information on the speed of cell division was available. However, this new technology takes a picture of the cells every 12 minutes, resulting in a little film that shows how fast and at what exact point in time the difference stages of cell division are completed. This provides us with important information on the quality of the fertilised egg and enables us to implant the one egg that shows the best development characteristics – and this explains the high success rate of the treatment. But this is just one of the advantages of using an embryoscope: If a cell is conspicuous, experts from all over the world may be consulted to help younger embryologists make the right choice. “When I saw the prototype at a trade fair in the US in 2008, I immediately knew that I was looking at the future”, says Dr Michael Schenk, who has since closely followed the development of the embryoscope. “We want to offer our patients the best possible therapy – and we are able to do so thanks to our in-house R&D department.” Independent studies, more effective therapies and state-of-the-art equipment are bringing more and more international patients to Austria. Video: Development up to blastocyst level PICSI – a natural method for assessing sperm quality and selecting the best possible sperm for fertilisation. Principle The method revolves around a PICSI petri dish that is coated with hyaluronic acid. Hyaluronic acid is a substance that is naturally found around the female eggs and thus has no negative side effects either on the sperm or the egg cells. Only mature sperm has the receptors needed to bind with hyaluronic acid. This is nature’s way of making sure that only fully matured sperm reaches the egg cell. Indication Scientific studies show that mature sperm with fully developed receptors has a higher level of DNA integrity. The treatment is indicated in cases where anomalies have been found within the sperm; however, a minimum amount of sperm motility is required. Within this group of patients, PICSI has been successfully applied where fertilisation attempts have failed or several miscarriages occurred. Application for sperm selection This physiological process is imitated in the petri dish using hyaluronic acid, which means that only those sperm cells that bind with hyaluronic acid, i.e. those cells that are mature and have developed the required receptors, are used for fertilisation using ICSI (or PICSI), a physiological method for fertilisation. Application for sperm assessment In addition to being used for PICSI, hyaluronic acid can also be used for assessing the quality of sperm samples as part of a binding test during the process of clarification. Using the PICSI petri dish, the share of mature sperm cells with receptors in the ejaculated sperm is assessed, which then forms the basis for further treatment. The video analysis shows not just the free-swimming sperm cells in the vicinity in and around the hyaluronic acid (circular area), but also those sperm cells whose receptors on the head have bound with the hyaluronic acid on the bottom of the dish while their tails keep rotating. These sperm cells are counted out in the binding test and are used for fertilising the eggs with the PICSI method. Reproductive medicine is a vast area and relies on constant further development and training in order to ensure that patients receive the best possible level of care and expertise Dr Michael Schenk has always been keen on promoting research, development and the implementation of state-of-the-art technologies. As yet another step in this direction, he has just graduated from the genetics diploma course offered by the Austrian Medical Association and was awarded the ÖAK-DIPLOM in genetics by the Institute for Human Genetics at the Medical University of Graz in April 2014. Primarius Dr. Michael Schenk, MAS and the Kinderwunsch Institute are important partners for the Master’s degree course in Clinical Embryology of the UNI for Life. For more information, dates and curricula, visit the website of UNI for Life. by Dr. Michael Schenk Medicine often regards daily practice and scientific findings as opposites and treats them accordingly. In clinical embryology, however, practice absolutely needs science and science cannot exist without practice. The half-life of knowledge in this highly specialised field of research is short and the pressure for innovation is enormous. In the field of clinical embryology, the only way for the expert staff of an IVF laboratory to acquire skills and competences is always based on “best practice” and/or “learning by doing” approaches. Clinical embryology needs innovative, science-led opportunities to drive advances, to prepare clinical embryologists for the challenges of the future and to furnish them with a comprehensive knowledge base of the ethics of our daily work life, the demands that will be made of them as individuals and the highly diverse circumstances and frameworks prescribed by religious affiliations and legal stipulations. The Master’s degree course in Clinical Embryology takes all these requirements into account. The course was developed according to the requirements profile for embryologists of the European Society of Human Reproduction and Embryology (ESHRE) and provides comprehensive training. Graduates of the degree course will have the necessary technical, scientific and ethical knowledge as well as the required soft skills to enable them to work independently in an IVF laboratory and any institution dealing with reproductive medicine after just a short period of familiarisation.
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Drugi embrioskop na bazi time-lapse tehnologije stigao je u Austriju, i to upravo u Kinderwunsch Institut u Dobl. Embrioskop tvrtke FertiliTech iz Danske, uređaj je visoke tehnologije, koji povećava uspjeh pri postizanju željene trudnoće na 89%. Do nedavno oplođene jajne stanice nije bilo moguće stalno nadzirati te stoga nije bilo moguće dobiti točne informacije o brzini diobe stanica. Najnovijom tehnologijom svakih se 12 minuta uzima slika stanice - dobivenim slikama nastaje film u kojem se mogu pratiti brzina i pogotovu vremenski razmaci diobe stanica u raznim fazama razvoja. Na taj način dobivaju se informacije o kvaliteti oplođene jajne stanice. Samo stanica s optimalnim razvojem usađuje se pacijentici. To objašnjava visoku kvotu uspjeha. Međutim, to je samo jedna od prednosti embrioskopa. U slučajevima kada razvoj stanica prolazi netipično, zahvaljujući toj tehnologiji moguće je uključiti stručnjake iz cijelog svijeta, što mladim embriolozima pomaže u donošenju ispravnih odluka. “Kada sam 2008.g. vidio prototip na jednom sajmu u Americi, znao sam da je to tehnologija budućnosti”, rekao je Dr. Michael Schenk, koji od tada prati razvoj embrioskopa. „Želja nam je našim pacijentima ponuditi najbolju moguću terapiju, što i možemo zahvaljujući vlastitom odjelu za istraživanje i razvoj. Video: Entwicklung bis zur Blastozyste PICSI – prirodna metoda za selekciju i ocjenu stanica spermija. Princip Ovdje se radi o Petrijevoj zdjelici, koja je ispunjena hijaluronskom kiselinom. Hijaluronsku kiselinu nalazimo fiziološki u direktnoj blizini jajnih stanica. Prema tome PICSI (Physiological intracytoplasmic sperm injection – fiziološka intracitoplazmična injekcija spermija) ne pokazuje nikakav negativan popratni učinak niti na stanice spermija, niti na jajne stanice. Samo zrele stanice spermija posjeduju odgovarajuće receptore kako bi se povezale na hijaluronsku kiselinu. Time priroda jamči da samo zrele stanice spermija mogu prodrijeti do jajne stanice. Indikacije Znanstvene studije potvrđuju da stanice spermija koje posjeduju receptore, a time i odgovarajuću zrelost, pokazuju viši integritet DNK. Indikacije postoje samo kod loših nalaza spermija kako bi se dobio minimalan broj pokretnih stanica spermija. Kod ove grupe pacijenata bilježi se uspjeh pri neuspješnim pokušajima oplodnje te ponavljajućim spontanim pobačajima. Postupak selekcije spermija Fiziološki postupak selekcije spermija se oponaša u Petrijevoj zdjelici pomoću hijaluronske kiseline. Na taj način se u konačnici selektiraju stanice spermija, koje se vežu na hijaluronsku kiselinu, tj. koje su razvile receptore i postigle zrelost da bih ih se upotrijebilo za oplodnju putem ICSI metode – fiziološka metoda oplodnje, fiziološka ICSI ili PICSI. Postupak procjene kvaliteta spermija Pored upotrebe u okviru PICSI metode, hijaluronska kiselina može se koristiti u svrhu dijagnosticiranja za utvrdjivanje kvalitete spermija (test povezivanja). Pomoću iste Petrijeve zdjelice kao i za PICSI metodu može se utvrditi udio zrelih stanica spermija u ejakulatu koje sadrže receptore, kako bi se što bolje mogla dati preporuka za daljnju terapiju. U video analizi se pored slobodnoplivajućih stanica spermija oko i u području hijalorunske kiseline (kružni areal) mogu vidjeti stanice spermija, koje su sa svojim receptorima na glavi povezane s hijalorunskom kiselinom i nalaze se na dnu Petrijeve zdjelice, dok njihovi repovi i dalje rotiraju. Te stanice spermija će biti izabrane testom povezivanja, odnosno PICSI metodom bit će selektirane za oplođivanje jajnih stanica. Reproduktivna medicina široko je znanstveno područje koje zahtjeva kontinuirano obrazovanje i stručno usavršavanje kako bi se pacijentima omogućio vrhunski liječnički tretman. Michael Schenk pridaje veliku važnost stalnom unapređivanju istraživanja, razvoja i implementaciji najnovijih tehnologija. Kao daljnji korak u tom pravcu absolvirao je diplomski tečaj genetike pri Austrijskoj liječničkoj komori, te mu je u travnju 2014. dodijeljena diploma Austrijske liječničke komore iz genetike od strane Instituta za humanu genetiku Medicinskog sveučilišta u Grazu. Primarijus dr. Michael Schenk, Master of Advanced Studies, i Kinderwunsch Institut su važni partneri za smjer master studija Kliničke embriologije u okviru programa usavršavanja „UNI for Life“ na Karl-Franzens-Sveučilištu u Grazu. Više informacija o projektu, rokovima te studijske planove naći ćete ovdje: by Dr. Michael Schenk Dnevna rutina i znanost često se u medicini doživaljavaju i žive kao suprotnost. No, u kliničkoj embriologiji praksa ne može bez znanosti, niti znanost može bez prakse. Znanstvene spoznaje u tom visokospecijaliziranom stručnom području prilično su nove, a inovacijski pritisak je jako visok. Na području kliničke embriologije stručno osoblje, koje radi u laboratorijima za in-vitro-fertilizaciju, svoju kompetenciju može izgraditi gotovo isključivo putem dobre prakse /„best practice“ i/ili na principu „learning by doing“. Međutim klinička embriologija upućena je na nove mogućnosti koje pruža znanstveni rad kako bi se dalje razvijala, kako bi pripremila buduće kliničke embriologe za potrebe budućnosti i prenijela im sveobuhvatno znanje o etici njihovog svakodnevnog posla, o zahtjevima koje će postavljati sebi samima i posebnim uvjetima koje propisuju religijska pripadnost i zakoni. Studijski smjer za Mastera kliničke embriologije razmatra te visoke ciljeve. Razvoj tog nastavnog smjera osmišljen je prema profilu zahtjeva za embriologe od strane stručnog udruženja European Society of Human Reproduction and Embryology (ESHRE) i nudi opsežno obrazovanje. Apsolventi i apsolventice tog sveučilišnog smjera raspolažu potrebnim stručnim, znanstvenim i etičkim znanjem te ostalim nužnim vještinama tzw. soft skills, kako bi već nakon kratkog perioda pripreme i uvođenja u posao samostalno mogli raditi u IVF labaratoriju ili pak u ostalim institucijama koje se bave reprodukcijskom medicinom.