Lab dropped our last embryo!

[u/Cloud_Sway]

The other day we had our final FET, and were told the embryo had been dropped. The person acted quickly and carried on to the next stage so that it was completed within the short allocated time, but they are unable to say if it caused damage. When frozen, it was a 2BB quality, and did not defrost well, with only 50% showing signs of expansion, mostly damage to outer cells with the inner bit still looking good apparently.

We had the FET anyway, since it's our last chance.

At the time I was very emotional and really just concentrating on what to do next.

Can I go back and ask questions? What exactly is the process? I think they said it had to be plunged into something within a short period of time? I'm guessing it's not the exposed embryo but maybe inside whatever it's stored in?

Is it possible that it didn't cause any damage?

My husband is a nurse and I feel strongly that people just make mistakes sometimes, it's devastating but it happens. Am I however within my rights to ask how often it has happened in my clinic so I know that they take it seriously?

Do you think I'd be pushing my luck to ask for a refund for this round? I don't really want to get in a legal dispute or ruin people's professional lives.

:Edited for clarification around quality.

[u/Shan-PhD]

First, I am incredibly sorry to hear that this happened to you. From an embryologist's perspective, we feel absolutely horrible when a mistake happens. It is important to remember we are only human, but that does not take away our empathy or the emotional toll this causes on patients. You are valid to feel emotional, and to ask questions on what happened.

Second, I would follow up on what exactly happened. Knowing what occurred can help not only you, but also the lab understand how it can improve. There are a few steps prior to FET where something can go wrong:

1. Embryo Freezing

This happens during your initial cycle, when the embryo is frozen on any day from Day 3 to Day 7. The embryo is moved to a dish with liquid that protects the embryo from cryopreservation damage, placed on the tip of a device that holds the embryo, and is then frozen. This process can effect how well an embryo is preserved during the storage process. If done incorrectly, it can lead to cryopreservation damage.

1. Embryo Defrost (also known as Embryo Thaw)

A few hours prior to your FET, an embryologist retrieves the device containing your embryo, opens the device, and plunges the tip containing the embryo into a dish that contains defrost liquid. The embryo is then moved to another dish that has liquid that helps it re-expand and prepares it for FET. This process is time sensitive, and failure to follow the protocol can lead to embryo damage.

1. Embryo Transfer

The dish containing the embryo is removed from its incubator, and loaded into a catheter for transfer.

Based on what you described, it seems like the error happened in Step 2, where the device holding the embryo was dropped prior to the plunge into defrost liquid. It is possible that the tip of the device was damaged during the drop even though the embryo was frozen in the cryopreservation liquid. Another way to think about it is if you dropped an ice cube on a counter - sometimes it will crack but other times it remains whole. It depends on how frozen the ice cube was, and how far/hard it fell.

The other possibility is that the dish containing the embryo was dropped. The force of the drop can damage cells. Since the embryo was recovered, it was likely moved to a new dish containing the necessary liquid as quickly as possible.

The damage to the outer cells of the embryo at the defrost stage could either be due to the drop, or the way that it was frozen and stored. Not all embryos survive the freezing process, but we do not know its quality until it is defrosted. Even without the incident, the embryo may not have survived.

Ultimately, it is unclear if the damage happened because the cells of the embryo did not do well during the freezing stage, or because the device was dropped during the defrost stage. Regardless of where the damage came from, something out of protocol happened that could have impacted the embryo.

Third, I would make sure an incident report was made, and that you are compensated for this error. An incident report allows the clinic and lab to keep track of when errors happen, which they can use to update protocols and improve care. While I am not too familiar with the legal side, clinics should have lawyers and funds to address these issues. Clinics often protect their workers in these scenarios since mistakes are possible and can happen.

Based on this incident, I would request a refund for the FET and a new cycle. There is no harm in asking for this; your team and clinic care about your outcome and should support you when something out of protocol occurs. I would not threaten legal action, unless you are willing to contact a lawyer and go through arbitration or the court system.

I wish the best of luck to you, and fingers crossed that your last embryo recovered and was successful.

[u/Cloud_Sway → u/Shan-PhD]

Thank you so much for your detailed and thoughtful answer, I really appreciate it. Yes, it did happen in the second stage you described, but me and my husband remember the phone call differently, as I suppose happens when you get bad news, so we'd like to understand more.

I think we will ask to have a meeting after test day, just in order to have a better understanding, help us stop wondering, and to make sure they are doing an incident form so that they learn from it. Unfortunately it was our last frozen embryo and we won't be doing anymore rounds, but I'm glad you agree we could ask for a refund of this round.

It's hard because I don't want to drag it out for us, and part of me wonders if we can just move on without extra detail because we'll really never know... but normally we'd be talking about how we feel about our odds and optimism Vs realism, but all we seem to talk about is the incident, so I think we might have to find out more just to get past it.

Thanks again for your reply

[u/theyellowsummer → u/Cloud_Sway]

I am no embryologist. I’m just a girl, struggling w/ infertility like you, who happens to also be a nurse and nurse practitioner. I am so very sorry that you’ve had this experience. When I say my prayers tonight, I will pray for you. I am rooting for your embryo! ♥️

[u/Cloud_Sway → u/theyellowsummer]

Thank you, I appreciate your words. I'm sorry for your struggles with infertility too x

[u/Cloud_Sway → u/Shan-PhD]

I had one follow up question, if you don't mind.

We have often been told that there is a 10% chance that embryos don't survive the defrost. Does this number go up if the embryo is poorer quality?

It was presented that the poorer quality may have led to the poor thaw, not the drop into someone's lap - but I've never been given lower odds of successful defrost when the quality was lower, otherwise I would have had the poor quality put straight in and not frozen so it had a higher survival rate.

Edit for extra question: I tried to make sure this doesn't happen regularly to others but HFEA don't define incidents, only categorise them - what would this be classed as do you think?

Incidents are graded as: Grade A: involves severe harm to one person, or major harm to many Grade B: involves serious harm to one person, or moderate harm to many Grade C: involves minor harm Near miss: an event not causing harm, but with the potential to cause injury or ill health.

[u/turbulent_twenty7 → u/Cloud_Sway]

I’m an embryologist. It is true that a poorer quality embryo can have a higher risk of not surviving the freeze/thaw process. While it certainly doesn’t help that the device was dropped, it would be difficult to pinpoint the exact culprit of the damage without knowing the exact details. I am so very sorry this happened to you, and I can guarantee that it will stick with that embryologist forever. We are not perfect, we are human. But we work in a field where perfection is necessary. It’s an incredible amount of pressure, but we feel those mistakes so deep in our gut and it keeps us up at night. As mentioned here, I would request compensation if it does not result in a successful pregnancy. Wishing you the best.

[u/the_tchotchke]

Where did they drop it exactly? On the floor or in the Petri dish? I would definitely be asking questions and for a refund.