I was welcomed by Mr Tonguz Çakmak, an experienced embryologist, who led me upstairs to the operation room. I was instructed to put on a face mask, a hair net, foot protection and a gown. I was led past a patient whose mouth was covered with a gas mask; she was surrounded by a group of stereotypical surgeons in teal gowns and white face masks who loomed over her, holding various pieces of equipment.
I entered the laboratory. A woman was bent over a microscope, indulged in her work. I noticed several incubators in the corner of the room. Mr Çakmak sat down at a bench and signalled for me to approach. He placed a petri dish under a microscope and showed me 6 embryos. He explained how they were in the blastocyst stage and that they were 5 days old.
A few moments later a surgeon yelled “ready!” Mr Çakmak drew two of the embryos out of the dish with a long, thin, pipette-like tool. A nurse turned off the lights in the operation room. Mr Çakmak rushed in and injected the embryos into her fallopian tube. Mr Çakmak returned to the lab and took of his gloves. He began to prepare the next set of embryos. There was a serious feeling about the room; it was evident that Mr Çakmak was concentrating hard. The procedure was repeated swiftly a second and third time, and then Mr Çakmak sat down, wiped his sweaty forehead with his sleeve, and breathed a sigh of relief.
While the operation was taking place I began exploring the laboratory, and the incubators in the corner caught my eye. I noticed that the screen read ‘set conditions: 37oC and 6% CO2’. I asked Mr Çakmak about this and he explained that these were the ideal conditions for embryonic development, and I realised that they mimicked the conditions present in the female fallopian tubes.
I noticed that there were no windows in the lab and remembered how the lights had been turned off during the operation. Mr Çakmak told me that white light was harmful to the embryos.
After a short lunch break, Mr Çakmak began to prepare the eggs of another client. He added an acidic solution to them while they were in a petri dish. He explained how the solution dissolved the zona pellucida. This would allow easier penetration later on in the process.
His female colleague was preparing the sperm cells. She carried out a sperm selection process so that only the female (X) sperm cells would be used (the client had requested a female child). She also removed all of the deformed (two-headed or two-tailed) sperm cells.
We then moved over to a larger microscope. Mr Çakmak had set up a monitor so I could observe the work he was doing. He got a feel of the equipment by moving a high precision, ultra-thin pipette up and down slowly. He hovered over a collection of wriggling sperm cells. He closed in on a particularly energetic one. He violently jabbed the tail of the sperm multiple times with his pipette in order to break its tail. He explained that this was essential so that the tail did not move about in the egg and disturb the contents of its cytoplasm. He then drew the sperm cell into the pipette and repeated the process for a second sperm cell, drawing it into the same pipette.
He moved the pipette to the part of the petri dish where the eggs where located. He secured an egg with a microscopic clamp and jabbed its membrane with his pipette. Once he had ruptured the membrane, he drew some of the egg’s cytoplasm into the pipette before ejecting it back into the egg along with one of the sperm cells. He repeated this for a second egg cell and then placed the embryos into an incubator where they would develop into blastocysts.
His female colleague collected leftover embryos and froze them in liquid nitrogen.
By the end of the day a chronological sequence of events had formed in my mind: a woman comes to the clinic and is given an ovulation stimulant so that she releases multiple eggs at once. These eggs are prepared by removing their zona pellucidas. Sperm cells are donated by a man. The sperm cells are also prepared, in order to match the gender requested by the parent. IVF (in-vitro fertilisation) takes place: the sperm cell is artificially injected into the egg cell. The embryos are incubated in ideal conditions for 5 days. The woman returns to the clinic, is given anaesthesia, and the embryos are implanted into her fallopian tubes. Any leftover embryos are frozen in liquid nitrogen.
I thoroughly enjoyed this experience and I learnt a lot about embryology and genetics. I was amazed at the level of professionalism and the scientific ability displayed by Mr Çakmak and his colleagues. The experience also stimulated many of my thoughts regarding ethical issues, which I will discuss in a further article.