A Day in the Life of Andrew Thomson, Laboratory Manager at the LWC Cardiff
We speak to Andrew Thomson, Laboratory Manager at the LWC Cardiff about the latest techniques in the laboratory which are helping to improve the success rates for our patients in Wales.
My name is Andrew Thomson and I am the Laboratory Manager at LWC Cardiff. I am responsible for looking after all three labs in Cardiff, Swansea and Bristol and providing scientific guidance to all staff and patients. I am mainly based in Cardiff where all IVF, ICSI, embryo biopsy and freezing etc is performed but I do rotate through Swansea and Bristol with the rest of my team. I’m originally from Scotland and now live in Wales with my wife and 4-year-old son.
I originally studied Biomedical Science in my degree but actually changed my course to Human Biology so that I could study human reproduction which has definitely worked out for me! I was very lucky to get a job straight out of university at Oxford Fertility where I completed all of my embryology training. I spent 6 years here before I moved to UHCW NHS Trust in Coventry where I was heavily involved in the training of scientists on a national scheme called the Scientist Training Programme (STP). Both clinics gave me a great foundation to build on for my next role at LWC. I joined LWC in May 2018 first as Senior Embryologist whilst I settled into the position and team. I then officially became the Laboratory Manager six months later and have loved every second of being here.
A day in my life
Laboratory procedures are planned several days in advance so we have a general plan of action for each day but that often gets added to, so every day is always completely different! Running three sites means liaising with three different teams to ensure everything runs as smoothly as possible. As the laboratory manager I split my time between operational management and time in the lab doing procedures such as ICSI. Our lab practice is underpinned by “Precision Embryology”. 98% of the patients who come through the laboratory at the LWC Cardiff have embryos placed in a time-lapse imaging incubator. This technology takes a picture of the embryos every 5 minutes meaning we have up to 142 hours of images to analyse for EACH embryo. This allows us a team to select the best embryo for transfer without disturbing the embryos environment and maximising our success rates.
Other days I spend in the office helping advise patients on all aspects of their treatment which may include suggestions for future treatment as well as guidance on choosing donor eggs or sperm. I personally review all of the paperwork for all donor eggs, donor sperm or embryos from another clinic being transported into LWC Cardiff to ensure they are compliant with HFEA regulations.
One of the first things I did upon joining LWC was getting the lab accredited by the National School of Healthcare Science to train STP students. This has allowed us to train our existing staff to further their own careers and I review their progress with them on a monthly basis to ensure they are meeting their targets in clinic as well as academically.
I’m also the quality lead in the laboratory. This includes analysing our Key Performance Indicators (KPIs). Every lab operational decision is made by me. For example, based on the last 12 months data, I have recently changed our embryo transfer policy so that any patient with at least 3 fertilised eggs will now always have blastocyst stage embryo transfer.
Without doubt, my favourite lab procedure is ICSI. As part of precision embryology, we pay very close attention to timings of events. Egg collections are timed to be performed at exact time intervals after the patient’s final injection and collected eggs are left as undisturbed as possible for a few hours after this until they are due to be mixed with sperm which again happens at a very specific time point.
For ICSI, we must first mix the eggs with a special enzyme and then look to see how many of the eggs are viable and mature to inject. I will then make up a dish with a special chemical which slows the sperm down. I use a very high magnification microscope to find the best-looking sperm and then using a very fine needle I break the tail of the sperm to stop it swimming before picking it with the needle and injecting it into the egg. In my opinion, ICSI is the most technical procedure that we perform in an IVF laboratory.
ICSI training doesn’t start until embryologists already have a few years’ experience in the lab and trainees tend to spend up to six months training by injecting tiny air bubbles into eggs which have been donated to training before they will be able to perform clinical cases. Even then they will only inject a few eggs while a more experienced embryologist injects the majority. It is usually at least a year’s training before you are allowed to ICSI an entire set of eggs. I review everyone’s success rates every 3 months to ensure we are performing as well as possible. The following day we will find out if the eggs have fertilised which normally occurs 70-80% of the time. Sometimes the eggs don’t like to be injected and will degenerate which can happen up to 5% of the time. It’s the procedure you feel most responsible for so when you do achieve 100% fertilisation you do feel like a superhero!
The best part of my job
My favourite part of my job is speaking to patients. I make a lot of phone calls updating people on the fertilisation of their eggs and the progress of their embryos. Patient don’t spend as much time with the embryology team as they do with the doctors or nurses, so you may only meet us briefly. However, we know patients very well. We’ve spent a lot of time reviewing your notes, your consent, your medical history and your embryo development to put all of the jigsaw pieces together and decide on the best plan of treatment for you. I also do the majority of the bad news phone calls. In such a high pressure setting, embryologists have to be perfect, but even when things go perfectly, treatment doesn’t always work for patients. Having personally received bad news in an inappropriate manner, I take great personal responsibility for delivering bad news.
We are in the process of setting up embryology consultations. This will allow our patients to book an appointment with me similar to that which they would do with their fertility specialist or counsellor, where we can discuss the outcome of their previous treatments and review the time-lapse data we have collected from their embryos. I am also happy to review time lapse videos from new patients who have had treatment elsewhere to see if there is anything different we can offer.
From September, I will be the workplace supervisor for a PhD student in collaboration with Cardiff University. We will investigate the time-lapse data that we have been collecting to develop artificial intelligence to select the best embryos for patient treatment. This is really cutting-edge technology and is an incredibly exciting time to be in the field. I’ve lectured at different universities so hopefully this will lead into doing that on a more regular basis.
I presented some research at the 2019 Fertility Conference in Birmingham comparing fresh vs frozen embryos. I am currently writing this up for publication in a scientific journal later this year.
Also, I have been invited by the National School of Healthcare Science to assess every final year Reproductive Science STP students sitting their final verbal exams. This is their most important exam as if they pass, they can register with the Health and Care Professions Council (HCPC) as Clinical Scientists and practice embryology independently.
My own personal goal is to attain Fellowship of the Royal College of Pathologists. This is the highest accolade embryologists can attain and only about 10 embryologists have achieved this. I have passed the first examination and will sit the final assessment in September 2020.