A Day in The Life of Elena Linara-Demakakou, Deputy Manager in Embryology
We spent some time with the Deputy Manager in Embryology, Elena Linara-Demakakou, to find out more about what her job entails and to hear what exciting new developments are coming up in the LWC Harley Street laboratory.
My name is Elena Linara-Demakakou and I am the Deputy Manager in Embryology at LWC in Harley Street. I am originally from Corfu, in Greece and came to the UK in 2000 to study Biomedicine at the University of Nottingham. While studying I took a particular interest in Genetics and Reproductive Medicine and moved to London to study at UCL for my postgraduate degree in Preimplantation Genetic Diagnosis and Fetal Medicine. Whilst I was studying there I discovered the “beauty” of Clinical Embryology and the impact that I could have as a scientist to so many people that they face medical difficulties to start or complete their family. After finishing my degree, in 2007, I started training as an Andrologist at the LWC Sperm Bank. I then moved in to training as an Embryologist in 2008 and after five years of intensive training and studying I became a registered Clinical Embryologist with HCPC. I’ve now been in the field of IVF for 12 years and in that time, I have progressed to become a Senior Clinical Embryologist, the Deputy Manager and the Quality Lead in Embryology. I live in London and in my free time I enjoy going to museums and nature parks with my husband and two daughters. I love cooking and I have my own blog where I share Greek recipes.
A day in my life
As an embryologist, my daily goal is to create, analyse and select embryos that have high potential to implant and create a live birth. I work with eggs and sperm to create embryos that are suitable to be used for fresh embryo transfer or frozen for future use. My job has lots of different tasks, it requires great attention to detail and great patience as embryology procedures take a long time and can be complicated. My job can be very stressful and a great responsibility. My goal (to create a baby) is of ultimate importance and this gives me power to continue and thrive.
I start my day by checking the fertilisation of the eggs from the egg collections the day before. After fertilisation checks, I must grade and select together with JinJun Wang, our Laboratory Manager, all available embryos for patients’ different treatments. The embryos are cultured for five to seven days to reach the blastocyst stage. In order to maximise the possibility of attaining a successful pregnancy, the ability to select the embryo with the highest developmental potential is paramount. To grade and select the best embryos we look at lots of key developmental parameters of the embryos and we also use time-lapse technology to see the morphokinetic analysis of them. We must assess several parameters including the number of cells, the expansion of the embryo, how compacted the cell masses are and if there is any fragmentation or degeneration. If the patient is having a fresh embryo transfer, then we will select the best embryo for transfer. For patients freezing their embryos for a future transfer (which the majority of patients do now) all embryos of good quality will be frozen. Every patient is different and even embryos that are the same number of day old will give us different features between patients. Not all patients will have the same outcome as there are many reasons affecting reproductive outcomes.
Every morning I work with the team in theatre on egg collection procedures. After the doctor has aspirated the follicles, I take the follicular fluid and look under the microscope to identify the eggs. I clean the eggs and add them to the culture dishes ready to be fertilised with sperm. The andrology team then prepares the sperm sample either from the patient’s partner or from a sperm donor. Once the sample is ready, the creation of embryos can occur with either IVF or ICSI. When patients require ICSI, I do this under a special microscope whereby I must select a single normal spermatozoon and microinject the sperm in to the cytoplasm of the egg, which will hopefully bypass any fertilisation issues.
Another important task in my job is to do embryo transfers or embryo freezing. After selecting the best embryo for transfer I carefully load it on to a very fine catheter and give to the doctor to complete the procedure. Using ultrasound guidance, the catheter is passed through the patient’s vagina in to the uterus where the embryo is released. I will then check the catheter to make sure that the embryo has been successfully transferred.
More and more of our patients are now choosing to freeze all their embryos and plan a transfer in a later frozen embryo transfer cycle. Our results show that the success rate is higher when we transfer an embryo in a different cycle from the egg collection procedure. All freezing in the LWC laboratory uses the “fast-freezing” technique called vitrification. This involves several steps of dehydration and equilibration of the embryo and finally vitrification. The water from the embryo is removed by exposing the embryos in an increasing concentration of cryoprotectants. This ensures that the percentage of water in the embryo is minimal which diminishes the chance of ice crystal formation that could damage the cells in the embryo and subsequently its potential to survive thawing and implant later on. The embryo is then loaded in to a very fine device and dipped in to liquid nitrogen to be stored for the future.
The morphology of the embryo and its relationship with the final outcome is well documented in the literature but we know that in many cases this is not enough, and thus further tests might be necessary. For such cases, we have a great genetics team which I am highly involved in to perform preimplantation genetics testing (PGT). My role is to perform the biopsy on embryos that need to be genetically tested for different genetic conditions (such as Cystic Fibrosis or Beta Thalassaemia).
The best part of my job
Like all of us at the LWC, the best part of my job is meeting and seeing pictures of the babies born following treatment. The best reward for me is to see the patient’s smile that finally holds the baby they always wanted. Knowing that I have been able to create these embryos is very special.
I have always been very interested in research and development and since September 2018, I gained a licence for the clinic by the NSHCS to be able to train embryologists in house through the Scientific Training Programme (STP). I now have three trainees that are all at different stages and are doing very well. In three years’, time they should all have completed their registration and I will be looking forward to having more trainees come through.
A key part of the job as an embryologist is to ensure that we do our utmost for the patient to get pregnant. I am therefore very interested in the ultimate quality control of the laboratory that ensures constant optimum conditions for an embryo to be created and grow. I am constantly working with the team to enhance success rates and improve patient care. I am now hoping at LWC Harley Street to introduce embryology consultations which will take place before or after treatment in conjunction with the patient’s appointments with our fertility specialists and counsellors. This will enable the patient to meet with their embryologist and be guided throughout their journey at the LWC to make sure they are fully informed about their embryos and always have their questions answered.