Entrevista con el cliente "In vitro fertilization is a race against time. I thought this microscope was very helpful in that sense."
In April 2022, insurance coverage for infertility treatment started in Japan, making it easier for couples who want to conceive to receive ICSI treatment. However, in general, there is still a belief that “infertility is not a disease”, so there are many patients who suffer from anxiety or feel impatient during treatment. We interviewed Shoko Ieda and Sumi Shimamura of the Minatomirai Yume Clinic, who say that they find it rewarding to acknowledge these emotions and help such patients with the birth of their babies, about their impressions of using “ECLIPSE Ti2-I”.
*Customers have provided feedback to Nikon on this microscope’s features and clinical usefulness, based on their own personal experience
Shoko Ieda
Embryology Laboratory Manager
Minatomirai Yume Clinic
Sumi Shimamura
Chief Embryologist
Minatomirai Yume Clinic
Less invasive treatment that takes into account the patient’s body
— What are the characteristics of your clinic?
Ieda: Our clinic mainly focuses on a form of treatment called the “natural cycle” method. Since its opening in 2008, about 7,000 babies have been born. We have conducted approximately 50,000 cycles of egg retrieval, and performed in vitro fertilization and other operations using approximately 120,000 eggs. We have about 20 embryologists who are all committed to improving and maintaining their skills.
— What is the “treatment based on the natural cycle” like?
Ieda: In many facilities, the mainstream treatment is to use hormones to mature and fertilize many eggs at once. However, the use of hormonal drugs puts a strain on the woman’s body. In the “natural cycle” method, only one egg is carefully matured, without using hormones wherever possible. However, since the number of eggs that can be collected is limited, it is necessary to ensure that only one egg is fertilized and then returned to the patient’s uterus. The challenges are considerable, but when you consider the patient’s body, I think treatment that puts less strain on their body is important.
— What do you keep in mind in your work?
Ieda: We handle our patients’ precious eggs, sperm, and fertilized eggs. There should never be any mix-ups, so we always double- or triple-check. A fertilized egg becomes a baby, so all processes such as egg retrieval or implantation, not to mention ICSI, must be performed very carefully. Therefore, I think the most important thing for embryologists is to constantly strive to improve their skills in order to maintain a high level of technique.
Shimamura: I always keep in mind that there is a patient behind the egg and sperm, and treat them with the thought that they actually are “humans”.
— When do you feel that your work is worthwhile?
Ieda: That’s when a patient becomes pregnant and gives birth. There are some people who do not get pregnant even if they are young, so it is sometimes difficult to make a decision on how to proceed with the treatment. Therefore, I feel a great sense of accomplishment when a patient who has struggled in treatment succeeds in conceiving. Recently, the number of young embryologists at our clinic has been growing steadily, so in that respect I find it rewarding, too.
Shimamura: I feel rewarded when I succeed in fertilizing an egg that was difficult to fertilize after changing the method, or succeed in implanting a fertilized egg that was difficult to implant after changing the culture medium. I also find it rewarding when patients who have conceived and “graduated” from treatment come back to this clinic to have their second child.
— What do you think is the difficult thing about ICSI?
Shimamura: ICSI is a technique that puts you under pressure. The responsibility is great because the sperm selected by one embryologist will have half the genetic information of the fertilized egg, which will affect the success rate. So, we want to select sperm carefully, but if we spend too much time on it, the egg will be in a “waiting state”, which creates a dilemma: we need to fertilize them as soon as possible. We put a lot of effort into “choosing quickly but selecting the best sperm”.
Fast and smooth microscope operation reduces the skill gap between experts and nonexperts
— What was your first impression of ECLIPSE Ti2-I?
Ieda: The response of the microscope when I operated the buttons was fast, and that was very helpful in performing ICSI. I also felt that it was compact and didn’t take up much space.
Shimamura: Its size was such that it could easily fit onto the clean bench of our clinic, and I felt that it was “highly functional but slim at the same time”.
Button switching between observation modes enables streamlined ICSI workflows.
— How did you like the function that allows you to switch observation modes with a single button operation?
Ieda: This function changed observation modes swiftly just by pushing the switch button, making operating the microscope much easier. At first, I was operating the buttons while checking their positions. However, thanks to the button placement that is easy to access and remember, once I got used to it, I was able to operate it almost without looking. The lens switching speed is also fast. I felt that the time required for ICSI is shorter than before.
Shimamura: With conventional microscopes, I sometimes felt momentarily confused when changing modes. On the other hand, with this microscope, modes are switched quickly by a single push of the button, so I can quickly move on to the next task. In vitro fertilization is a race against time. I thought this microscope was very helpful in that sense, too.
Observation modes can also be selected and confirmed on the touch panel.
— What did you think about the feature that displays the status of the microscope on the touch panel?
Shimamura: I think there are few microscope touch panels that display the status in such detail. This feature is very convenient because when you are worried about whether the current setting is right, you can check it by just taking a look at the touch panel instead of the objective.
Ieda: This touch panel can be used even with gloves on, making operation very smooth. Embryologists who wear gloves for ICSI are required to take off the gloves every time they operate panels that are not compatible with gloves. Compatibility with gloves is a huge advantage.
Shimamura: During blastocyst biopsies, we also wear gloves, so we used to take off our gloves every time we operated the touch panel. Since it can be operated with gloves, I think it has become possible to operate the microscope while maintaining cleanliness.
Ieda: Since the displayed content includes, in addition to the objective magnification, observation modes such as spindle observation or IMSI, even if you forget what the current mode is, you can look at the display to check it, which will help prevent mistakes.
Additionally, during IMSI, I was able to clearly and quickly recognize the presence and shape of vacuoles in the sperm head, which made me realize how good the lens performance of this microscope is.
Shimamura: I think that such a clear vision of sperm helps you quickly judge whether it is a good sperm or not.fast
Alerts tell you which microscope settings need to be corrected.
— How did you like the ability to alert you to errors in the settings?
Ieda: If you are not used to microscope operation, you will probably touch many buttons and unintentionally change the settings, and then continue operation without realizing it. For example, you may think that you are observing at a magnification of 40x, but in reality, it is 60x. This microscope will tell you this, so you will notice mistakes. In particular, embryologists who are not yet familiar with using a microscope tend to get flustered at such times, so the alert display will greatly help them.
The color display of the spindle allows its position to be clearly identified.
— What did you think of the function of displaying the spindle in color in all directions?
Ieda: It is very important to identify the position of the spindle before performing sperm injection. If you observe the spindle with this microscope, you will see it in red or blue colors which do not disappear even while the egg is being rotated. This helps identify the spindle position with less opportunity to lose sight of it.
Shimamura: The spindle looks a little different depending on the degree of maturation of the egg. Such coloring makes it easier to recognize that degree, and I can tell whether the egg has matured enough to move on to ICSI.
— Please tell us what you think about the benefits of ECLIPSE Ti2-I
Ieda: The advantage of this microscope is that the settings can be switched with a single touch of the button, reducing the time and effort for operation and enabling ICSI to be performed very speedily. This lessens the strain that is placed on the egg and sperm during ICSI, which I think will lead to stable results. Since our clinic focuses on the “natural cycle” treatment, the quality of manipulation on the obtained single egg is crucial. In that sense, we regard this highly maneuverable microscope to be our very strong ally.
Embryologists who have just started to learn ICSI focus on mastering the technique, so it takes longer to get used to microscope operation. However, if the microscope is easy to operate, they could hope to achieve results comparable to those obtained by a veteran. So, I think that these microscopes are a very powerful tool. Microscopes are a real must-have for us. I believe that having one good microscope will reduce the disparity in the skills of embryologists and support the birth of babies for as many patients as possible.
Shimamura: This microscope memorized the brightness when I adjusted the light intensity, and reproduced that brightness every time I switched observation modes. This made me feel that I could customize the microscope to my liking. The observation mode can be switched quickly, and you can operate it with a touch of the button without taking your eyes off the eyepiece, so you can get used to using it in a very short time. The microscope is like a partner for embryologists. The skills of embryologists are based on good tools and equipment. In that sense, this microscope is very helpful for us.
On the improvement of the technology of ICSI and the status of embryologists
— Please tell us about your future goals and challenges.
Shimamura: ICSI is considered to be an advanced technology that requires a sense of responsibility, but I think it should be a technique that can be done in the same way by everyone. In order to achieve this, automation of ICSI would be ideal. I also believe that standardization of the technology and the establishment of guidelines are essential.
Ieda: In fact, the occupation of embryologist is still not nationally certified in Japan. I am currently going through a lot of trial and error in order to establish a national certification for embryologists. For example, differences in the size of the facilities in which they work lead to differences in the employee benefits of embryologists. In addition, it is a job which makes great demands on the nerves, so some embryologists are mentally tired and want to quit. In order for them to work positively, it is important that the job of embryologist is a stable profession. First of all, my goal is to properly establish the status of embryologists. I believe that my role is to create a comfortable working environment for embryologists in the future.
Note: The institutions and job titles listed with each researcher reflect their affiliation at the time of the interview.
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