Dr Peter Hollands
25 April 2002
The role of the clinical embryologist has changed in many significant ways since the profession began. In the early days at Bourn Hall Clinic the embryologists? role was confined to the laboratory. The scientists there carried out excellent work in an environment they knew and loved. They often worked very long hours (no change there then!) especially in the days before down regulation. I was often still at the clinic at midnight to do the insemination for an LH surge egg collection carried out at 8.00pm. These were pioneering days and the embryologists involved accepted the work gladly. Their 21st century colleagues have very different demands on them including ICSI licensing, never ending rules and regulations and ever changing technologies.
Probably the most significant change is the amount of legislation and documentation related to the work. In the UK and in many other countries there are now very specific laws governing the practice of IVF clinics and the embryologists often find themselves responsible for this paperwork. This can place enormous pressures on embryologists, especially those working in small teams. Failure to comply with these regulations will result in closure of the clinic and possible personal prosecution. Clinics should seriously consider administrative back-up for this increasing amount of red-tape. It is unfair to expect already stretched scientific staff to complete this paperwork.
A second very significant change is the amount of patient contact most embryologists are expected to carry out. In the early days of IVF the most patient contact I ever got was at embryo replacement (transfer) when I was expected to say:
?Hello Mrs Bloggs, you have got three embryos to replace now and six to freeze?.
Today many embryologists find themselves in long involved discussions with very well informed patients (thanks to the internet!). There is very often little or no training for this new role and many embryologists can find it very daunting. I do agree that some patient contact does enable the scientist to put his role into context but I also believe that this should be in moderation!
Another point of hot debate is the salary available to clinical embryologists. In the UK there are two types of clinic: National Health Service (NHS) government run clinics and privately run clinics. In the NHS clinical embryologists come under the clinical scientist grade. In this system a very experienced clinical embryologist very often earns the same as a new graduate going into the computer science business! This offers very little encouragement to clinical embryologists who are, after all, working with human life with an enormous responsibility. In the private sector the situation is slightly better but the embryologist still receives much less reward than his clinical colleagues. I would dearly like to work full-time in clinical embryology but unless I can get the job of scientific director in a private clinic (about as likely as me needing to muck out my little boys? rocking horse) I could not even match my meager academics? salary. There is clearly an enormous divide between clinical and scientific salaries within IVF clinics, something which the professional bodies representing clinical embryologists could well spend some time and effort addressing.
I am sure that we would all agree that the best IVF clinics are those at which there is a team effort and a good team spirit. At the clinics where I have worked there has always been a very good team spirit but this is apparently not always the case. There can be a tendency for ?the lab? to be undervalued and for scientists to be down-trodden by clinical staff. This will result in very poor co-operation between team members which almost always reflects in the overall performance of the clinic. These concepts are illustrated perfectly when some clinicians decide that they will ?learn embryology? and then do without an embryologist. I understand that this often happens because of lack of money but what kind of message does this send to embryologists? Would these clinicians attempt to do the nursing, the portering, the maintenance or the cleaning to save money? Probably not!
Many of my colleagues are also involved in ground-breaking clinical research including the development of the full potential of embryonic stem cells, a subject which I laid the foundations for in animal studies in the 1980?s. These researchers often work in their own time (after a long day of clinical work) and very rarely work with the financial support of their host laboratory. The profession must recognise the importance of these researchers if the field is to progress.
Clinical embryology is a satisfying job. It is a pleasure to serve the patients we treat and especially to see their joy when the outcome is positive. Nevertheless, we as a profession must ensure that we are respected in our work and that we are given the appropriate professional status and salary. At present this is often not the case.
Dr Peter Hollands
Anglia Polytechnic University, East Road, Cambridge, UK, CB1 1PT
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