The assisted reproductive technology laboratory: toward evidence-based practice?

In the past decades, the efficiency of human assisted reproductive technologies (ART) has improved. We have witnessed important new developments such as intracytoplasmic sperm injection, blastocyst culture, vitrification, and methods for genetic analysis of human embryos. Despite these improvements, current ART laboratories are to a large extent composed of general laboratory equipment that is not designed and manufactured especially for human ART. Human reproductive cells have different physiochemical requirements than somatic cells. We encourage the development of laboratory equipment, utensils, and consumables that are designed specifically for human ART. In addition, the quality and consistency of commercially available culture media have improved, but the composition of commercially available ART culture media varies considerably. It is difficult to see the scientific rationale for this variation. Currently it is not known which of these formulations gives the best clinical results. Finally, selection of embryos in routine ART should be done with the use of variables that have been shown to have statistically independent selection power. With the advent of automatic and objective methods for recording morphology and growth kinetics of human embryos, there is a possibility to pool data sets from many different clinics. This may enable the construction of selection algorithms based on objectively recorded embryo parameters. New methods for the genetic analysis of chromosomal status of embryos may prove to be useful, but they should be tested in controlled randomized trials before being introduced for routine use in ART.