Singapore embryologist explains how she sows the seeds for a baby

SINGAPORE - Using the in-vitro fertilisation (IVF) method, Ms Joyce Elizabeth Mathew has helped dozens of infertile couples become parents.

The Chief embryologist of the assisted reproductive technology programme at the Clinic for Human Reproduction at the National University Hospital (NUH) often selects the best sperm and injects it directly into the egg, using the intracytoplasmic sperm injection (ICSI) method. This is done when the sperm is of poor quality and quantity.

An older method involves placing an egg in a droplet of sperm. This is done for patients with many eggs and sperm of good quality and quantity.

Ms Mathew joined the department of obstetrics and gynaecology at NUH in 1993, after obtaining her Master of Science at the National University of Singapore. She has helped set up IVF laboratories overseas and trained embryologists here and overseas.

She has been married for 25 years to a businessman. They have a 24-year-old daughter.

I specialise in embryology because…

This is a unique calling and a very fulfilling job. We are scientists who work with sperms, eggs and embryos to help infertile couples have babies.

Our work involves the use of highly specialised and sophisticated equipment and we need to have good psychomotor skills because eggs and embryos need to be handled gently.

The egg and sperm are fascinating because…

The human egg is the largest cell in the body, at 120 microns, and the sperm head is the smallest cell, at about 5 microns. The successful union of these two results in something truly miraculous.

One little known fact about in-vitro fertilisation (IVF) is...

It is considered a success with the implantation of the embryo to the endometrium (lining) of the uterus.

Other than the ability of the endometrium to receive the embryo, the woman's age plays a major role in IVF success because declining egg quality with increasing age gives rise to poor quality embryos.

If I were to give an analogy for what I do, I would be...

An organic farmer who selects the best seed and sows it on fertile ground.

Unlike a normal gardener who uses fertiliser and pesticide, the organic gardener works in harmony with the natural systems by adding organic matter to the soil. He pays special attention to the temperature and environment.

When the seed takes to the ground, it germinates and grows into a beautiful plant.

Similarly, embryologists try to mimic the natural conditions in the human body. In a petri dish, we monitor and nurture the embryos under optimum temperature, add nutritive medium and remove waste.

A typical day for me starts...

At 7.30am at the assisted reproductive technology laboratory. This is when we check for fertilisation and development of the embryos.

IVF follows a strict timeline and each check is time-specific. On a typical day, we have many embryos at different stages of treatment - fertilisation, embryo growth, freezing, transfer and thawing. Each procedure has a specific workstation.

We call our patients daily to update them on the progress of their embryos.

In the afternoon, after eggs are retrieved from new patients, I perform intracytoplasmic sperm injection for challenging cases.

Occasionally, very early in the morning, I perform specialised procedures such as embryo biopsy. During this procedure, one or two cells are removed from an embryo and sent to the genetic laboratory to rule out any known chromosomal abnormalities or genetic diseases.

Some mornings, I am involved in teaching and training health-care professionals such as doctors and scientists looking to specialise in assisted reproduction techniques.

I have departmental meetings once a week. Our procedures are usually completed by 6pm.

I have come across all types of cases...

Including some male patients having extremely poor sperm quality and, sometimes, no sperm in the seminal fluid. In such cases, we can consider retrieving sperm from the testicular tissue and injecting it into the eggs.

In the past, female patients had very few options to preserve their fertility after undergoing cancer treatment. But now, we freeze their ovarian tissue before they go for chemotherapy. Once their cancer treatment is completed, the tissue is transplanted back to the ovary.

The best part of my job is...

I need to keep abreast of new technology in this fast-developing field. With every new cutting edge breakthrough, such as embryo biopsy and ovarian tissue cryopreservation, there is yet another new service we can provide to our patients.

The most challenging part of my job is...

The long hours and the need to work during weekends and public holidays because embryo development needs to be monitored daily.

Yet, I still find what I do extremely fulfilling. It is worthwhile to invest so much time and effort to care for a delicate, growing life.

Things that put a smile on my face are..

When I see our patients carrying their bundles of joy and knowing that I was the first to see the beginning of their precious lives.

It breaks my heart when...

Despite all the efforts, the treatment is unsuccessful for some patients.

This can happen when the embryo does not implant to the uterus or if there is a spontaneous abortion, which is usually attributed to implantation problems from the lack of endometrial receptivity and genetic abnormalities in embryos or poor quality embryos.

I would not trade places for the world because...

I am awestruck every time a life is created and after 20 years, I still consider it a privilege to be playing a small part in the miracle of life.

My best tip...

Start planning for a family early. If you have been unsuccessful after trying for a year, seek help. Women who are 35 years or older should see their doctors after six months of trying.

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