Forma Scientific, Inc. (incubators, cryopreservation dry shippers, laminar-flow bench workstations)
MVE (liquid nitrogen freezers)
Nikon (inverted microscope) (Note: a video camera may be used with this.)
Eppendorf (micromanipulator, centrifuges)
Mid-Atlantic Diagnostics: K-System (air suspension workbench with stereo microscope built into a vertical laminar flow cabinet)
Barnstead/Thermolyne (test tube mixers, rotators, and shakers)
Thermo Forma (microcentrifuges)
Diagnostics Products Corporation (Immulite endocrine analyzer)
A list of the principal pieces of equipment follows. It should be noted that there are consultants specific to the IVF field who specify equipment and do the laboratory layout, although the embryologist will have considerable input and may, in fact, take entire responsibility for the design and equipment selection (Figure 4-35). The relationship of each piece of equipment to another affects the electrical plan, requiring careful coordination.
General Lab Equipment. Includes refrigerators and freezers; cryogenic storage tanks; specialized microscopes; air suspension tables; centrifuges; test tube mixers, shakers, and rotators.
Andrology Lab. Includes laminar-flow hood; refrigerator; centrifuges, both large and small; phase microscope with fluorescence; warming oven; water-jacketed CO2 incubator; dry shipper tanks (Figure 4-35).
Embryology Lab. Includes laminar-flow hood; stereo microscopes; stage warmers; centrifuges, large and small; computers and printer; incubators (tabletop model, water-jacketed CO2, and high-effieciency partic-ulate air [HEPA]-filtered C02); water purification system; waterline pressure pump and tank; dry heat ovens.
Embryology Micromanipulation Area. Includes air suspension table (to minimize vibration); inverted microscope; video camera, monitor, and recorder; stage warmer. The video camera and monitor enable the embryologist to perform the procedure at magnification on the monitor, rather than looking through the microscope. It also shows (if the OR has a large monitor) the embryo being loaded into the syringe just prior to the transfer procedure.
Cryopreservation Area. Includes laminar-flow hood, planar cell freezer, heat sealer, stereo dissecting microscope, liquid nitrogen tanks.
Microscopes need to be at sit-down workstations and must be at a comfortable height for the embryologist. This can differ depending on whether that individual is short or tall, which can sometimes be accommodated by adjusting the chair height. The selection of a task chair for this position is also very important as individual comfort and ergonomic features matter.
Note that there should not be overhead cabinets above the balance table in the micromanipulation area, the computerized semen analyzer, the cryopreservation counters, or the autoclave area. Areas under the cryopreservation countertop should be open to accommodate liquid nitrogen storage tanks on wheels. CO2 lines should be centrally piped to the workbenches where it is needed. The endocrine analyzer can, if space is limited, be located outside the lab.
Lab Storage. If an adequate water purification system is not centrally installed, there will be a need to store quantities of ultra-pure water, which is delivered in large bottles. There are also many chemicals that need to be stored to support the lab functions.
HVAC/Air Quality Standards. Air quality is an important factor when trying to maintain process integrity. Testing reliability, results, and personal protection can be affected by airborne contamination. Air quality in laboratories is defined by Federal Standard 209E with classifications of Class 1, 10, 100, 1000, and so on. This Class number is the maximum allowable number of particles 0.5 micron and larger per cubic foot of air; the lower the number, the cleaner the air. International Standard IS014644-1 classifications are rated as ISO Class 1, ISO Class 2, and so forth. According to both standards, Class 1 is the cleanest, ultra-pure air. ISO Class 2 correlates most closely to Federal Standard Class 100.The standard for an embryology lab is Class 100 air quality. The labs will have several laminar-flow hoods for carrying out certain procedures. The room should have a four-stage HEPA filtration system that purifies the air of the entire lab. The labs must have individual temperature, humidity, and velocity controls and there must be access to overhead ducts for periodic cleaning and changing of air filters. Air intake must not be near any source of contaminiation, and air from the hoods may need to be ducted directly to the outdoors, due to the chemicals used.
Lighting. Lighting in each section of the lab should be individually dimmable. It must be an incandescent source as fluorescents generate a frequency that may affect cellular development of the embryos. Procedures in exam rooms are generally done in full light, but being able to dim the lights during ultrasound is advisable. This could also be accomplished by being able to turn off the overhead lights and have just a wall sconce remain (Color Plate 14, Figure 4-36). In large procedure rooms, a ceiling-mounted surgical light is required. Here, as well, being able to dim the lights is important during ultrasound-guided procedures. There will be a large video monitor placed so that the patient can see when the embryologist loads the syringe for the embryo transfer. Room lighting needs to be placed to avoid glare on monitors.
Electrical. Of utmost importance in the labs is an uninterrupted power source for incubators, alarm systems, and monitors. Various types of back-up power systems are available. In addition, surge protection is needed for all electrical and electronic equipment.
Security and Alarm Systems. Laboratory security sometimes involves video cameras. Depending on the number of people who have access to the lab, a fingerprint identification system or magnetic card reader may be required. Alarm systems monitor incubators, gas and liquid nitrogen tanks, and cryotank monitors, relaying a message when equipment malfunctions. Successful results in this specialty demand precise temperature control and environmental conditions. Forma Scientific makes a monitor/alarm system that can interface with up to 24 pieces of equipment. It also makes the Sensaphone® telephone dialing system that interfaces with the alarm system to automatically dial several sequential telephone numbers of laboratory staff if something is amiss at the lab.
Medical Gases. There are a large number of medical gas cylinders within this suite. Even if general anesthesia is not used, there will be a need for centrally piped oxygen in the procedure rooms and the recovery room. The IVF culture area and micromanipulation area require vacuum and CO2. The cryopreservation area requires liquid nitrogen (LN2) and vacuum, and the media prep and androlo-gy areas require CO2 and vacuum.
Plumbing. Sinks must be precisely located in the laboratory areas. In addition, certain pieces of equipment may need to be connected to water and drain. As in any lab, noncorrosive piping must be used and sinks should be stainless steel. Eyewash diverters on sinks must meet OSHA requirements.
Interior Design Considerations Embryology Laboratory. Purity of materials is of utmost importance. Off-gasing of volatile organic compounds (VOCs) from synthetic materials and contact cements used in plastic laminate casework should be reduced to the minimum possible. At completion of construction, high-velocity air filtration and fans should be used to exhaust as much of the construction dust and off-gasing of materials as possible prior to commissioning the lab. Usually, for two weeks prior to using human specimens, mouse or hamster eggs may be used to test conditions. Walls and floors should have no seams or crevices to reduce the possibility of contamination and make cleaning easier. Sheet flooring such as linoleum (made with natural materials) can be self-coved at the base to eliminate crevices. In terms of color, labs should be fairly neutral but white creates too much glare. A beige floor and walls work well. Embryologists often prefer to work on dark-colored (charcoal) countertops because it makes it easier to see dust. The doors to laboratories must have a sign saying Authorized Staff Only.
Procedure Room. Physicians often prefer a medium to dark floor in these rooms to eliminate glare. Note that the door will require a sign Proper Surgical Attire Required.
Well-established ART practices often attract celebrities, foreign dignitaries, and even heads of state who will be ushered into the office through a private entry, bypassing the waiting room. Occasionally, to accommodate these individuals, the office is closed so that no one but staff is present during the visit.
A collection of fertility dolls from various cultures is interesting and relevant. Although not recommended for the waiting room, in a corridor, a large photo wall can be attractively created with photos of parents and their babies. Physicians in this specialty receive hundreds of photos from grateful patients. These range from poorly composed snapshots taken with disposable cameras to professionally posed photos with twins or triplets wearing matching outfits with a seasonal theme such as Easter bunnies or valentines. They are fetchingly adorable. Most photos will be color, which will make the overall effect quite busy. A solution is to take all of them to a professional photo lab and have an internegative made to convert them to crisp black-and-white prints, in exactly the desired sizes to fit the designer's selection of frames. Additionally, magazine and newspaper articles featuring the physician(s) can be attractively matted and professionally framed. The physician's diplomas should be prominently displayed in his or her consultation room (private office). Frames need not match and are more interesting if they complement each other, but don't match. This is not the time to go to Aaron Brothers to buy a picture frame. Patients need to have confidence in the fertility specialist since they are investing a great deal of time, emotion, and money in this endeavor.
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A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.