Clinical embryologists are essential members of the fertility health care team. While the fertility doctor performs thorough clinical testing, assessment of patient history, and determines the best course for fertility treatments, it is the clinical embryologist who executes much of that care. Notably, clinical embryologists are tasked with the evaluation of oocytes (aka, “egg cells”), the preparation of spermatogonia (aka, “sperm cells”) for fertilization, and the generation, safe handling, evaluation, and storage of embryos. In addition, the clinical embryologist provides critical information to the fertility doctor that impacts ongoing and future treatment of the patient. As such, they communicate regularly with the entire health care team and sometimes are called upon to discuss results with the patient.
Clinical embryology is also a field at the forefront of understanding the intricate aspects of fertility and reproduction, including considerations such as same-sex couples and prenatal/postnatal issues. Even though topics related to infertility and embryology have been prevalent throughout history, formal recognition and establishment of the role of the clinical embryologists only occurred in the 1980s, coinciding with the birth of Louise Brown and the emergence of in vitro fertilization (IVF) programs. Even still, it took until 2009 for the World Health Organization to formally classify infertility as a disease.
Despite their crucial role among fertility treatment teams, clinical embryologists still face recognition challenges in some countries due to unclear regulations surrounding education, training, certification requirements, and the need for professional development. In response, the University of Toronto (UofT) introduced a Master of Health Sciences (MHSc) degree program in Laboratory Medicine. This two-year program, offered as a collaboration between the Department of Obstetrics and Gynaecology and the Department of Laboratory Medicine and Pathobiology, allows students choose to specialize in either the Pathologists’ Assistant field or the Clinical Embryology (CE) field. A recent publication authored by the CE leadership team not only highlights the innovative CE curriculum, but also proposes professional competencies of Clinical Embryologists, known as CanEMBs.
Co-authored by Dr. Danielle Bentley and published in Fertility & Sterility Reports, this publication provides a comprehensive overview of the innovative CE curriculum which is delivered within the two-year program. With a focus on fostering critical thinking and leadership in the field, the program integrates key features such as a clinical embryology skills development laboratory, a research capstone project emphasizing methodology and statistics, and 200 placement hours in advanced fertility clinics. Significantly, the program formalizes clinical embryology as a recognized discipline within clinical laboratory science, encompassing “[…] basic science training, specific embryology education, didactic teaching on advanced reproductive technologies, and then a hands-on component which is both in a simulation lab, an educational facility”, as described by the program’s field director, Dr. Heather Shapiro.
Pictured: Inside the clinical embryology skills development laboratory at the University of Toronto.
At the forefront of formalized training in Canada, the University of Toronto distinguishes itself from European counterparts with its integration of Canadian Embryology Competencies (CanEMBs) into the CE program. Similar to the CanMEDs framework for physicians, CanEMBs aim to enhance educational standards. Specifically, UofT’s CE program encompasses clinical embryology laboratory procedures, prioritizes professionalism and ethical conduct, fosters effective communication and teamwork, promotes continuous self-learning and research, advocates for health equity, and cultivates leadership skills. Graduates are well-prepared for careers in fertility laboratories, adept at collaborating with professionals, and addressing the evolving needs of fertility patients. Importantly, a goal of the program is to prepare clinical embryologists for appropriate integration of nascent and future technological advances.
To shed light on the program's distinctive features and the often-misunderstood role of the clinical embryologist, I had the opportunity to interview two of the program’s pioneers, Dr. Theodore Brown and Dr. Heather Shapiro.
“[Clinical embryologists are] responsible for the gametes and the early embryos, pre-implantation stage embryos, up to and partially including their transfer back into a recipient uterus. So that includes quite a bit of things,” explained Dr. Brown, as he emphasized the multifaceted and evolving role of the clinical embryologist. In assisted reproduction, while physicians perform the oocyte retrieval, the many subsequent steps are handled by skilled clinical embryologists. Dr. Brown also spoke of their role as advocates for embryos and supporters of patients, underscoring the importance of “rating morphology [of the embryo]” to meticulously select the most viable transfer into the recipient's uterus. He emphasized the imperative of “minimizing the impact fertility has [in society]”, acknowledging infertility as a debilitating disease for the mind and body – an aspect that was only formally recognized by the American Medical Association in 2017.
It is certainly clear that the clinical embryologist may be fulfilling several roles within the fertility laboratory. As the profession continues to grow across the country, one of the pressing action items will be the formal acknowledgment of the profession as a distinct and esteemed specialty within the comprehensive care team responsible for patient fertility: “I don't think that the goal of the clinical embryologist is to be seen as doctors; I think the goal of the clinical embryologist is to be seen as a recognized professional specialty - it's not the same as necessarily being a doctor,” as Dr. Shapiro clarifies. By providing industry-leading training in the field, the MHSc program is shaping trainees capable of not only serving in these complex and multidimensional roles, but also of advocating for the continued recognition of the profession and their patients alike.
With respect to early training and education, availability of undergraduate courses in human embryology remains limited across our institutions: "I think if you were to call existing clinical embryologists and ask them how many have taken a university course in embryology, my guess is it would be very close to zero,” Dr. Brown stated. In Canada, diverse educational backgrounds, including those from the non-biomedical sciences, are currently accepted when applying for positions within the profession. Often, new hires will undergo on-the-job training through an apprenticeship model tailored to be site-specific. The University of Toronto's MHSc program aims to formalize these training standards across the field, while simultaneously equipping trainees with proficiencies in workplace ethics, clinical research, decision-making, and critical thinking. According to Dr. Brown, aspiring clinical embryologists must "better understand what they're doing”, and “why they're doing it". While emphasizing adaptability, especially with the impending integration of artificial intelligence into clinical laboratories, he adds: “We need to know how to adapt. We need to know how to troubleshoot. And you can't troubleshoot if you don't know the theory behind things. So that's what we're trying to accomplish."
My interviews with Drs. Brown and Shapiro underscored the multifaceted responsibilities of clinical embryologists, emphasizing the growing need for standardized, formalized training. The comprehensive two-year clinical embryology program at UofT directly addresses this need, preparing students to adapt to technological advancements like artificial intelligence, as well as complex ethical considerations in the workplace. It is imperative to continue refining such training programs as allied health professions evolve. As the field constantly changes, medical professionals should remain adaptable. As our understanding deepens and demand for insights in reproductive sciences grows, the question arises: How will clinical embryologists adapt to keep pace with these advancements?
The referenced publication, "Education of the clinical embryology laboratory professional: development of a novel program delivered in a laboratory medicine department", is available for view here. More information on the graduate program in clinical embryology, offered as a MHSc degree in Laboratory Medicine at UofT, can be found here.