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. 2016 Aug;33(8):1009-15.
doi: 10.1007/s10815-016-0686-4. Epub 2016 Mar 16.

Are we ready to inject? Individualized LC-CUSUM training in ICSI

Mercè Durban  1 , Désireé García  2 , Albert Obradors  1 , Valerie Vernaeve  1 , Rita Vassena  3
Affiliations

Are we ready to inject? Individualized LC-CUSUM training in ICSI

Mercè Durban et al. J Assist Reprod Genet. 2016 Aug.

Abstract

Purpose: The objective of this prospective, single center study was to develop a personalized training scheme for intracytoplasmic sperm injection (ICSI) through the use of learning curve-cumulative summation (LC-CUSUM), which allows to tailor training to the trainee performance, and to validate it against the performance of experienced embryologists.

Methods: Five trainees microinjected latex microspheres (LM) into vitro matured oocytes. A microinjection was considered successful when the oocyte did not lyse in the 24 h following the injection.

Results: Each trainee became proficient at ICSI after a variable number of injections, ranging from 35 to 80. Trainees that achieved proficiency went on to perform ICSI with human gametes in a clinical setting with proficiency comparable to that of experienced embryologists.

Conclusions: We show that LC-CUSUM based personalized ICSI training is feasible and allows trainees to be as proficient as trained embryologists when treating actual patients.

Keywords: ICSI; LC-CUSUM; Learning curve; Training.

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Figures

Fig. 1
Fig. 1
ICSI training with LM. a LM in a drop of medium, with one LM loaded in the injection pipette. b ICSI initiated, the LM is visible close to the tip of the injection pipette. c An oocyte 24 h after injection; the LM is clearly visible in the cytoplasm of the oocyte (success for LC-CUSUM). d An oocyte 24 h after injection; the oocyte is lysed and degenerated (failure for LC-CUSUM)
Fig. 2
Fig. 2
LC-CUSUM curves of the trainees included in the study. To interpret the LC-CUSUM graph, one needs to remember that each success (no lysis) will cause the curve to move downward towards the decision limit (h LC = −0.92), while each failure will cause the curve to move back up towards the x-axis. Performance cannot be considered acceptable (i.e., the trainee is not proficient) while the score line remains in the area between the x-axis and the decision limit (h LC), the so-called continuation region. Monitoring therefore continues as the line move downwards until it crosses the h LC, when competence is achieved. a–d Trainees achieved competence after 35, 35, 70, and 80 procedure, respectively. e The trainee did not achieve competency after 80 procedures and was removed from LC-CUSUM
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