Keshav Malhotra: No Embryologist or Laboratory Technique Can Guarantee Euploid Embryos
Keshav Malhotra, Director of Ujala Cygnus Rainbow Hospital and Chairman of Embryology of the Indian Society of Assisted Reproduction, shared on LinkedIn:
“Over the last month, four embryologists have called me with the same story: every embryo in a particular cycle came back aneuploid, and the clinician blamed the embryologist.
They’ve also asked whether there is a sure-shot way to guarantee euploid embryos.
Two answers:
Most aneuploidy comes from female meiotic errors that are already present in the oocyte before it reaches the lab. Age remains the strongest predictor.
No embryologist, medium, incubator, technique, AI tool, or supplement can guarantee euploidy.
The lab does matter. Centre-level variation is real, and so is variation between genetics labs. But one all-aneuploid cycle is not a lab diagnosis. It needs age-stratified trends, the right denominators, and a proper review of KPIs.
Ensure you
Biopsy well. Take an adequate number of trophectoderm cells (commonly 5 to 7), avoid the inner cell mass, use minimal laser, and witness every step.
Tube cleanly, every time. Wear gloves and a mask, use DNA-free tubes, and use a fresh pipette for each embryo. Wash the biopsy in fresh drops of the solution your genetics lab specifies. Load the sample under the microscope with minimal volume, and visually confirm it is in the tube.
Witness every embryo-to-tube step, and include a blank control as your genetics lab advises. Track no-amplification and inconclusive rates per operator. When these rise, contamination or tubing technique is usually the first place to look.
Know your genetics lab. Their validation data, mosaic thresholds, and inconclusive rate.
Measure fairly. Age-stratified euploidy, euploid blastocysts per mature oocyte, and day 5, 6, and 7 biopsies reported separately, with KPIs tracked per operator.”
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