Everything You’ve Ever Wanted to Ask an Embryologist with Lucy Lines
Today, I’m so excited to bring you this conversation with Lucy Lines, an embryologist with over 20 years of experience in the field. Lucy began her career at Monash IVF in Melbourne in 2000.
She worked in fertility clinics around the world and consulted in clinics throughout Europe, the UK, and Australia.
She realized that in addition to creating babies, she also loves learning and helping people. Having faced infertility and multiple miscarriages herself, she now works as an educator and coach for fertility patients.
Her Instagram account is refreshing and informative. I love that she says she’ll happily answer all of the questions you save for the day when you finally meet an embryologist. She was so forthcoming with her wealth of knowledge and her own experience during our chat, I know you’ll enjoy this interview as much as I did!
Dr. Aimee: I am so lucky and excited to have Lucy Lines on today to talk to us about everything you ever wanted to ask an embryologist. Hi, Lucy, I feel like I already know you because of following you on Instagram and all of the great information that you provide people who follow you.
Lucy Lines: Thank you so much for having me, Aimee. It’s so exciting to meet someone that you’ve followed for so long. It’s like oh my god, I’m meeting a famous person. It’s really exciting.
Dr. Aimee: My mother always reminds me, “Aimee, you’re a nobody,” and I’m like okay, one day. Just kidding.
I’ve heard you say that you kind of fell into embryology. How did that happen?
Lucy Lines: I really did. When I first left school, I was never going to go to university. It was not my thing and I wasn’t going to do it. I got a job at McDonald’s. Turned out, that wasn’t my thing either. I did end up going to university, but I studied a bachelor of agriculture science. I was learning all about dirt and growing things, cows and sheep, and I ended up majoring in animal breeding and genetics, and I loved it.
So, then I went and worked as a veterinary nurse for a while. We were doing a lot of AI in cattle and sheep. One day, I just went, “I can’t do this anymore.” We had inseminated 2,000 sheep in a week and we were on this farm in rural South Australia, and I was just like I can’t do this. My dad presented me with a thing that he had received in the mail, he’s a rural GP in Australia, about a course at the Monash University in Melbourne which was a post-graduate diploma in reproductive science. I thought that fits beautifully, so I’ll go and do that.
While I was doing that, I was volunteering in a research lab at the Institute of Human Reproduction in Melbourne. The woman who ran that lab put my name forward for this job at Monash IVF. She came to me and said, “You have an interview for this job.” I said, “What is it?” She said, “It’s an embryologist.” I said, “Great. What’s that?” I had no idea.
I went to the interview and I worked out a little bit about it and kind of landed in it and went “This is where I was meant to be, this is perfect.”
Dr. Aimee: I love that. An embryologist is kind of like a gemologist. You’re studying these beautiful sparkly cells, and I think of them as diamonds. Can you tell us a little bit about the training that an embryologist needs and what does an embryologist do?
Lucy Lines: When I first started my training, the senior embryologist in the group that I was in said that it takes about a year to train an embryologist, but about five years before they’re actually any good. It was sort of this thing that you were very much the junior and you had everything to learn, which is completely true. You cannot learn to be an embryologist except in an embryology lab. Of course, once you’re in an embryology lab, you’re actually dealing with embryos, so the training for an embryologist is very structured and it’s very stepwise.
At the time that I did my training, which was in 2000, Monash IVF was still in the phase of teaching the world how to do IVF, so we got a lot of visitors from overseas who were coming to learn about how we did things. We had a real opportunity to learn and grow. I was there for two years, and in those two years, I learned how to do an egg collection, how to do all the different bits and pieces. Very much a process of see one, do one, teach one, with a lot of scaffolding and support around you because, obviously, you’re dealing with people’s hopes and dreams and futures.
So, I did that. Then when I went to the UK soon after that — I actually went to Sweden first, but then the UK — in the UK you have to get a license to do ICSI, so you have to do a certain number of intracytoplasmic sperm injections in order to receive your license to be allowed to do them on your own. So, the training is different everywhere, but it’s very scaffolded, very structured, and very stepwise.
Dr. Aimee: How did your own journey being a fertility patient yourself affect your work as an embryologist?
Lucy Lines: That’s a bit of an emotional one. When I first started embryology, I was single, footloose, fancy free, I thought I had forever. I was 27, 28, babies were one day in the future. Like most young girls, I guess I grew up to believe that I would just meet Prince Charming, get married, and have babies, and that’s how it was going to go.
My Prince Charming turned out to be a man in Sweden who is a British man who had three children already. When we first started dating, children were nowhere near his radar. I said to him, “I can’t invest more in this relationship if children aren’t somewhere on the radar.” He said, “I’ll meet you in the middle. If it happens naturally, great. If it doesn’t, I’m not doing IVF.” I said, “That’s really conflicting for me because I work in IVF, but okay.”
That was kind of the agreement we had from the beginning. So, I never actually did a cycle of IVF myself, but it took us 12 months to conceive our first child, and I miscarried that baby at 13 weeks, which was devastating. I’m sure anybody who has been through a miscarriage knows that you will always remember when it was, you’ll always remember the due date, all of that stuff. It then took us another 12 months to conceive our second baby, our first child, and I sent her to high school this week.
Dr. Aimee: That’s so special.
Lucy Lines: I can’t believe it. She’s big. So, it was a very conflicting time for me because during that time I moved a lot around the world. He was in Sweden, I worked in England, I worked in Ireland, I came back and worked in Australia. We managed that relationship long distance and bit by bit things came together.
During that time when I was miscarrying babies, it was all very challenging. I was working within the fertility business, so it was a very disparate sort of part of my life. I kind of separated off my own personal bit from what I was doing at work. I guess it gave me a lot more empathy for what people were going through, this desire to have a baby and how deeply ingrained that is and how much it drives your every waking thought. But I also had the science to fall back on. X plus Y doesn’t always equal Z, and all that.
It was challenging, there’s no denying that.
Dr. Aimee: It’s clear that you love your work and you love educating people. What do you do now?
Lucy Lines: I’ve struggled to find a word for myself, because I’m not really a fertility coach, I’m an embryologist. Just recently this week, I’ve decided I’m the embryologist in your pocket. What I’m doing now is I run a business called Two Lines Fertility, which is quite literally just me in this room in my house in Australia. I’ve built a website, I obviously have the Instagram account, and I do a lot of one-on-one consultations with people, helping them to understand what they’re going through, wherever they are in their fertility journey (and wherever they are in the world!)
So, to stop the late night Google searches and to help people bring their general knowledge of their bodies and how they function up to a certain level so that when they get to someone like you who is actually managing their treatment cycles or a fertility specialist, wherever they are in the world, their general knowledge is here, not down here, so they can go, “I understand what you’re saying, and now I’d like to know about this bit,” so they can ask informed questions of their specialists.
I work very much hand in hand with fertility specialists, acupuncturists, Chinese medicine people, massage therapists, reflexologists, all the different things to bring them together to help people feel a little bit of control over their fertility treatment, whether it’s IVF, IUI, or they haven’t even started yet, wherever they’re up to.
The business is called Two Lines Fertility and you’ll find it at TwoLinesFertility.com.au. I made sure the AU was on the end so that people would know where I was in the world, but I have clients all over the world.
Dr. Aimee: I think you’re the embryologist in your pocket, but also with all of the questions that you get, I imagine they could create an AI, like a Lucy embryologist AI tool for people, kind of like an Alexa, but a Lucy.
Lucy Lines: Sort of. I get text messages from my clients at 6:00 on a Saturday night, “I’m supposed to take my trigger injection, but I can’t remember when, how, or what, and I can’t get hold of my doctor.” Especially when those clients are in Melbourne or Australia, I often know their fertility specialist, and I can just ring them to say, “Hey, this patient is having a bit of trouble. What should I tell them?” So, I work together with the specialists in that way.
Dr. Aimee: That’s really sweet. That’s a great little tidbit there. What are some of the most common questions that people ask you about embryology?
Lucy Lines: They really vary a lot. Right from the beginning of, “Is it true that I’m born with all of the eggs that I’ll ever have,” and “Why do I read in so many places that I can’t do anything about my egg quality? When you say that I can, what are you talking about there?” That’s a really big area of conversation that I have.
Another really common question is, “I had beautiful eggs collected, and I’ve only ended up with one for transfer. Where did all of the others go, what happened along the way?” Or a lot of people further down the journey will say, “I’ve had five transfers with what the embryologist told me were beautiful embryos. Why are my embryos making it to day five or six and I don’t have a baby yet?”
Those kinds of questions, really the answers to those can’t be answered in one quick conversation. You need to do a whole lot of investigation, as you know, into what some of those reasons might be.
Dr. Aimee: Let me just ask you some questions that I imagine you get quite a bit as well.
How are embryos even chosen?
Lucy Lines: We generally choose embryos based on a number of time points through their development that they have to reach. We like them to be within a certain timeframe and at a certain developmental stage by that timeframe. That gives us some information about what the embryo is up to.
Generally speaking, we do choose embryos based on how they look, but we know that’s an inexact science. It’s a little bit like saying this gorgeous baby is going to grow up to be really successful. You can’t possibly tell that by looking at a beautiful baby. You can’t really tell that from an embryo either. When we combine what the embryo looks like together with the genetic information about the embryo, obviously we have more information, and that’s about the best we can do.
Dr. Aimee: Why do some embryos grow and some embryos don’t?
Lucy Lines: It’s genetics. It’s just kind of how things go. When we do an egg collection, we’re not taking eggs from the ovarian pool, we’re taking eggs from the cohort that started growing two and a half months ago or three months ago. In that cohort in the natural system, only one of those eggs would make it to ovulation. It’s natural to expect that some of those eggs really shouldn’t have applied for the job to be the egg that got ovulated because they were never going to be any good at it anyway. So, it’s right to expect that some of them aren’t going to make it.
Dr. Aimee: How do you keep track of each embryo? It seems like there’s a lot to watch and take care of.
Lucy Lines: There is a lot to watch and take care of. On any given day in the embryology lab, an embryologist will be doing paperwork for tomorrow’s egg collections, collecting eggs for today, doing fertilization checks on yesterday’s egg collection, looking for development in the other ones, doing embryo transfers, and freezing. It’s a lot to keep track of.
There is a very structured plan for how an embryology lab works. There are very strict rules and regulations about how you handle those things. Embryos are too small for us to see, so obviously they’re stored in dishes in droplets of oil. The dishes are labeled. A lot of labs these days use RFID labeling. There are a lot of checks and balances to keep track of those embryos all the way through.
I have a blog on my website, it’s one of my most recent blogs, that is How Do I Know These Embryos Are Mine. You can go through that blog and have a bit of a read about all of the checks and balances that we have from egg collection through to embryo transfer so that we can be sure that these embryos are yours.
Dr. Aimee: I think that’s great. I imagine there’s going to be even more technology coming through the pipeline soon. Along those lines, what things do you think patients can look forward to in the future? Are there any embryology breakthroughs or predictions that you have for our future?
Lucy Lines: I think there’s always loads. There’s a lot of research going on into particular AI, as you mentioned. Obviously, judging embryos by how they look and the genetics is not always possible, how they look is inexact. The development of the timelapse incubators and the AI technology to go with that is giving us a whole lot more information about embryos that we may not be able to see in the less than a minute that we look at them down the microscope. So, the AI technology is really interesting.
The addition of growth hormones to culture media is looking really promising. There’s some really interesting data coming out of that as well.
Flow technology, there’s a bit of a development of culture media dishes that have a flowing culture media through them rather than a static environment. Obviously, in the reproductive tract, there is a lot of flow going on, it’s not just a static environment. Some of that research is really fascinating, too.
Dr. Aimee: Wow. I didn’t know about some of those things. Thank you for shedding some light on it. That’s exciting.
What are some embryology myths that you want to bust for people?
Lucy Lines: One of the first ones that I really came across was people saying, “I’m not sure about IVF. Don’t you think you’re playing God a bit? Don’t you think if people can’t conceive that there’s probably a reason for that?” I want to say that we can create embryos, we can transfer beautiful embryos back to people who ostensibly have the same reason for their infertility, the same quality embryos, and one will get pregnant and the other doesn’t.
Someone else still has a really big hand in this. Whether you want to believe that’s God or Buddha or the universe or just pure science, I don’t know, whatever you want to believe. We have access to tools that can help us achieve things, but it’s not black and white, we’re not playing God. Someone else still has a really big hand in it. That’s the main one that I think I’ve countered all of my life from all different aspects in my world, my personal life and my professional life.
Dr. Aimee: I hear you loud and clear with that. I have to tell you, when someone says to me, “I just want to conceive naturally,” I’m just like what do you think happens when I put an embryo in, it’s nature, there’s nothing else other than nature that is making it so that embryo can stick and grow. Hopefully, by people hearing us talk about it in this way, it might change how people think about the things it can do.
Lucy Lines: It’s so hard to get the language around that right because we do talk about natural conception or IVF, it’s an either/or. Exactly as you say, we collect ten eggs from someone and we put them together with the sperm in the incubator overnight, and some of them will fertilize, and some of them won’t. That’s not science. That’s something else, whatever it is, that’s nature. Then some of them develop and some of them don’t, and that’s nature, too. They’re in the same environment. It’s not science.
Dr. Aimee: Lucy, thank you for joining us today and shedding light on everything that you do. I love the story about how you started as an embryologist and what led you there. Thank you for Two Lines Fertility. What’s your Instagram for people who haven’t followed you yet who are going to because of listening to you today?
Lucy Lines: You’ll find me @ TwoLinesFertility.
Dr. Aimee: Easy enough. Is there anything else that you want to share with our listeners today?
Lucy Lines: I do have a program called IVF WTF. IVF WTF and includes step-by-step details of an IVF cycle and what to expect, along with how to prepare for treatment.
Before that I had a “MindFul Program.” We launched it for the first time in October last year and we’re doing the second round now, and then we’ll do it again two or three more times during the year. I ran this with a fertility hypnotherapist.
It’s such a combination of my science, what you can do, what you can’t do, what you can control, and getting that general knowledge up to a really good level, and then my collaborator Tanja Mulcahy’s injection of mindfulness, mindfulness practices, and how to reconnect that neuroscience of the thoughts that you have and how that impacts how your body functions. The two working hand in hand really does create the ultimate preparation for IVF.
Dr. Aimee: And ultimate preparation for life in general. I took courses like this when I was in my early 20s to prepare me for what I do today. I’m so surprised that so many people haven’t done that kind of work. I almost think it should be mandatory before you even graduate high school.
Lucy Lines: I agree. I had a hemithyroidectomy late last year in November, and in the lead-up to that everyone was like, “Lucy, you must be terrified. What if it’s this? What if it’s something else?” I’m like I’ve had 20 years of what-ifs, I’m really good at those now, I’m really good at taking myself to a space where I know I can’t control that, so let’s do some breathing, let’s find some peace, let’s find a place where it’s cool, manage the things we can, and find a way to be okay with the things that we can’t.
Dr. Aimee: That’s great. Very well said. Thank you again, Lucy. We hope to have you back on to talk about your programs and all of the wonderful things that you’re doing. I hope you’ll join us again.
Lucy Lines: Thank you so much for having me.
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Originally published at https://www.draimee.org.
