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Introduction

In 1978 the world was amazed by the birth of Louise Brown, the first baby born as a result of in vitro fertilization (IVF). The IVF procedure involves taking oocytes, or eggs, from the woman's body.  Eggs and sperm are brought together, or fertilized, in the laboratory (in vitro).  Developing embryos are placed in the uterus where pregnancy can occur.  Originally developed as a treatment for women with blocked or damaged fallopian tubes, IVF is now used to treat many forms of infertility. The common nature of this procedure is evidenced by the fact that about 70,000 cycles of IVF are performed in the United States each year.  At the University of Mississippi Medical Center (UMC), more than 480 IVF pregnancies have occurred since the program was established in 1984.  Our IVF program, the first IVF center established in Mississippi, now performs approximately 150 IVF cycles per year. We have prepared these documents to share important and helpful information with you about this exciting new technology.

The basic steps in an IVF treatment cycle:

  • down-regulation
  • ovarian stimulation
  • egg retrieval
  • insemination, fertilization, micromanipulation, embryo culture
  • laser assisted hatching
  • embryo transfer
  • cryopreservation
Down-Regulation IVF depends on the recovery of mature eggs from the ovary. To prevent the premature release (ovulation) of the eggs, a medication (Lupron) is given to desensitize the pituitary gland and prevent the normal "signal" for ovulation. Lupron is administered as a daily injection beginning during the cycle immediately preceding the IVF treatment. After 10-14 days of Lupron injections, down-regulation is complete and the next phase of treatment is begun. Lupron is also continued throughout the ovarian stimulation phase.  Other drugs that accomplish this down regulation include Antagon® and Cetrotide®.
Ovarian Stimulation The next step in IVF is stimulation of the ovaries to produce several mature eggs. This is different from the natural cycle where a single egg normally develops each month. To accomplish this, patients receive daily injections of follicle stimulating hormone (FSH) or human menopausal gonadotropins (hMG).  These hormones (Follistim®, Gonal-F®, Repronex®, Bravelle®, or Menopur®) are given early in the menstrual cycle.

During ovarian stimulation, the ovaries are monitored carefully to evaluate the response to medications. Vaginal ultrasound examinations are performed to visualize the ovarian follicles that contain the eggs and blood samples are obtained to measure estrogen production. When the follicles appear mature, an injection of human chorionic gonadotropin (hCG) is given to trigger the final phase of egg maturation. Egg retrieval is typically performed 37 hours following this injection.
Egg Retrieval The egg retrieval is accomplished by transvaginal ultrasound aspiration. The retrieval is performed in our minor surgical procedure room in our facility. Light sedation by intravenous injection and a local anesthetic are given. Using the vaginal ultrasound, a needle is advanced through the wall of the vagina and into the ovary. The follicles are evacuated  and the fluid is taken to the IVF laboratory where it is examined for eggs by our embryologists.
Insemination, Fertilization, Embryo Culture After egg retrieval, the IVF team will determine which eggs are suitable for fertilization.  Using semen provided by the husband, sperm cells are put into culture with the eggs and placed in an incubator. The following day, the eggs are evaluated with a microscope for signs of fertilization. If all goes well, 3-6 days after the egg retrieval procedure, healthy appearing embryos that continue to grow are selected for embryo transfer and/or cryopreservation.
Micromanipulation, Intracytoplasmic Sperm Injection (ICSI), Testicular Sperm Extraction

One of the most exciting developments in the field of IVF is   Intracytoplasmic Sperm Injection (ICSI). With this micromanipulation procedure a single sperm cell is injected directly into the egg. Due to the very high fertilization rates (>70%), this technique is used for most couples undergoing IVF.  This technique is an effective treatment for men with very low sperm counts.  Some husbands that have no sperm in the semen sample can undergo surgical sperm retrieval from the testes (TESE, testicular sperm extraction) or epididymal sperm aspiration (MESA), and by utilizing ICSI, fertilization and pregnancy can be achieved.  ICSI also is an effective treatment for couples who have previously demonstrated a problem with fertilization or for unexplained infertility in couples that have not responded to other therapies.
Laser Assisted Hatching, Preimplantation Genetic Diagnosis (PGD) Our newest technique for aiding couples with difficult infertility is the use of a laser to help the embryo hatch (or escape) from the surrounding membrane (zona pellucida). This technique promises to be a great benefit for selected couples.  In addition,  by using this technique to create an opening in the zona, a single cell can be removed from the embryo, sent to a laboratory for Preimplantation Genetic Diagnosis, and tested for a specific genetic defect indicated by the couples medical history .
Embryo Transfer The final step in the IVF process involves the transfer of embryos into the uterine (endometrial) cavity. This procedure is performed in the office and does not require anesthesia. The cervix is visualized and a narrow catheter containing the embryos is threaded through the cervix and into the endometrial cavity. The embryos are released into the endometrial cavity and the catheter is withdrawn. Normal activities may be resumed the day following the transfer procedure. Progesterone supplements are usually given for two weeks following embryo transfer to support the lining of the uterus.  A pregnancy test is performed two weeks after the embryo transfer procedure. We follow the American Society of Reproductive medicine guidelines regarding the number of embryos to be transferred.
Blastocyst Transfer Our goal  is a single pregnancy.  For that reason the embryos are evaluated on day 3 following egg retrieval.  If there are adequate numbers of good quality embryos, they may be cultured to the blastocyst stage (day 5 or 6), and then only the two best blastocysts will be transferred.
Cryopreservation Embryo cryopreservation allows excess embryos generated during the IVF cycle to be frozen and stored. These embryos can be transferred to the uterus at a later time to establish a pregnancy without stimulation medications or invasive procedures. This results in a second attempt at pregnancy with a much lower cost.
Oocyte Donation For some couples, pregnancy may not be achieved through traditional approaches. If the eggs are of poor quality, especially in patients over 40, oocyte donation may be needed. In these cases, the donor goes through IVF and provides the eggs, which are fertilized by sperm from the patient's husband. The resulting embryos are then transferred to the patient. As a result of this process, a patient with a very low chance of success, can often delivery a child that is genetically related to her husband.

There are two type of oocyte donation used at the UMC Program:

Embryo Donation For some couples, a donor embryo cycle may be suitable.  Previous patients may be willing to donate embryos to a recipient couple who would undergo frozen embryo transfer cycle.
Risks of IVF

There are infrequent but special complications associated with IVF. These include:

  • Ovarian Hyperstimulation Syndrome. This temporary condition results from painful enlargement of the ovaries following stimulation with hMG. Patients usually recover with bed rest at home but sometimes hospitalization is needed.
  • Egg Retrieval Procedure. This entails a small risk of reaction to anesthesia, bleeding, infection, or injury to internal organs during the procedure.
  • Birth Defects.  Some studies suggest an increase risk of birth defects in children born from IVF procedures.  This risk appears to be very small and may be related to the cause of infertility.  Our program has not seen an increase in the birth defect rate, but that possibility remains.  Some causes of male infertility are unexplained and/or related to genetic problems, and therefore male children from ICSI might have reproductive problems as an adult.  Furthermore, approximately 1 in 20 individuals in the general population will have some birth defect (usually minor).
When Pregnancy is a Problem

Multiple Pregnancy. Approximately 25% of pregnancies resulting from IVF are twins. Five to seven percent of all pregnancies may be triplets or greater.  Our program has not had a quadruplet pregnancy since 1995.

Ectopic (tubal) pregnancy occurs in 5% of IVF pregnancies.

Miscarriage complicates approximately 25% of all IVF pregnancies.
Success Rates Success following IVF is dependent on obtaining adequate numbers of mature eggs for fertilization and adequate sperm to fertilize these eggs. The wife's age and the husband's sperm count have a profound influence on the likelihood of pregnancy following IVF. At UMC we report our pregnancy success rate as clinical pregnancies (those seen with ultrasound) per embryo transfer. Our program's pregnancy success rate is comparable to the national average and updated pregnancy rate information is available upon your request.
The Laboratory Our IVF Laboratory is equipped with the latest technology for control of air quality.  The laboratory is accredited by CLIA and the College of American Pathologists (CAP).  We are a member of the Society for Assisted Reproductive Technology (SART) and abide by the guidelines of the American Society for Reproductive Medicine (ASRM).
Costs of IVF Estimated non-binding fees for IVF and embryo transfer reflect current estimates. These estimates are based on an average cycle. If your cycle is longer, costs may be higher.


Our dedicated team of IVF specialists, reproductive nurses, embryologists, and support staff are committed to providing the best care for our patients. For more information about our program or to schedule an appointment please call:

New Patients: (601) 815-1080 or (866) 330-9805

Returning Patients:  (601) 984-5330  

   
Physicians

William H. Cleland, MD

Bryan D. Cowan, MD

Randall S. Hines, MD

   
Nurses

Carolyn Parks, RN

Vicky Butler, RN
   
Laboratory Support

Victoria M. Sopelak, PhD

Lisa Dorman, MT

Kay Sullivan, MT

Amanda Taylor, MT
   
Office Personnel

Pam Fryer, CMA

Becky Kellogg

Barbara White