| 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). 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 30,000 cycles of IVF are performed in the United States
each year. Our IVF program started in 1984 and now performs approximately
165 IVF cycles per year. We have prepared these documents to share important
and helpful information with you about this exciting new technology. |
| 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. |
| 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, daily injections of human menopausal gonadotropin (hMG)
(Follistim®, Gonal-F®, Repronex ®) 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 38 hours
following this injection. |
| Egg Retrieval |
The egg retrieval procedure is accomplished by transvaginal ultrasound aspiration. This procedure is performed
in our minor surgical procedure room in the Pavilion. 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 |
When we determine that eggs suitable for fertilization are present, a semen sample is obtained from the husband.
The husband's sperm cells are placed together 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, 3-5 days
after the egg retrieval procedure healthy appearing embryos that continue
to grow are selected for embryo transfer and/or cryopreservation. |
| Micromanipulation |
One of the most exciting recent developments
in the field of IVF is the development of Intracytoplasmic Sperm Injection
(ICSI). With this micromanipulation procedure a single sperm cell
is injected directly into the egg. This technique is an effective
treatment for couples with very low sperm counts or who have previously
demonstrated a problem with fertilization. |
| 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. |
| 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 |
While embryo transfers are generally done on day 3 following egg retrieval, in certain cases, embryos may be cultured until day 5 and blastocyst transfer performed. |
| 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.
|
| 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.
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. |
| 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 three 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. |
| ICSI |
Intracytoplasmic sperm injection
(ICSI) is a laboratory procedure developed to help infertile couples with
male-factor infertility or fertilization problems. ICSI involves
the injection of a single sperm directly into a mature egg (oocyte).
This injection is accomplished by skilled laboratory professionals utilizing
a microscopic glass needle to inject the sperm into the egg. |
Sperm Problems
|
A variety of sperm problems
can account for male infertility. Sperm may be completely absent
in the ejaculate (azospermia) or present in low concentrations (oligospermia).
The sperm may have poor motility (asthenospermia) or an increased percentage
of abnormal shapes and forms (teratospermia). There may also be abnormalities
in the series of steps required for fertilization, such as sperm binding
to and penetrating the egg. Deficiencies in any of these aspects
of sperm function generally lead to lack of fertilization.
ICSI can assist fertilization
when sperm will not bind or penetrate an egg. It can also treat men
with extremely low numbers of sperm.
|
| Indications for Intracytoplasmic Sperm Injection |
Indications for Intracytoplasmic Sperm Injection:
|
| Outcome of Treatment |
ICSI is not a perfect technique. Some eggs will be damaged by the ICSI process. Some eggs have plasma
membranes that are difficult to pierce. In others, the fertilized
egg may fail to divide or the embryo may stop growth. Egg fertilization
rates of 50% are expected but only 20%-30% of egg retrievals produce a
baby. Other factors such as poor egg quality and maternal age may
cause these percentages to drop. |
| Perinatal Outcome Studies |
Some studies demonstrate an increase in the birth defect rate in patients using IVF or ICSI. It is not known if this slight increase is related to the procedures or some other factor. 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). |
| 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 (601) 815-1080 or (866) 330-9805.
| Physicians |
William H. Cleland, MD
Bryan D. Cowan, MD
Randall S. Hines, MD
|
| Nurses |
Carolyn Parks, RN
Vicky Butler, RN
Lynn Haynes, 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
|
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