In vitro fertilization (IVF) is a therapy that is used for treating infertility, as well as some genetic disorders. The IVF procedure involves taking oocytes, or eggs, from the woman’s body. Eggs and sperm are brought together in the laboratory (in vitro). Developing embryos are placed in the uterus, where pregnancy can occur.
Mature oocytes must be retrieved from the ovary in order to perform an IVF cycle. Natural ovulation (release of eggs) is inhibited by the administration of one of two medications, Lupron or Ganirelix. These drugs act to inhibit the normal signal for ovulation. Lupron injections are given daily during the cycle prior to IVF treatment. Down-regulation is complete after 10-14 days of Lupron injections. In other cases, smaller doses of Lupron (Microdose Lupron) can be used just before and during the treatment cycle to prevent ovulation. Ganirelix is often used instead of Lupron, and is given after stimulation of the ovary has begun.
Ordinarily, one mature follicle produces an egg each month. IVF patients are given injectable hormones, which stimulate the development of several mature oocytes. Follicle Stimulating Hormone (FSH) injections, such as Follistim, are given daily in the early stages of the IVF cycle. The MRM staff monitors each patient’s response to these medications using vaginal ultrasound. This process allows the staff to better evaluate the development of the mature follicles. Estrogen levels are measured through blood samples. When the follicles are mature, the patient is given an injection to trigger the final phase of maturation. This trigger may be hCG (human chorionic gonadotropin) or Lupron. An egg retrieval is performed 35-37 hours later.
Egg retrieval is performed using needle aspiration in the MRM procedure room. An anesthesiologist provides the patient with light sedation using a combination of an intravenous injection of Versed and Fentanyl. A local anesthetic is also given. With the aid of a transvaginal ultrasound, the MRM staff evacuates individual mature follicles by placing a needle through the wall of the vagina and into the ovary. Our embryologist analyzes the follicular fluid in the laboratory to determine the presence of eggs.
Insemination, Fertilization, ICSI, Embryo Culture
Once the egg retrieval is complete, the MRM staff determines which eggs are to undergo fertilization. The embryologist begins the process of fertilization using sperm provided by the patient’s husband. In most cases, intracytoplasmic sperm injection (ICSI) is used to inject a single sperm into an egg.
ICSI is an effective treatment for men with very low sperm counts. For some cases in which there is no sperm in the husband’s semen sample, sperm can be surgically retrieved from the testes and used with ICSI to achieve fertilization and pregnancy. ICSI is also an option for couples who are seeking treatment for infertility and have not responded to other treatments.
In some cases, standard insemination of the eggs is used for fertilization. The embryologist deposits some of the husband’s sperm with the wife’s eggs, which are then moved to an incubator.
The day after insemination by ICSI or traditional IVF, the eggs are examined with a microscope for indications of fertilization. If all goes well, 3-5 days after egg retrieval, healthy embryos that continue to grow are selected for embryo transfer.
Laser Assisted Hatching
Another technique for aiding couples with complicated infertility is the use of a laser to help the embryo emerge from the surrounding membrane (zona pellucida).
The ultimate step in IVF is the transfer of the embryos into the uterine (endometrial) cavity. This procedure, performed in the MRM procedure room, does not require anesthesia. A narrow catheter containing the embryos is passed through the cervix and into the endometrial cavity under ultrasound guidance. The embryos are discharged into the endometrial cavity, and the catheter is removed. Normal activities may be continued the day after the transfer procedure. Patients take progesterone supplements after the embryo transfer to support the lining of the uterus. 10-12 days after the embryo transfer procedure, a pregnancy test is performed.
Excess embryos generated during the IVF cycle can be frozen and stored. The embryos can be transferred to the uterus at a later time to achieve a pregnancy without the need for stimulation medications or invasive procedures.
Risks of IVF
There are uncommon but special complications associated with IVF. These include:
Ovarian Hyperstimulation Syndrome (OHSS)
This rare condition results in painful enlargement of the ovaries due to hormonal stimulation. Patients typically recover with bed rest at home, but hospitalization is sometimes needed. Procedures to remove excess fluid from the body are required in rare situations.
Egg Retrieval Procedure
There is a small risk of reaction to anesthesia, bleeding, infection, or injury to internal organs during the egg retrieval procedure.
When Pregnancy is a Problem
Approximately 1 in 8 couples experience infertility. Often a direct relationship is identified for the cause of infertility (advanced age, diminished ovarian reserve, endometriosis, tubal factor, ovulation disorders, hormonal imbalances, pelvic disease, male factor, and others) but many times the source of infertility is unknown. Both known and unknown causes of infertility can create a challenge for the couple attempting to overcome this disease.
An estimated 12%-15% of couples use ART (Assisted Reproductive Technology) to assist in their family planning, and this represents only about half of the number of women/couples who actually need infertility services. It is our goal at MRM to provide all levels of services for all couples who need our assistance, whether it be conservative interventions to the most advanced, we are here to guide you through your options and set the best plan in motion for you.
The goal of IVF is to have one healthy child per embryo transfer. MRM takes great pride in our extremely low twin rate from IVF with the use of Preimplantation Genetic Screening (PGS) and elective single embryo transfers. In fact, between 2016-2018, we have only had five twin pregnancies with more than 250 PGS embryo transfers. This desired number of singleton pregnancies is achieved through our careful and thorough assessment of each embryo prior to selection for an embryo transfer. Throughout the country, a common past practice was to transfer a minimum of two embryos at a time following IVF. This has been done in hope of improving the pregnancy rate but led to more twin and triplet pregnancies.
With our selection process and the use of PGS, the majority of our patients receive a single embryo transfer and subsequently deliver a single, healthy baby. While IVF is generally considered a safe and effective treatment option for infertility, in some cases failed pregnancy, miscarriage, and rarely even ectopic pregnancy can result from treatment.
Oocyte Donation (Egg Donation)
For patients who have poor egg quality or quantity (diminished ovarian reserve), we offer oocyte donation. The patient can provide known donors, or our anonymous donor list can be used. Anonymous egg donors are screened for genetic and infectious diseases. The pregnancy rate using oocyte donation is related to the age of the donor and is higher than the pregnancy rate for standard IVF. Learn about Egg Donation here.
Mississippi Reproductive Medicine strives to provide the best possible care at the most effective cost. Costs are subject to change and the specific financial information is available upon request.