Down-Regulation
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. Ganirelix may be used in some protocols, and is given after stimulation of the ovary has begun.

Ovarian Stimulation
Ordinarily, one mature follicle produces an egg each month. However, IVF patients are given injectable hormones, which stimulate the development of several mature oocytes. Follicular 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 of human chorionic gonadotropin (hCG) to trigger the final phase of maturation. An egg retrieval is performed 37 hours later.

Egg Retrieval
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 and a local anesthetic. 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 semen provided by the patient’s husband. In some instances, 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. This technique is also an option for couples who are seeking treatment for infertility and have not responded to other treatments.

In many 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).

Embryo Transfer
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. 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 for two weeks after the embryo transfer to support the lining of the uterus. 10-12 days after the embryo transfer procedure, a pregnancy test is performed.

Cryopreservation
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.

Other Factors:
Oocyte Donation
For patients who are 40 or older, or patients who have a poor response to fertility medication, we offer oocyte donation. The patient can provide known donors, or our anonymous donor list can be used. Anonymous egg donors are tested 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.

Risks of IVF
There are uncommon but special complications associated with IVF. These include:

Ovarian Hyperstimulation Syndrome
This rare condition is caused by painful enlargement of the ovaries due to hormonal stimulation. Patients typically recover with bed rest at home, but hospitalization is sometimes needed.

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:
Multiple Pregnancy
Approximately 25% of IVF pregnancies result in twins. 5-7% of all pregnancies may be triplets. The risk of multiple births is decreased by limiting the number of embryos transferred based on age. When only two embryos are transferred, which is the norm, the twinning rate will be approximately 20% and triplet pregnancies will be rare.

Ectopic (Tubal) Pregnancy
A pregnancy that occurs outside of the uterine cavity occurs in 5% of IVF pregnancies.

Miscarriage
The loss of a clinically recognized pregnancy occurs in approximately 20% of all IVF pregnancies.

Financial Information
Mississippi Reproductive Medicine strives to provide the best possible care at the most effective cost. Costs are subject to change and specific financial information is available upon request.