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PubMed1994

Detection and measurement of thyroid stimulating hormone in human follicular fluid.

The objectives were to measure thyroid stimulating hormone (TSH) levels in human follicular fluid (FF) and compare them with serum levels. Serum and FF samples were obtained from women (n = 41) undergoing in vitro fertilization/embryo transfer, gamete intrafallopian transfer and zygote intrafallopian transfer. Ovulation induction was achieved using human menopausal gonadotropins and human chorionic gonadotropin (hCG) after pituitary suppression with a gonadotropin releasing hormone agonist. Blood samples obtained on the day of hCG injections were assayed for TSH. Follicular fluids were obtained at the time of oocyte retrieval (approximately 34 hours after hCG injection). Serum and FF TSH levels were measured using an enzyme immunoassay. The correlation between serum and FF TSH levels was determined. Comparison between mean serum and FF levels was done using Student's t test after logarithmic transformation of the data. Levels of TSH in FF (1.71 +/- 0.14 microIU/mL, mean +/- SEM) were not different (P > .05) from levels in serum (1.43 +/- 0.10). Serum and FF levels correlated positively (r = .7). TSH appears to be present in human FF, and the levels in FF are similar to those in serum.

Female↗
PubMed2004

Intrafallopian transfer of gametes and early stage embryos for in vivo culture in cattle.

It may be possible to avoid inadequate in vitro culture conditions by incubating gametes or embryos in the oviducts for a short time. Ideally, an optimized procedure should be devised, combining in vitro and in vivo systems, in order to achieve synchronization in cattle. We transferred gametes as well as embryos in various stages of development and placed them into the oviducts. Embryos were recovered on Day 7 by flushing of oviducts and uterine horns. Blastocyst rates were determined on Day 7 and on Day 8. Experimental designs included transfer of in vitro matured cumulus oocyte complexes into previously inseminated heifers (COCs group), transfer of in vitro matured COCs simultaneously with capacitated spermatozoa (GIFTs group), transfer of four to eight cell stage embryos developed in vitro after IVM/IVF (Cleaved Stages group) and a group of solely in vitro produced embryos (IVP control group). Our results indicate that in vivo culture of IVM/IVF embryos in the homologous bovine oviduct has a positive influence on subsequent pre-implantation development. In addition, we have evidence that in vitro maturation and in vivo fertilization cannot be synchronized.

Animals↗
PubMed1989

Outcome in 242 in vitro fertilization-embryo replacement or gamete intrafallopian transfer-induced pregnancies.

Two centers combined data on 152 in vitro fertilization embryo replacement and 90 gamete intrafallopian transfer generated pregnancies. The outcomes of the pregnancies with respect to abortion, ectopic gestation, and multiple gestation were evaluated independently by method and by center. Only with multiple gestation by center was a difference seen. Variables examined included estradiol levels, luteal phase support, maternal age, and prior reproductive history, and the number of eggs or embryos replaced.

Abortion, Spontaneous↗
PubMed1990

Transcervical intrafallopian transfer of zygotes.

Reportedly, gamete intrafallopian transfer and zygote intrafallopian transfer are successful methods in assisted conception. This pilot study describes the experiences and results of a recently developed technique of vaginal transcervical intrafallopian transfer. In a group of 38 women with unexplained infertility, oocytes were retrieved. In 25 patients, pronucleate embryos were transferred to the fallopian tubes. A positive pregnancy test was reported in 8 cases. Considerations pertaining to this method and technical implications are discussed.

Adult↗
PubMed1990

Follicular development, oocyte maturity and fertilization in vitro.

Forty-four infertile women in 44 cycles were stimulated by CC/hMG/hCG (39 cycles) and by CC/hCG (5 cycles) for the purpose of in vitro fertilization (IVF, 37 cases with 35 transfers) and gamete intrafallopian transfer (GIFT, 7 cases). Intraoperative ovum pick-up was performed 32-36 hours after hCG injection. Blood E2 and P levels were determined. Blood E2 was found to be proportional to the number of mature and intermediate oocytes obtained, and correlated with the number of follicles (greater than 10 mm) and the total follicular fluid volume. Altogether 213 follicles aspirated were analyzed. There was a highly significant linear correlation (r = 0.72, P less than 0.01) between the follicular diameter (X cm) on the operation day and the aspirated follicular fluid volume (FFV, Y). The equation of the line was Y = 3.8 X-4.4. The higher concentrations of follicular E2, P, FSH, LH and lower T concentration were crucial to the maturing process of oocytes. It was found that mature oocytes could be retrieved from 26.5% of the small follicles, so it is worthwhile to aspirate the small ones. The fertilization rate was much higher with the mature oocytes than the immature ones. But the morphologically mature oocytes might function differently, i.e. the mature oocytes retrieved from the small follicles or from follicles with unbalanced hormonal microenvironment usually give a low fertilization rate.

Adult↗
PubMed1995

Experience using preparations of follicle-stimulating hormone alone to stimulate the ovaries for assisted conception after pituitary desensitisation and simplified management of treatment.

The results are reported of 2,204 cycles of treatment started for in vitro fertilisation and embryo transfer or gamete intrafallopian transfer, during 5 years, 1990-1994, using only follicle-stimulating hormone (FSH) preparations to stimulate the ovaries following pituitary desensitisation, combined with greatly simplified scheduling and monitoring of treatment. The physiological principles underlying these choices are discussed. In all women under 40 years of age and men with normal sperm, the use of unpurified urinary FSH in 1990-1993 resulted in oocyte collection in 94% of cycles started, pregnancy in 29% and live births in 23%. Using highly purified urinary FSH (uFSH-HP; Metrodin HP) during 1994, the rate for oocyte collection was 97% and pregnancy 25% (birth rates not yet available). The difference compared with previous years was not significant. A study of 93 first cycles using uFSH-HP showed that the dosage required was usually (expressed as medians) 24 ampoules over 12 days (2 ampoules/day) resulting in 9 oocytes (range 2-36) of which 93% were mature and 64% resulted in cleaving embryos. The results are comparable with the best using human menopausal gonadotropin or unpurified FSH and classical detailed monitoring.

Adult↗
PubMed2001

Equine sperm-oocyte interaction: results after intraoviductal and intrauterine inseminations of recipients for oocyte transfer.

Insemination of recipients for oocyte transfer and gamete intrafallopian transfer (GIFT) in five experiments were reviewed, and factors that affected pregnancy rates were ascertained. Oocytes were transferred into recipients that were (1) cyclic and ovulated at the approximate time of oocyte transfer, (2) cyclic with aspiration of the preovulatory follicle, and (3) noncyclic and treated with hormones. Recipients were inseminated before, after, or before and after transfer. Intrauterine and intraoviductal inseminations were done. Pregnancy rates were not different between cyclic and noncyclic recipients (8/15, 53% and 37/93, 39%). The highest numerical pregnancy rates resulted when recipients were inseminated with fresh semen from fertile stallions before oocyte transfer or inseminated with cooled transported semen before and after oocyte transfer. Oxytocin was administered to recipients before oocyte transfer when fluid was imaged within the uterus. Administration of oxytocin to recipients at the time of oocyte transfer resulted in significantly higher pregnancy rates than when oxytocin was not administered (17/26, 65% and 28/86, 33%). Intraoviductal and intrauterine inseminations of recipients during oocyte transfer resulted in similar embryo development rates when fresh semen was used (12/22, 55% and 14/26, 55%). However, embryo development rates significantly reduced when frozen (1/21, 5%) versus fresh sperm were inseminated into the oviduct. Results suggest that insemination of a recipient before and after transfer could be beneficial when semen quality is not optimal; however, a single insemination before transfer was adequate when fresh semen from fertile stallions was used. Absence of a preovulatory follicle did not appear to affect pregnancy rates in the present experiments. The transfer of sperm and oocytes (GIFT) into the oviduct was successful and repeatable as an assisted reproductive technique in the equine.

Animals↗
PubMed1991

Follicular fluid lipoproteins in preovulatory period and their relationship with follicular maturation and progesterone production by human granulosa-luteal cells in vivo and in vitro.

Follicular fluid (FF) lipoprotein content was evaluated in an in vitro fertilization/embryo transfer and gamete--intrafallopian--transfer program and correlated to follicular and oocyte maturation. Moreover, the in vitro progesterone response of granulosa-luteal cells from 10 patients to high-density lipoprotein (HDL) and to low-density lipoprotein (LDL) was assessed. Most FFs contained only HDL. Sixteen out of 97 FFs contained also very low levels of LDL and very-low-density lipoprotein (VLDL). The presence of LDL was associated to features of follicle and oocyte hypermaturity. LDL alone induced a much more potent increase of progesterone (P) release by granulosa-luteal cells than HDL alone, and the HDL partially reversed the potent effect of LDL. It is concluded that in late follicular phase HDL maintains P release by granulosa cells at a low rate and prevents a potent stimulation of P production by LDL which might cross the maturating blood-follicle barrier, until increasing passage of LDL in FF decreases the HDL:LDL ratio and the action of LDL becomes prominent.

Female↗
PubMed1986

A new stirrable catheter for gamete intrafallopian tube transfer (GIFT).

Cannulation of the fimbriated end of the fallopian tube during gamete intrafallopian tube transfer (GIFT) may be at times extremely difficult and even require minilaparotomy. An ideal laparoscopic GIFT catheter should be flexible and stirrable, have a small diameter, and yet be sturdy enough to enable its manipulation. Such a catheter was developed in collaboration with Cook Ob/Gyne, a Division of Cook Inc., Indiana, with primary emphasis on easy laparoscopic manipulation. Its use in eight attempts of GIFT resulted in three pregnancies (37%).

Catheterization↗
PubMed1993

Current management of unexplained infertility.

During the last decade, numerous studies have evaluated the effectiveness of various treatments for unexplained infertility. Few studies employ a design that allows for appropriate comparison with an untreated control group. This article reviews the efficacy of clomiphene citrate, human menopausal gonadotropin, intrauterine insemination, superovulation with intrauterine insemination, and gamete intrafallopian transfer in the treatment of unexplained infertility. Treatment for patients with unexplained infertility with superovulation or gamete intrafallopian transfer is promising, but the incremental contributions of intrauterine insemination, superovulation, or gamete intrafallopian transfer beyond untreated controls await appropriately designed trials. When counseling patients regarding treatment options, both the expected increase in cycle fecundity and treatment expense should be considered.

Clinical Trials as Topic↗
PubMed1992

Creating brave new families with advanced reproductive technologies.

The advanced reproductive technologies such as in vitro fertilization, gamete intrafallopian transfer, and donor gametes have created "brave new families," which can no longer be described by traditional definitions based on genetics and gestation. Understanding the particular stresses and issues that these families face can be particularly helpful to the clinician working with these couples and their children. The potential long-term effects also are explored.

Adoption↗
PubMed1991

Pregnancy rates after peritoneal ovum-sperm transfer.

We present the technique of peritoneal ovum-sperm transfer as an option for treatment in couples with unexplained infertility factors. In 1989 we reported the first successful pregnancy, in the United States, after transferring sperm and oocyte into the peritoneal cavity. We now report the results of a prospective study of this procedure. Twelve women with unexplained infertility underwent 23 cycles of peritoneal ovum-sperm transfer. Ovulation stimulation was achieved with human menopausal gonadotropin. Ultrasonographically directed oocyte recovery was performed by the transvaginal route with the patient under local anesthesia and sedation. After oocyte recovery, 4.5 +/- 0.4 (mean +/- SE) oocytes and 13.3 +/- 1.0 (mean +/- SE) x 10(6) motile spermatozoa were transferred into the pouch of Douglas. Six clinical pregnancies occurred in 23 stimulated cycles for a pregnancy rate of 26% per cycle. This value compares with the overall pregnancy rates of 16% for in vitro fertilization and 27% for gamete intrafallopian transfer reported by the In Vitro Fertilization Registry. Thus these preliminary data suggest that peritoneal ovum-sperm transfer is at least as successful as in vitro fertilization and gamete intrafallopian transfer. Advantages of peritoneal ovum-sperm transfer over gamete intrafallopian transfer include its being an office nonsurgical procedure not necessitating a general anesthetic and decreased cost. Therefore peritoneal ovum-sperm transfer is a reasonable first approach in couples with unexplained infertility.

Adult↗
PubMed1992

After superovulation-intrauterine insemination fails: the prognosis for treatment by gamete intrafallopian transfer/pronuclear stage transfer.

OBJECTIVE: To determine the prognosis for gamete intrafallopian transfer (GIFT)/pronuclear stage transfer (PROST) treatment after prior superovulation-intrauterine insemination (IUI). DESIGN: Matched, retrospective. SETTING: Outpatient university endocrine-infertility program. PATIENTS, PARTICIPANTS: One hundred forty-four women matched for infertility factors and age were studied according to the following three treatment groups: superovulation-IUI only, GIFT/PROST only, or GIFT/PROST after superovulation-IUI. MAIN OUTCOME MEASURES: Per cycle and cumulative pregnancy rates (PRs) were compared utilizing life table analysis. RESULTS: Cumulative PRs (0.408) for superovulation-IUI only were lower than initial (0.469) and cumulative (0.802) cycle fecundity of GIFT/PROST (P = 0.002). Per cycle and cumulative PRs did not differ between GIFT/PROST only versus GIFT/PROST after superovulation-IUI. CONCLUSIONS: Gamete intrafallopian transfer/PROST may be cost-effective when compared with superovulation-IUI. The prognosis for GIFT/PROST success is not negatively affected by earlier superovulation-IUI treatment failure.

Adult↗
PubMed1995

Development of hydrosalpinx during ovulation induction.

We have observed that hydrosalpinx develops in some patients undergoing ovulation induction as part of in vitro fertilization-embryo transfer and gamete intrafallopian transfer programs. Increased tubal secretions due to multihormonal stimulation causes a blocked tube to distend by the time of oocyte harvest. In a subset of women, hydrosalpinx was not identified on initial pelvic sonograms. Hydrosalpinx became apparent during serial sonography to monitor follicular development. We performed a retrospective chart review of these cases in order to confirm this finding with hysterosalpingography or laparoscopy. Nine of 316 women developed unilateral (eight cases) or bilateral hydrosalpinx (one case) during stimulation. Recognition of this sonographic finding is important to the referring physician because it has important therapeutic and outcome implications.

Adult↗
PubMed1994

Electroejaculation for the treatment of idiopathic anejaculation: a case report.

Electroejaculation to produce semen from anejaculated males has been employed successfully in conjunction with intrauterine insemination (IUI), in vitro fertilization/embryo transfer, and gamete intrafallopian transfer. We herein report the use of IUI to achieve pregnancy following electroejaculation in a patient with primary idiopathic anejaculation. This 30-year-old patient had a history of anejaculation that was noted after marriage, but had normal sexual potency and occasional nocturnal emission. Electroejaculation was successfully used to obtain semen. The highly motile sperm was recovered from swim up procedure and used for IUI. The 25-year-old wife was given clomiphene citrate and Pergonal for ovulation induction. A triplet pregnancy was achieved. At 26 weeks of gestation, the first triplet was delivered after spontaneous rupture of membrane. We tried to delay delivery of this retained twin pregnancy. Thirty-two days later, the remaining two fetuses were delivered weighing 1100 gm and 900 gm. Ninety-three days after delivery, these two babies were discharged, putting on weight to 3564 gm and 3264 gm. This case represents the first success of using electroejaculation to achieve pregnancy from anejaculated patient in Taiwan.

Adult↗
PubMed1996

[Modern fertilization techniques].

In Germany, some 17.2% of married couples are unintentionally childless. Of these, about one-third have a male factor infertility (with disordered spermatogenesis), which in part is unresponsive to drug treatment. In such cases, assisted reproductive techniques are giving childless couples new hope. The techniques are based on two principles: 1) in vitro improvement in semen quality in the laboratory, and 2) the overcoming of natural barriers to fertilization. The latter includes intra-uterine insemination (IUT), in vitro fertilization and embryo transfer (IVF/ET), gamete intrafallopian transfer (GIFT), subzonal sperm insemination (SUZI), zona pellucida drilling, and intracytoplasmatic injection of sperm (ICSI). ICSI has also used epididymal spermatozoa obtained by microsurgical aspiration (MESA) and sperm extracted from testicular biopsies (TESA). These methods have their own specific indications, contraindications and pregnancy rates. However, assisted conception techniques should not be considered outside the overall situation of the couple, including ethical, sociological, physiological and general medical problems.

Female↗