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PubMed1988

[Pregnancy following intratubal gamete transfer by hysteroscopy].

The method of gamete intrafallopian transfer (GIFT) was first described by Asch and has since the been introduced into the treatment of sterility not caused by the tubes. Standard technique for this method is laparoscopy. We report on the first pregnancy in our hospital when gamete intrafallopian transfer was undertaken hysteroscopically, i.e. combined with a transvaginal ultrasound-guided puncture of follicles for obtaining oocytes. The procedure is described. The important aspects of this technique are discussed briefly and the advantages shown: Shorter duration of intervention, reduced traumatisation of the patient and the possibility of effecting the operation without anaesthesia. The stress resulting from this technique is hardly different from that during intratubal embryo transfer provided this too is effected with sonographically monitored transvaginal follicle puncture.

Adult↗
PubMed1995

Human chorionic gonadotropin patterns in early pregnancy after assisted reproduction.

BACKGROUND: Assisted reproduction implies increased risks of pathological pregnancy, necessitating close follow up of early pregnancy. The use of serum hCG levels two and three weeks after embryo transfer for prediction of pregnancy outcome after in vitro fertilization-embryo transfer (IVF/ET) or gamete intrafallopian transfer (GIFT) was evaluated. METHODS: Three hundred and twenty-nine treatment cycles were included. Serum samples were obtained on days 14 and 21 after ET and hCG was determined by fluoroimmunoassay. Receiver operating characteristic (ROC) curves were analyzed to find cut-off levels of hCG giving maximal sensitivity and specificity, identifying a low risk group and a high risk group with regard to pathological pregnancy. RESULTS: The group of patients carrying a viable pregnancy had significantly higher hCG levels two and three weeks after ET than the group of patients carrying a pathological pregnancy. Furthermore, the daily increase in hCG was higher. In multiple gestations, the levels of hCG were significantly higher compared to singleton pregnancies. Ninety per cent of the patients with an hCG level > or = 150 IU/L 13-15 days after ET carried a pregnancy to term (the low risk group). Conversely, 50% of the patients with hCG < 150 IU/L carried a pathological pregnancy (the high risk group). CONCLUSION: A single determination of the hCG level two weeks after ET, combined with transvaginal ultrasound two to three weeks later, is a reliable follow-up. In cases of subnormal hCG levels (< 150 IU/L), a second hCG determination one week later followed by sonography is recommended.

Chorionic Gonadotropin↗
PubMed1988

Gamete intrafallopian tube transfer (GIFT): making laparoscopy more than "diagnostic".

Diagnostic laparoscopy is commonly performed on patients as part of a complete infertility investigation. Recently published protocols have investigated the efficacy of using empiric ovulation induction, intrauterine insemination, or both before beginning in vitro fertilization. Because many patients enrolled in these protocols will be exposed to both ovulation induction and diagnostic laparoscopy, the authors reasoned that it would be more effective to begin ovulation induction at the time of the proposed diagnostic laparoscopy in order to allow gamete intrafallopian tube transfer (GIFT) at the same time. Twenty-five nulliparous patients underwent diagnostic GIFT. There were eight continuing pregnancies in this group (32%). Diagnostic GIFT is a more effective use of the opportunity provided by laparoscopy than diagnostic laparoscopy alone.

Adult↗
PubMed1998

Use of the antral follicle count to predict the outcome of assisted reproductive technologies.

OBJECTIVE: To evaluate the predictive value of the antral follicle count in patients undergoing assisted reproductive technologies (ARTs). DESIGN: Prospective study. SETTING: Tertiary care institutional hospital. PATIENT(S): Consecutively seen patients undergoing ARTs such as IVF-ET, gamete intrafallopian transfer, and tubal embryo transfer (TET). INTERVENTION(S): The ovarian antral follicle number was determined by transvaginal ultrasonography on the first or second menstrual day, before the administration of gonadotropins, in patients undergoing ARTs. MAIN OUTCOME MEASURE(S): Ovulation induction was accomplished with the use of GnRH agonist down-regulation combined with FSH and menotropin stimulation. Gamete intrafallopian transfer or TET was performed in patients with patent fallopian tubes, and IVF-ET was undertaken in the remaining patients. Analysis of variance and Mantel-Haenszel monotonic test for trends were used for data analysis. RESULT(S): A total of 149 treatment cycles for 130 couples were performed during the study period. The procedures performed included 89 ETs, 26 gamete intrafallopian transfers, 13 TET cycles, and 21 incomplete cycles (9 poor responders, 6 failed retrievals, and 6 nonfertilization cycles). All treatment cycles were divided into three groups according to the number of antral follicles (i.e., < or = 3, 4-10, and > or = 11) to evaluate the influence of various factors. The antral follicle count correlated significantly with patient age, day 3 serum FSH level, use of gonadotropins, serum estradiol concentration, number of oocytes retrieved, and, later, number of oocytes or embryos transferred. The group of patients who had a lower antral follicle count also had a significantly higher rate of cycle cancellation compared with the other two groups (68.8% vs. 5.3% and 0, respectively). No pregnancies occurred in the low antral follicle count group, whereas there was a trend toward an increasing number of pregnancies per attempt as the number of antral follicles increased (0, 23.7%, and 36.8%, respectively). CONCLUSION(S): It is easy to determine the number of antral follicles with a diameter of 2-5 mm on the first or second day of menstruation, or just before the administration of exogenous gonadotropins. We were able to predict the ovarian response and pregnancy results of patients undergoing ARTs with the use of this simple procedure.

Embryo Transfer↗
PubMed1997

Cost of assisted reproductive technologies for a health maintenance organization.

OBJECTIVE: To calculate the cost of assisted reproductive technologies (ART) for a health maintenance organization (HMO), assess factors that contribute to the cost per delivery and to analyze how utilization rates can be controlled by the use of clinical criteria. STUDY DESIGN: Pregnancy outcome and a cost analysis of all ART cycles at an HMO in a state with mandated coverage for these procedures was performed. All patients (n = 148) undergoing ART cycles insured by the HMO performed at one in vitro fertilization (IVF) center during 1990-1995 were studied. RESULTS: ART cycle outcomes and a cost analysis, including global cycle and cancellation charges, medication costs, obstetric costs and neonatal care costs, were assessed. ART cycles (n = 375) included IVF (n = 278), gamete intrafallopian transfer (n = 46), cryopreserved embryo transfer (ET) (n = 42), zygote intrafallopian transfer/tubal embryo transfer (n = 7) and donor oocyte (n = 2). Pregnancy outcome with IVF was 18.3% deliveries per retrieval, for gamete intrafallopian transfer 27.8% deliveries per retrieval and for frozen ET 19% per procedure. Overall, 62/148 (41.9%) of the patients delivered. There were 35 singletons, 22 twin sets and 5 triplet sets. This resulted in an average cycle cost per delivery of $36,417. The mean obstetric and neonatal charges were $9,329 for a singleton delivery, $20,318 for twins and $153,335 for triplets. If these charges are expressed in terms of the number of infants born, a twin pregnancy would cost $10,159 per infant and a triplet pregnancy, $51,112. The ART cycle cost per HMO plan member was $2.49 per annum. Our IVF utilization was 295 cycles per million population. CONCLUSION: An HMO can control the cost of ART services by establishing preauthorization clinical criteria. Our utilization rates might be used as a benchmark for other insurers considering ART coverage. The cost of ART ($2.49 per annum) would be only a small fraction of the typical annual insurance premium.

Abortion, Spontaneous↗
PubMed1992

Expectations of assisted conception for infertility.

OBJECTIVE: To provide reliable prognostic information for couples seeking assisted conception. DESIGN: Analysis of four years' practice (1988-91). SETTING: Private university service linked with NHS reproductive medicine services. PATIENTS: 804 couples with various causes of subfertility, median duration five years, median age of women 34 years. INTERVENTIONS: 1280 completed cycles: 950 in vitro fertilisation, 144 gamete intrafallopian transfer, and 186 intrauterine insemination and superovulation. MAIN OUTCOME MEASURES: Pregnancy and birth rates per cycle and cumulative pregnancy and take home baby rates per couple. RESULTS: In women under 40 years and men with normal sperm, whatever the cause of infertility, results with in vitro fertilisation improved steadily reaching a pregnancy rate per cycle of 30% (95% confidence interval 26% to 35%) during 1990-1 and birth rate per cycle of 29% (23% to 35%) in 1990. Pregnancy and birth rates for gamete intrafallopian transfer were 36% (28% to 44%) and 26% (17% to 37%) and for intrauterine insemination 18% (12% to 24%) and 16% (10% to 22%). After six cycles cumulative probability of pregnancy was 82% and cumulative take home baby rate 70%. Considering only in vitro fertilisation and gamete intrafallopian transfer after four cycles the pregnancy rate was 78% (66% to 91%). CONCLUSIONS: Conception is less likely in women over 40 and men with sperm dysfunction. For other couples the prognosis for a live birth is at least as good as for fertile couples if they persist with treatment.

Adult↗
PubMed1986

[Intrauterine pregnancy following intratubal gamete transfer--a case report].

Since the beginning of 1986 gamete intrafallopian transfer (GIFT) has been used in the treatment of infertile couples. Only patients in whom tubal patency has been ascertained are included in the programme. After hormonal stimulation of the ovaries and laparoscopic follicular aspiration oocytes and semen are transferred by means of catheterisation into the fallopian tubes. The first pregnancy in our department established by gamete intrafallopian transfer--and the first in Austria to our knowledge--is reported.

Adult↗
PubMed1997

Assisted reproduction technology in Queen Mary Hospital: ten years' experience.

PURPOSE: To review the experience of an assisted reproduction program. DATA SOURCES: Department of Obstetrics and Gynaecology, University of Hong Kong. STUDY SELECTION: Assisted reproduction in a tertiary referral centre. DATA EXTRACTION: Results of assisted reproduction from 1986-1996. RESULTS: In the past ten years, 1561 treatment cycles of in vitro fertilization and embryo transfer (IVF), 257 of gamete intrafallopian transfer (GIFT) and 217 of pronuclear stage tubal transfer (PROST) were initiated. The clinical pregnancy rates per cycle started were 10.8% for IVF, 16.3% for GIFT and 15.7% for PROST. As a result of improvement in ovarian stimulation and embryo culture, the success rate of the program increased in recent years. The pregnancy rate of IVF per embryo transfer was 20.2% in 1995. Embryo cryopreservation program was started in 1992. Since then, 664 cycles of replacement of frozen-thawed embryos were completed with a pregnancy rate of 14.6% per cycle. One hundred and forty-three cycles of assisted fertilization using various techniques, namely partial zona dissection, subzonal sperm injection and intracytoplasmic sperm injection, were performed. The success rate was the highest for the latter technique with a pregnancy rate of 14% per transfer cycle. A prospective randomized control trial on the use of coculture in assisted reproduction had also been done. Results indicated that coculture of embryos with human oviductal cells improved the implantation rate of the embryos. CONCLUSION: Various technique development have been made to improve the success rate of assisted reproduction as well as the quality of treatment of infertility.

Embryo Transfer↗
PubMed1988

Successful pregnancies from men with retrograde ejaculation with the use of washed sperm and gamete intrafallopian tube transfer (GIFT).

Viable sperm were collected from men suffering from retrograde ejaculation by the technique of rapid washing of semen/urine in a buffered collection solution. The utilization of washed semen/urine from two men with retrograde ejaculation in the GIFT procedure lead to successful conceptions and the birth of two healthy female babies. Thus, the technique of rapid washing of sperm from retrograde ejaculating men coupled with GIFT represents a viable alternative for the attainment of pregnancy.

Ejaculation↗
PubMed1989

[Intratubal gamete transfer].

Three years' experience with gamete intrafallopian transfer (GIFT) are reported. Between June 1985 and July 1988, 173 clinical pregnancies were achieved in 357 patients over 488 cycles; 34 biochemical pregnancies achieved have not been included. There were 44 spontaneous abortions (25.4%) and 13 ectopic pregnancies (7.5%). Multiple pregnancy occurred in 13.9%. In the group with long-standing sterility without successful treatment, a clinical pregnancy rate of 43.3% was achieved; in cases with andrological subfertility 29.6%; and in cases with genital pathology the pregnancy rate achieved was 31.7%.

Adult↗
PubMed2002

Effect of time of oocyte collection and site of insemination on oocyte transfer in mares.

The objective of the study was to compare embryo development rates after transfer of oocytes collected 22 or 33 h after hCG injection into recipients inseminated within the uterus or the oviduct. Oocytes were collected at approximately 22 or 33 h after hCG injections and incubated for approximately 16 or 1.5 h, respectively, before transfer. Intrauterine inseminations using 1 x 10(9) progressively motile sperm were done approximately 12 h before and 2 h after transfer. For intraoviductal inseminations (gamete intrafallopian transfer [GIFT]), semen was centrifuged through a Percoll gradient, and 200,000 progressively motile sperm were transferred with oocytes into the oviduct. Time of oocyte collection (22 or 33 h) after hCG injection did not affect embryo development rates (17/25, 68%, vs 12/23, 52%, respectively; P = 0.40). When results from oocyte collections at 22 and 33 h after hCG were combined, oocyte transfer with intraoviductal vs intrauterine insemination resulted in similar (P = 0.70) embryo development rates (12/22, 55%, and 17/26, 65%, respectively). However, the interaction between time of oocyte collection and site of insemination tended to be significant (P = 0.09), suggesting that GIFT using oocytes collected at 33 h after hCG may not be as effective as using oocytes collected at 22 h after hCG. Because intraoviductal insemination requires a low number of sperm, GIFT could be used in cases of male subfertility, frozen semen, or sexed sperm.

Animals↗
PubMed1996

Transcervical gamete and zygote intrafallopian transfer. Does it enhance pregnancy rates in an assisted reproduction program?

OBJECTIVE: To evaluate the role of early tubal transfer procedures, we compared outcomes of transcervical gamete intrafallopian transfer (TC-GIFT) and transcervical zygote intrafallopian transfer (TC-ZIFT) versus in vitro fertilization/embryo transfer during the first two years of our assisted reproduction (AR) program. STUDY DESIGN: Prospective, nonrandomized, concurrent, controlled comparison of TC-GIFT and TC-ZIFT pregnancy outcomes versus those after IVF-ET. All cycles for patients less than age 39 undergoing transfer of at least three viable oocytes, zygotes or embryos in the first two years of our program were included. Patients with normal fallopian tubes underwent TC-GIFT (n = 9) or TC-ZIFT (n = 12), whereas those with tubal compromise underwent IVF-ET (n = 28). RESULTS: Implantation rates were 4.2% for TC-ZIFT, 2.8% for TC-GIFT and 3.7% for combined TC procedures as compared to 7.4% for IVF-ET. Delivery rates were no different for the TC procedures than the IVF-ET procedures (14%). Patients ages, number of oocytes retrieved and number transferred were comparable between the TC and IVF-ET groups. CONCLUSION: TC-GIFT and TC-ZIFT did not enhance the pregnancy outcome as compared to IVF-ET in the first two years of our AR program. Ultrasound-directed tubal catheterization is harder to learn and more difficult and expensive to perform than simple uterine embryo transfer. Since we could not demonstrate an improved outcome for TC transfers even in a new AR program, IVF-ET and laparoscopic GIFT are now our procedures of choice.

Cervix Uteri↗
PubMed1992

Gamete and zygote intrafallopian transfers and related techniques.

Until recently, most authors reported superior results (ie, higher implantation and pregnancy rates) with gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) compared with results using in vitro fertilization-embryo transfer (IVF-ET). According to these investigators, the advantages of tubal over uterine transfer are related mainly to a stable tubal environment and a more appropriate arrival time of the embryo into the uterine cavity. However, more recently, the use of IVF-ET has been increasingly extended to etiologies other than tubal infertility. Indeed, the recent simplification of this technique and the achievement of pregnancy rates comparable to those obtained with tubal transfers have seriously questioned the value of ZIFT and any other type of tubal embryo transfer. As discussed in this review, the results obtained with various transfer procedures in nontubal infertility must still prove ZIFT to be a more effective procedure than IVF-ET. Efforts to develop transcervical methods of transfer to the tube have not translated into higher pregnancy rates than those with IVF-ET. On the other hand, laboratory conditions appear to affect embryos in ways not corrected by the tubal milieu. Negative effects of laboratory conditions on embryos are confirmed by differences in results between GIFT and ZIFT that are accentuated with age. The results obtained with GIFT in patients 40 years of age and older seem to emphasize not only the high compliance of the endometrial receptivity but also the relevance of the biologic potential of the embryos in the process of implantation at this age.

Adult↗
PubMed1988

Transvaginal pulsed Doppler ultrasound assessment of blood flow to the corpus luteum in IVF patients following embryo transfer.

The waveforms of vessels supplying the ovaries of women on an in-vitro fertilization (IVF) programme were studied using transvaginal B-mode and Doppler ultrasound. There were 125 scans recorded in 65 women at weekly intervals from 3 days after embryo transfer or 5 days after gamete intrafallopian transfer (GIFT) until confirmation of pregnancy or onset of menses. At each examination the signals obtained from vessels supplying the ovaries were recorded and quantified using a resistance index (RI). Fifteen patients became pregnant of whom one has subsequently miscarried. There was a highly significant difference in the RI values between patients who became pregnant and those who did not; no patient who became pregnant had a RI greater than 0.5. Oestrogen to progesterone ratios were calculated in the subgroup of non-pregnant patients and there was no correlation between these values and the RI values. This new technique enables prediction of IVF treatment failure earlier than has been reported previously and may reflect the inadequacy of the corpus luteum.

Corpus Luteum↗
PubMedDate not supplied

The influence of infertility etiology on the outcome of IVF-ET and GIFT treatments.

The present report examines retrospectively the success rates of both in-vitro fertilization and embryo transfer (IVF-ET) and gamete intrafallopian transfer (GIFT) in relation to the underlying infertility disorder. Reduced fertilization rates were seen when the male partner was oligospermic or had both IgA and IgG in his semen, or the female partner had elevated LH concentrations during the follicular phase. In IVF-ET, the chance of pregnancy was reduced in women with elevated LH concentrations or endometriosis. Pregnancy rates for patients treated in the GIFT program were significantly better (P less than .001) than for those treated by IVF-ET. Of special interest was the finding of an improved chance of pregnancy for patients with severe endometriosis treated by GIFT (P less than .001). With oligospermia, pregnancies were only achieved in the GIFT program when the insemination number was increased. The pregnancy outcome was similar in both programs, with approximately 70% of pregnancies delivering beyond 20 weeks' gestation. However, there was a high rate of ectopic pregnancy, particularly in cases with underlying tubal disease. These findings have led to revised guidelines for the accurate counseling of patients, and provide further insight into the possible mechanism of various disorders contributing to infertility.

Adult↗
PubMed1991

High preovulatory serum luteinizing hormone level is unfavorable to conception.

Serum estradiol, progesterone and luteinizing hormone (LH) levels of 16 pregnant and 58 non-pregnant stimulated in vitro fertilization-embryo transfer (IVF-ET) or gamete intrafallopian transfer (GIFT) cycles have been compared with regard to their predictive value for achievement of pregnancy. Serum estradiol and progesterone pattern of the pregnant and non-pregnant group did not show any significant difference. Around the time of ovulation induction by human chorionic gonadotropin (hCG) the serum LH values proved to be higher in the non-pregnant group than in the pregnant one. In spite of having a permissive function, preovulatory serum estradiol and progesterone seem not to have a predictive value with regard to pregnancy. Elevated preovulatory serum LH is detrimental for pregnancy, therefore the measurement of serum LH beyond hCG administration also, and the cancellation of cycles with high serum LH levels shortly before oocyte retrieval is recommended.

Adult↗