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PubMed1991

Unexplained infertility.

Unexplained infertility is a multifactorial disorder of reproduction. This review examines the potential contribution of decreased uterine perfusion, obscure luteal phase defect, intrinsic endometrial factor ovum captor inhibitor, microscopic endometriosis, and psychologic factors for the cause of unexplained infertility. Although specific therapy for unexplained infertility does not exist and treatment-independent pregnancy frequently occurs in this group of patients, many couples pursue treatment. In vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, superovulation with intrauterine insemination, and direct intraperitoneal inseminations are several treatment options reported to be successful. However, a randomized prospective study using a uniform diagnostic assessment, strict entry criteria, identical ovulation-induction schemes, and semen-processing protocols is lacking to determine which patients will be most appropriately treated with each procedure and which is more effective. Unexplained infertility is not and should not be considered a permanent state. These couples should be considered to be subfertile rather than infertile.

Female↗
PubMedDate not supplied

Assisted conception and immunological infertility.

Our work with a group involved in Assisted Conception (AC) has provided us with a perfect opportunity for making an assessment of the efficiency of the techniques used for the treatment of Male Antisperm Autoimmunization (MAA) and Female Antisperm Isoimmunization (FAI). The aim of this study is to present all the most important methods of AC used by our group for the treatment of immunological infertility, such as intrauterine insemination, intraperitoneal insemination, intrafallopian gamete transfer, in-vitro insemination and intrauterine embryo transfer, intrafallopian zygote transfer, intrafallopian embryo transfer, and gamete micromanipulation. In-vitro fecundation would appear to be particularly efficient in cases of FAI, while MAA would seem to benefit more from the use of gamete micromanipulation.

Autoimmunity↗
PubMed1992

Zygote intrafallopian transfer or in vitro fertilization and embryo transfer for the treatment of male-factor infertility: a prospective randomized trial.

OBJECTIVE: To compare zygote intrafallopian transfer (ZIFT) and in vitro fertilization and embryo transfer (IVF-ET) as treatments of male-factor infertility. DESIGN: Patients were prospectively randomized to ZIFT or IVF-ET. SETTING: In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. PATIENTS: One hundred fifty-seven couples were enrolled in the study. Inclusion criteria allowed only first trials of couples with long-standing infertility caused by a male factor. Female factors were excluded. INTERVENTIONS: In ZIFT, up to three fertilized oocytes were transferred into one single patient fallopian tube by means of laparoscopy 18 hours after insemination. In IVF-ET, cleaving embryos were replaced into the uterine cavity about 48 hours after insemination. MAIN OUTCOME MEASURES: Fertilization and transfer rates, implantation and pregnancy rates, pregnancy outcome, and cost per procedure were evaluated. RESULTS: Implantation rates of 12.3% and 10% per replaced conceptus were achieved for ZIFT and IVF-ET, respectively. CONCLUSIONS: This study demonstrates no therapeutic advantage of ZIFT over IVF-ET in male-factor infertility in terms of reproductive outcome or economic benefit.

Adult↗
PubMed1994

Successful pregnancy following zygote intrafallopian transfer for congenital cervical hypoplasia.

BACKGROUND: Congenital cervical atresia and hypoplasia are rare abnormalities that generally require reconstructive or extirpative procedures to relieve outflow tract obstruction. Infertility is a common sequel, and only four previous pregnancies have been reported. In selected cases, zygote intrafallopian transfer (ZIFT) or other assisted reproductive techniques may offer alternatives for conception. CASE: A 21-year-old amenorrheic woman experienced a spontaneous gush of vaginal bleeding following an 11-year history of cyclic lower abdominal pain. Regular but prolonged and painful menses ensued. After another 8 years of primary infertility, transcervical and transfundal hysteroscopy demonstrated congenital cervical hypoplasia and a normal endometrial cavity. Conception was achieved during her third cycle of ZIFT. Delivery occurred by elective cesarean at 39 weeks for a persistent oblique fetal lie. CONCLUSION: A successful pregnancy was established following ZIFT in a woman with congenital cervical hypoplasia. The endometrial cavity was evaluated by a previously unreported technique, transfundal hysteroscopy. The use of appropriate surgical or assisted reproductive techniques in conjunction with individualized post-conception management may permit successful pregnancy and delivery in selected women with congenital cervical hypoplasia and atresia.

Adult↗
PubMed1994

Tubal catheterization for intrafallopian insemination and transvaginal gamete (GIFT) or zygote intrafallopian transfer (ZIFT): our experience in a total of 1128 treatment cycles.

PURPOSE: Our purpose was to increase the number of fertile spermatozoa at the natural site of fertilization by retrograde tubal insemination (TV-IFI; transvaginal intrafallopian insemination) and also to perform transvaginal GIFT or ZIFT (TV-GIFT or TV-ZIFT) avoiding the laparoscopic procedure, especially in selected high-risk cases. RESULTS: The method was used in a total of 1128 treatment cycles (948 for TV-IFI and 180 for TV-GIFT or TV-ZIFT). TV-IFI was possible in 882 of the 948 cycles, resulting in 108 clinical pregnancies (12.24%). The remaining 66, due to bilateral tubal catheterization failure (6.9%), underwent intrauterine insemination (IUI) instead. Bilateral TV-IFI gave better results than unilateral, while combination with IUI did not seem to improve the outcome. Of the 180 cycles prepared for TV-GIFT or ZIFT the procedure was completed in 166, resulting in 24 clinical pregnancies (19% per patient and 14.45% per cycle). Due to bilateral tubal catheterization failure (8.2%) in the remaining 14 cycles (9 patients), IVF-ET was employed as an alternative. CONCLUSION: Simple and cost-effective TV-IFI may achieve a reasonable pregnancy rate, justifying its application in cases with previously failed IUI and before entering the IVF program. On the other hand, TV-GIFT or ZIFT, although less effective than the classical laparoscopic approach and IVF-ET, is worth pursuing, considering its safety and the minimal surgical intervention without anesthesia, and especially in selected high-surgical risk and obese patients.

Adult↗
PubMed1993

Conversion from a failed transcervical zygote intrafallopian transfer to a successful delayed uterine embryo transfer.

Transcervical ZIFT is an alternative to IVF-ET and laparoscopic GIFT. However, tubal catheterization cannot be accomplished in all cases. We describe a successful twin pregnancy that resulted from delayed uterine transfer of four embryos following unsuccessful TC-ZIFT transfer. Further data are needed to determine optimal management in cases of failed transcervical tubal transfer procedures.

Adult↗
PubMed1994

A prospective randomized crossover comparison of zygote intrafallopian transfer and in vitro fertilization-embryo transfer in unexplained infertility.

60 couples aged under 38 with unexplained infertility were recruited in this prospective randomized crossover study to compare the efficacy of treatment between ZIFT and IVF-ET. A total of 150 stimulation cycles were commenced and 132 proceeded to successful egg collection (88%). Fertilization successfully occurred in 114 cycles (86.36%). A total of 110 embryo replacements were carried out, (52 uterine transfer and 58 tubal transfer). This prospective randomized cross over trial demonstrated the trend for higher implantation rate, pregnancy rate, and ongoing pregnancy rate with ZIFT over IVF-ET for patients with unexplained infertility. The actual implantation rate, pregnancy rate, and ongoing pregnancy rate with ZIFT were 13.7, 34.5, 31.0 per cent respectively compared to the results from IVF-ET which were 12.1, 26.9, 25.0 per cent respectively. However, the difference was not statistically significant. Although this study showed a 5 per cent ectopic pregnancy rate with ZIFT and none with IVF-ET, the difference was not statistically significant. Similarly, there was no difference in the overall miscarriage rate and multiple pregnancy rate between the two protocols. In conclusion, this prospective randomized crossover trial demonstrated the trend for higher reproductive outcomes in term of implantation rate, pregnancy rate, and ongoing pregnancy rate with ZIFT over IVF-ET in unexplained infertility but the difference was not statistically significant.

Adult↗
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

Zygote intrafallopian transfer with "donor rescue": a new option for severe male factor infertility.

Clinical pregnancies have been initiated by ZIFT using zygotes produced by reinsemination of oocytes with donor sperm ("donor rescue") after an initial 15- to 20-hour exposure to husband's sperm. A total of 54 oocytes from four couples experiencing failed fertilization by husband's sperm were reinseminated with donor sperm, resulting in 38 zygotes (70.4% fertilization). Four zygotes were transferred during ZIFT in each case and resulted in two (50%) continuing pregnancies. Additional zygotes from donor reinsemination were cryopreserved for each couple. Donor rescue expands the utility of ZIFT as a treatment for male factor infertility.

Embryo Transfer↗
PubMed1992

Laparoscopic zygote intrafallopian transfer using augmented local anesthesia.

In this study, 29 laparoscopic ZIFTs were performed in 21 patients using local anesthesia augmented with intravenous analgesia. The technique was well tolerated; significant discomfort arose only when the fallopian tubes were manipulated and was minimized by transferring zygotes to one tube only. Seven pregnancies resulted, of which three have delivered and one is ongoing.

Adult↗
PubMed1991

A clinical pregnancy after a simple method of zona cutting, cryopreservation, and zygote intrafallopian transfer.

A 30-year-old nulliparous woman, who was infertile for greater than 3 years, conceived after the procedures of a simple method of zona cutting, cryopreservation, and ZIFT. This case illustrates: (1) acid medium, chymotrypsin, or sucrose are not needed for the procedure of zona cutting; (2) the zygotes resulting from zona cutting survive through freezing and thawing; and (3) oocyte retrieval can be done concomitant with conservative surgery for endometriosis.

Adult↗
PubMed1994

Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure.

OBJECTIVE: Our purpose was to evaluate a tactile non-ultrasonographically directed approach to transvaginal tubal cannulation and embryo transfer during the zygote intrafallopian tube transfer procedure. STUDY DESIGN: We studied the application of the tactile approach to transvaginal tubal cannulation and embryo transfer in 68 consecutive zygote intrafallopian tube transfer cycles. RESULTS: The tactile approach to transvaginal tubal cannulation and subsequent embryo transfer was successful in 93% of couples. Pregnancy occurred in 16 of the 63 (25%) women undergoing a successful transvaginal embryo transfer. CONCLUSION: The tactile approach to transvaginal tubal cannulation was found to be easily learned and provided a safe and convenient method of tubal embryo transfer. This low-cost approach, which has application to transfer of both embryos and gametes, deserves further study.

Catheterization↗
PubMed1993

The use of surrogate gestational carriers for assisted reproductive technologies.

OBJECTIVES: We determined the effect of embryo transfer, zygote intrafallopian transfer, and frozen embryo transfer on clinical outcomes after surrogate gestational transfers. STUDY DESIGN: Prospective randomization was carried out. RESULTS: Forty-five infertile couples were matched with a gestational surrogate carrier and underwent 81 cycles of embryo transfer with various assisted reproductive technologic procedures. Nineteen cycles produced a clinical pregnancy, with delivery in 15 of 81 cycles (18.5% live-birth rate). Fifteen of the 45 couples (33%) had a child from the surrogate gestational carrier program. CONCLUSION: No significant differences in clinical outcome were observed on the basis of the type of procedure performed or the age of the patient.

Adult↗