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PubMed1998

[Dilemmas in assisted reproduction]

Modern reproductive technologies, particularly in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), have made possible the establishment of new families through the birth of hundreds of thousands of children worldwide. Meanwhile, these technologies have compelled men to face the possibility of intervening at the very origins of their own biological existence, hence creating doubts and questions beyond the domain of medical science. Society is now asking itself whether all that is scientifically and technically possible is necessarily beneficial to mankind. The answer to this question is not to be found in biological science alone, but instead requires multidisciplinary reflection including all forms of knowledge: philosophical, bioethical, and religious, all contributing to the unavoidable adventure that we are endowed with in the search for a better life.

Journal Article↗
PubMed1998

Trends and international comparisons in infertility in circumpolar areas.

Infertility is an increasing problem for both individuals and societies. The number of couples seeking treatment for infertility is increasing each year, and public interest seems to be rising along with the new treatment methods and the improving results. Male infertility is also of great interest now that several studies suggest a deterioration in the quality of semen in many countries, Finland being an exception. The assisted reproductive technologies have improved tremendously since the first child conceived by in vitro fertilization was born in 1978. The new techniques include e.g. intrauterine insemination (IUI), gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), intracellular sperm injection (ICSI) and various combination treatments. These treatments are costly and both physically and emotionally stressful, and the success rate varies according to the aetiology of infertility, the age of the woman treated and the method used. More information is needed about the aetiology and incidence of fertility disorders as well as about the availability of treatment in the circumpolar areas and the couples' opinions of treatment. Our own study population, which was drawn form the northern Finland birth cohort for 1966, provides an outstanding opportunity to study these issues, since data are available for the whole life course of the individuals, dating back to prenatal life.

Adult↗
PubMedDate not supplied

Relationship of a human oocyte scoring system to oocyte maturity and fertilizing capacity.

A simple, quick, and semiquantitative human oocyte scoring system is described. Oocyte-corona-cumulus complexes were spread, either by tilting the dish or by aspiration of the fluid, and examined under the dissecting microscope. A maximum of four points was assigned to each of the following: cumulus expansion, cumulus appearance, amount of cumulus, corona expansion, corona appearance, and oocyte appearance. The oocyte score was significantly correlated to two important physiological parameters of oocytes, nuclear maturity (P less than .02) and fertilization rate (P less than .0001). This oocyte scoring system is useful for selecting oocytes for in vitro fertilization and embryo transfer (IVF-ET) or gamete intrafallopian tube transfer (GIFT), for training new laboratory personnel in recognizing the important characteristics of a mature oocyte, and in the standardized reporting of oocyte quality by different IVF-ET or GIFT programs.

Clomiphene↗
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↗
PubMed2003

Effective use of assisted reproduction.

Subfertility affects one in seven couples in the western world. Although the availability of assisted reproduction has changed the outlook for many childless couples, the procedures themselves have far-reaching implications in terms of invasiveness, acceptability and cost. There is now greater awareness that effective care involves using treatments that combine efficacy, appropriateness and efficiency with safety. Randomized trials addressing assisted reproduction are few and generally tend to suffer from a number of methodological inadequacies. Although IVF continues to be the treatment of choice for couples with persistent infertility, there is currently insufficient evidence from trial data to indicate that IVF is more effective than the other treatment options available for unexplained infertility. Intracytoplasmic sperm injection is beneficial in severe male factor infertility but is not warranted in other situations. There is an urgent need to focus on developing strategies to improve success rates of assisted reproduction and minimize the side-effects such as ovarian hyperstimulation and multiple pregnancy. Multiple pregnancy is the most common major complication of IVF and has a profound effect on maternal and neonatal morbidity as well as health service costs.

Adult↗
PubMed1999

Full term delivery following cryopreservation of human embryos for 7. 5 years.

Successful pregnancy in a 44 year old woman is described following the transfer of embryos which were cryopreserved for 7.5 years. The embryos were obtained during a gamete intra-Fallopian transfer (GIFT) procedure in 1989. To our knowledge this is one of the longest published periods of cryopreservation of embryos which has resulted in a healthy baby. This report illustrates the previously presumed viability and normality of human embryos undergoing long-term cryopreservation. Additionally, it emphasizes the importance for advanced reproductive technique programmes and patients to review and update their embryo status.

Adult↗
PubMed1992

Transvaginal gamete intra-fallopian transfer and embryo intra-fallopian transfer.

This study describes the conduct and results of a recently developed technique for transvaginal catheterization of the Fallopian tube in order to transfer gametes or early embryos. Transvaginal gamete intra-Fallopian transfer (TV-GIFT) was performed in 46 patients after stimulation with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) and transvaginal oocyte retrieval. This resulted in 11 (23.9%) pregnancies. Eight patients delivered healthy children, including one set of twins. Two patients had abortions at 8 and 11 weeks of gestation and one had an ectopic pregnancy. In a first series of 11 women, oocytes were fertilized in vitro and a maximum of three embryos at the 2- to 8-cell stages were transferred into one tube. Three of the 11 cycles with tubal embryo-stage transfer' (TV-TEST) resulted in clinical pregnancy.

Catheterization↗
PubMed1989

The purpose of prelaparoscopy transvaginal retrieval and evaluation of oocytes in a modified GIFT procedure.

To minimize the risk of submitting the patient to an 'unnecessary' laparoscopy in cases of unsuccessful oocyte retrieval and to reduce gamete exposure to the probable adverse effects of the CO2 pneumoperitoneum and anaesthetic agents, we have performed transvaginal oocyte recovery prior to performing the laparoscopy for gamete intra-Fallopian transfer (GIFT). When the recovered oocytes had a low potential for fertilization, the GIFT laparoscopy was cancelled and fertilization in vitro and zygote intra-Fallopian transfer (ZIFT) were attempted instead. By introducing this modified, two-stage GIFT procedure, the laparoscopy time was reduced to a quarter of that required for the more time-consuming, conventional GIFT method (18 +/- 4 min and 76 +/- 13 min respectively in the same unit). Of the 35 cases selected for this modified GIFT treatment, only 26 were considered suitable to proceed to laparoscopy, resulting in eight clinical pregnancies (30.7%). The remaining nine (25.7%) GIFT cases were cancelled, due either to the absence of oocytes in four or to their poor quality in five (oopenia). The latter were diverted to IVF and out of five cases, only two oocytes were fertilized and proceeded to ZIFT. No clinical pregnancy resulted. In conclusion, we propose that securing the retrieval of oocytes of appropriate quality seems to be a logical and necessary preliminary step before embarking upon laparoscopy for GIFT or ZIFT, depending upon the biological status of the gametes. By employing this procedure, unnecessary and costly laparoscopy can be avoided in certain cases.

Carbon Dioxide↗
PubMed1992

Oocyte and embryo donation: evaluation of 412 consecutive trials.

A total of 199 patients (412 consecutive cycles) were treated by oocyte-embryo donation in 336 replacement cycles. Of these, 296 involved intra-uterine embryo transfers, 38 zygote intra-Fallopian transfers (ZIFT) and two gamete intra-Fallopian transfers (GIFT). Of the 336 replacements, 244 (73%) constituted transfers of fresh concepti and 92 (27%) of frozen-thawed ones. A total of 85 pregnancies were achieved of which 16 ended in preclinical abortions, giving a clinical pregnancy rate of 34.7% per patient, 20.5% per transfer and a take-home baby rate of 29.1% per patient. The pregnancy rate was significantly higher (P less than 0.05) following fresh gamete or embryo replacement (23%; 56/244) than following that of frozen-thawed embryos (14.1%; 13/92). No significant difference was observed when intra-Fallopian replacement was applied (27.5%; 11/40) as opposed to intra-uterine (19.6%; 58/296). Ovarian function was not found to be of significant importance to the achievement of pregnancies after oocyte donation since comparable pregnancy rates per replacement and per started cycle were obtained in patients with ovarian failure and in those with functional ovaries (19% and 15.4%; 24.2% and 20.2% respectively). Comparison of the implantation and abortion rates between these two groups did not reveal any significant difference (11.1% and 11.1% versus 14.8% and 16.6%). The highest pregnancy rate among patients with ovarian failure was observed in those with primary ovarian failure (26.4%; 14/53), while the lowest was among women who had received chemotherapy and/or radiotherapy (9%; 1/11).(ABSTRACT TRUNCATED AT 250 WORDS)

Embryo Transfer↗
PubMed1993

A critical appraisal of assisted reproduction techniques.

Several treatments for infertility have been promoted with only little supporting objective data demonstrating their therapeutic value. The choice of an assisted reproductive technique depends on a balance between numerous factors. Seldom is the choice absolute as in patients with tubal block. There is conflicting evidence on the efficacy of simpler methods such as ovarian stimulation with or without artificial insemination and the available data suggest that the more invasive methods such as gamete intra-Fallopian transfer or in-vitro fertilization are more effective in the treatment of couples with unexplained infertility. Equally, there is no conclusive evidence that pregnancy rates with any of the invasive techniques are superior to any others. However, a higher implantation rate following tubal embryo transfers is observed in many studies. This review presents a critical assessment of the effectiveness of assisted reproductive techniques.

Embryo Transfer↗
PubMed1999

Contribution of the assisted reproductive technologies to fertility in males suffering spinal cord injury.

This study reviews 19 couples referred between 1990 and 1997 for fertility treatment for anejaculatory infertility in the male partner following spinal injury. Using sperm obtained by assisted ejaculation procedures, 14 of the 19 patients (74%) achieved at least 1 pregnancy. Pregnancy rates per treatment cycle were 12.0% for timed intrauterine insemination, 38.9% for gamete intra-Fallopian transfer and 19.2% for intracytoplasmic sperm injection followed by uterine embryo transfer. Choice of the appropriate assisted reproduction treatment to match the available semen quality results in a high level of success in such patients.

Adult↗
PubMed1990

The use of gonadotropin-releasing hormone agonist to regulate oocyte retrieval time.

We investigated the use of a gonadotropin-releasing hormone agonist (GnRH-a) to assist in the synchronous entry of a fixed number of subjects into in vitro fertilization (IVF) and gamete intrafallopian tube transfer cycle. Using a protocol in which a GnRH-a was given in the follicular or luteal phase, the clinical pregnancy rate per procedure was 27%. We conclude that the use of a GnRH-a for synchronous cycles in IVF-embryo transfer is efficacious and results in acceptable pregnancy rates.

Embryo Transfer↗