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PubMed1989

Immediate versus delayed progesterone supplementation in gamete intrafallopian transfer (GIFT).

Exogenous progesterone (P) was supplemented to gamete intrafallopian transfer (GIFT) patients to determine the optimal timing to start P supplementation and the role of isthmic block in GIFT. Patients were alternatively divided into two groups. In the immediate group, exogenous P was supplied from the day of surgery. In the delayed group, P was supplied 4 days after the surgery, the day the fertilized ovum is supposed to arrive in the uterine cavity. Except for higher serum P levels on luteal day 3 in the immediate group, no significant differences were found in serum P levels during the early luteal phase, the pregnancy rate, and the abortion rate between the two groups. It is possible that in stimulated cycles, higher serum P levels during the early luteal phase render the endometrium receptive for embryo implantation, albeit unlock the isthmic block. It may not be crucial to start exogenous P supplementation either before or after a fertilized egg(s) arrives in the uterine cavity. The role of isthmic block in GIFT needs further evaluation.

Fallopian Tubes↗
PubMed1996

In vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination: efficacy and potential health hazards on babies delivered.

OBJECTIVE: The purpose of this article was to review the efficacy and potential hazards of assisted conception. STUDY DESIGN: A review of pertinent scientific articles published in English was done. RESULTS: There are no adequate prospective, randomized, controlled, or comparative studies of sufficient power on the efficacy of in vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination in well-defined infertile couples. In vitro fertilization can overcome tubal sterility. The pregnancy per cycle is 19.8% and delivery per cycle is 16.0% for in vitro fertilization (all indications) and 29.5% and 19.8%, respectively, for gamete intrafallopian transfer. In limited prospective studies, in vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination have similar fecundity. Multiple births from in vitro fertilization and gamete intrafallopian transfer are increased, whereas preterm labor and low-birth-weight babies are significantly more common, even in singletons. CONCLUSION: The efficacy or relative superiority of IVF, gamete intrafallopian transfer, and superovulation with intrauterine insemination in nontubal subfertility remains to be shown by properly designed, prospective, randomized, controlled, or comparative studies. Therefore less invasive and less expensive methods such as expectant management or superovulation with intrauterine insemination should be used before embarking on in vitro fertilization and gamete intrafallopian transfer. Further studies on the outcome of babies delivered after assisted conception are required.

Female↗
PubMed1987

Gamete intrafallopian transfer: a treatment for long-standing infertility.

Gamete intrafallopian transfer (GIFT) has been described by Asch et al. (1,2) as an alternative technique in the treatment of infertile couples. At the University of the Orange Free State, the GIFT technique was introduced in July 1985, and during phase I, 31 patients were treated by means of GIFT. All patients had had at least six cycles of ovulation induction with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Their diagnoses were anovulation (3 patients), mild endometriosis (17 patients), and unexplained infertility (11 patients). All husbands' semen analyses were normal. Of the 31 patients, 3 failed, due to spontaneous ovulation before laparoscopy (1 patient) and unsuccessful follicle aspiration at laparoscopy with no oocytes found (2 patients). Four ongoing pregnancies resulted from the remaining 28 patients. This represents a pregnancy rate of 14.29% per laparoscopy (including the failures). The patients who became pregnant had had infertility treatment for 5, 6, 8, and 8 years, respectively. GIFT therefore appears to be a promising method of treatment for long-standing infertility.

Adult↗
PubMed1987

The role of gamete intrafallopian transfer (GIFT) in the treatment of oligospermic infertility.

Gamete intrafallopian transfer (GIFT) was used to treat 32 couples where the male partner was oligospermic (less than 12 X 10(6) motile spermatozoa per milliliter of semen). Initially, 100,000 motile spermatozoa were transferred per fallopian tube and no pregnancies were achieved in 11 cases. The technique was then modified so that a maximal number of motile spermatozoa were transferred (range, 0.11 to 0.90 X 10(6) spermatozoa) and 6 of 21 (29%) pregnancies resulted, with 325,000 spermatozoa being the lowest number associated with pregnancy. It appears that the modified GIFT technique, whereby an increased number of motile spermatozoa are replaced with the oocytes, is an effective therapy in the treatment of oligospermic infertility.

Fallopian Tubes↗
PubMed1991

Treatment of patients with unexplained infertility: gamete intrafallopian transfer (GIFT) versus tubal embryo transfer (TET).

This study compares the results of 65 cycles of gamete intrafallopian transfer (GIFT), and 19 cycles of tubal embryo transfer (TET) in couples with unexplained infertility (UI). Oocyte retrievals were carried out by laparoscopy in GIFT and transvaginally in TET, in which the embryos were transferred by laparoscopy into the fallopian tubes 48 hours later. The mean age, duration of infertility, serum estradiol levels on the day of human chorionic gonadotropin administration, number of large follicles (mean diameter greater than 10 mm) and the number of oocytes recovered were similar between these two groups. From the 65 GIFT cycles, 20 clinical pregnancies resulted (30.8%). From the 19 cycles of TET, 10 conceptions occurred (52.6%). The implantation and pregnancy rates after TET were higher than that after GIFT, but the differences were not statistically significant. The data suggest that GIFT has a similar success rate to TET in couples with UI.

Adult↗
PubMed1989

Gamete intrafallopian transfer: the effect of the number of eggs used and the depth of gamete placement on pregnancy initiation.

The role of the fallopian tube in initiating pregnancy was examined in 246 consecutive gamete intrafallopian transfer (GIFT) cycles. Before actual transfer, the ampulla of each tube was measured to determine the depth at which gametes could be placed. Fifty-seven transfers were made with four oocytes into a single tube; of these, when gametes were deposited deeper than 4 cm, the pregnancy rate was higher than when they were placed at between 3 to 4 cm (69.6% compared with 41.2%). Presumably, a deeper placement is more secure and decreases the likelihood of gamete displacement. The pregnancy rate also rose with the number of oocytes used: from 0% with a single oocyte to 42.9% with four oocytes.

Evaluation Studies as Topic↗
PubMed1996

The clinical efficacy of gamete intrafallopian transfer by minilaparotomy versus in vitro fertilization and embryo transfer.

OBJECTIVE: To evaluate the clinical performance of gamete intrafallopian transfer (GIFT) and in vitro fertilization and embryo transfer (IVF-ET). METHODS: Infertile women were divided into 2 groups: for GIFT, 239 patients (326 cycles) with at least 1 patent tube; and, for IVF-ET, 125 patients (210 cycles) with bilateral tubal occlusion. A specially designed retractor was developed to replace the gametes into an appropriate section of the Fallopian tube accurately and safely. Several parameters, including the pregnancy and delivery rates of each group, were compared. RESULTS: The success rate per trial in the GIFT group was approximately 1.5 times higher than that in the IVF group (pregnancy rate: 44.2% vs. 31.0%, p < 0.01; delivery rate: 33.4% vs. 22.9%, p < 0.01). The pregnancy and delivery rates of GIFT decreased steadily with the number of trials. These apparent decreases were not observed up to the 3rd trial in IVF-ET cases. CONCLUSIONS: GIFT with a minilaparotomy procedure yielded significantly higher success rates than IVF-ET. Accordingly, GIFT is considered to be the first treatment choice in infertility cases with at least 1 patent Fallopian tube.

Adult↗
PubMed1989

Gamete intrafallopian transfer: benefits of programmed stimulation.

Fifty-six cycles of gamete intrafallopian transfer (GIFT) were performed after programming by administration of norethisterone in the previous cycle. Ovarian hyperstimulation was achieved with clomifene citrate and human menopausal gonadotropins. Only one GIFT was performed during a weekend (1.8%). The implantation rate was 41.1% and the evolutive pregnancy rate 30.4%. The endocrinological influence of these regimens are discussed by comparison of those observed in an in vitro fertilization program. The main influence is a decreased serum luteinizing hormone (LH) level in the preovulatory phase.

Estradiol↗
PubMed1990

Gamete intrafallopian transfer in a woman with tubal occlusion. A case report.

Gamete intrafallopian transfer (GIFT) is usually performed when at least one fallopian tube is normally patent. We used GIFT in a case of bilateral tubal occlusion. The patient, who had primary ovarian failure, was enrolled in our GIFT program since it was assumed that her tubes were normally patent. Unexpectedly, at laparoscopy both tubes turned out to be distally occluded; nevertheless, GIFT was carried out by piercing the tubal wall. At this writing the patient had reached the 11th week of a normal intrauterine gestation and was still undergoing hormone replacement therapy.

Adult↗
PubMed1994

Treatment of endometriosis by carbon dioxide laser during gamete intrafallopian transfer.

BACKGROUND: Endometriosis is often encountered during laparoscopy performed for gamete intrafallopian transfer (GIFT) procedures. STUDY DESIGN: A prospective randomized study involving 44 patients with endometriosis (American Fertility Society (AFS) stages I through IV) was conducted. All patients underwent controlled ovarian hyperstimulation followed by laparoscopic GIFT procedures. Twenty-one patients had no carbon dioxide laser vaporization of endometriosis and twenty-one patients did receive laser vaporization. Two patients could not have GIFT performed due to tubal and peritubal disease. RESULTS: The results showed a clinical pregnancy rate of 38.1 percent in the treatment groups versus 47.9 percent in the control group (not significant, Chi square, and Student's test). The live birth rate from both groups was identical, at 23.8 percent per group. CONCLUSIONS: We conclude that CO2 laser vaporization of AFS stages I to IV endometriosis at the time of the GIFT procedure does not significantly affect either the clinical pregnancy rate or live birth rate from this form of assisted reproductive technology.

Adult↗
PubMed1999

[Tubal catheterization for transvaginal gamete intrafallopian transfer: an alternative technique for non-tubal infertility].

OBJECTIVE: To evaluate the outcome of transvaginal gamete intrafallopian transfer (TV-GIFT) for infertile patients with non-tubal factors. METHODS: Controlled ovarian hyperstimulation was used for all patients. Transvaginal ultrasound-guided oocyte retrieval followed by tubal catheterization for transvaginal gamete intrafallopian transfer of 3.3 +/- 2.1 oocytes (range 1-8) and 200,000 sperms in 50 microliters culture medium. RESULTS: The TV-GIFT was used in total of 23 treatment cycles. Of 23 cycles performed for TV-GIFT, the procedure was completed easily in 18 and difficult in 5, resulting in 5 clinical pregnancies(21.7% per cycle), 2 of which resulted in abortion, 2 ongoing pregnancy one was ectopic pregnancy. No pregnancy occurred in four cycles with only one oocyte transferred. CONCLUSIONS: Simple and cost-effective TV-GIFT may achieve a higher pregnancy rate. Compared with laparoscopically directed GIFT, tubal catheterization for TV-GIFT is safe and less invasive. It is an alternative for non-tubal infertility before entering the IVF-ET program.

Adult↗
PubMed1991

The reproductive outcome following a superhigh response to stimulation in gamete intrafallopian transfer program.

A retrospective analysis was carried out to assess the outcome of gamete intrafallopian transfer (GIFT) in cycles when more than 10 oocytes were retrieved (superhigh responders) from October 1987 through June 1989. There were 276 (13%) cycles with more than 10 oocytes retrieved among all GIFT cycles initiated during the period. Clomiphene citrate and gonadotropin were employed for ovarian stimulation in 105 (38%) cycles, and gonadotropin releasing hormone agonist in the remaining 171 (62%) cycles, employing either the flare (104 cycles) or the pituitary down-regulation (67 cycles) protocol. A maximum number of four oocytes was transferred per GIFT (3.5 +/- 0.4). The mean number of oocytes retrieved was 14.7 +/- 4.4 (range, 11 to 35). A significantly younger age group (less than 30 years) of patients was noticed in the study (31.9), and fewer women aged 40 and over (6.2%), compared to the general population of our patients. The pregnancy rate was 33.3% (n = 92) per cycle, with a delivery rate of 23.6% (n = 64) per cycle; the pregnancy loss rate was 30.8%. The reproductive outcome was lower in women aged 40 and over (pregnancy rate was 23.5%, but delivery rate was only 5.8% per cycle). The delivery rate was lower in the clomiphene citrate- and gonadotropin-stimulated cycles (51.7% per pregnancy) in relation to gonadotropin-releasing analogue and gonadotropin cycles (76.6% per pregnancy) and significantly so compared with the pituitary down-regulation protocol (83.3% per pregnancy). We conclude that a superhigh response develops more in younger women, and in such circumstances, the use of pituitary down-regulation with gonadotropin-releasing hormone will improve the reproductive outcome.

Adult↗
PubMed1991

Gamete intrafallopian transfer: assessment of the optimal number of oocytes to transfer.

The optimum number of oocytes that should be transferred at the time of gamete intrafallopian transfer (GIFT) is important information. Nonessential oocytes can be inseminated and frozen for later use or the extra oocytes can be donated to another women. In this preliminary study, the results of 399 consecutive GIFT procedures were evaluated retrospectively as a function of the number of oocytes transferred. Women who received four or more oocytes were three times more likely to achieve a clinical pregnancy than those who received three or less. There was no statistically significant difference in pregnancy rates between patients who received five, six, seven, or eight oocytes. Oocytes in excess of five may be more effectively used if they are fertilized and frozen as embryos for later transfer rather than replacing them all at the time of GIFT.

Clomiphene↗
PubMed1990

Gamete intrafallopian transfer (GIFT) in women with bicornuate uteri.

Fourteen women with bicornuate uteri underwent a total of 30 gamete intrafallopian transfer procedures. All patients responded adequately to ovarian stimulation. Eight women conceived, two of them twice. Five women delivered at term and three had a premature delivery. There was one spontaneous abortion and an ectopic pregnancy. No neonatal deaths occurred in this series. No increase in the incidence of spontaneous abortion was noted but there appeared to be an increase in the incidence of premature labor. These findings suggest that the prospects of conception for infertile women with bicornuate uteri treated with gamete intrafallopian transfer are similar to those of the rest of the infertile population treated at our center.

Adult↗
PubMed1997

The influence of endometriosis on the success of gamete intrafallopian transfer (GIFT).

PURPOSE: Our purpose was to evaluate the outcomes of gamete intrafallopian transfer (GIFT) therapy in patients with endometriosis. METHODS: One hundred eight GIFT cycles performed under the indication of endometriosis were compared to 156 GIFT cycles with indications of other disease entities. A maximum of seven oocytes was transferred into one or both fimbriate ends with prepared spermatozoa. Clinical pregnancy rates and outcomes were evaluated according to Mantel-Haenszel's chi-square test. Multiple logistic regression analysis was performed to determine factors influencing the success on pregnancy in the total treatment cycles. RESULTS: The anthropological variables, such as age of patients, duration of infertility, and semen grading, were comparable in both groups. The responses to controlled ovarian hyperstimulation (COH) were progressively decreased while increasing the severity of endometriosis conditions such as nonendometriosis, mild-form endometriosis, and advanced-form endometriosis patients. However, there were no significant differences in the clinical pregnancy rates (40.4, 36.7, and 41.7%, respectively), multiple pregnancy rates (34.9, 27.3, and 45.0%, respectively), and early pregnancy loss rates (27.0, 18.2, and 30.0%, respectively). Multivariate statistics of pregnancy rates that adjusted the effects of patients' age, tubal health, presence of active endometriosis and/or endometriomas, number of oocytes transferred, and quality of sperm exhibited no statistical significance between endometriosis and nonendometriosis groups. CONCLUSIONS: Our data show that patients with records of endometriosis have both a decreased ovarian response to gonadotropin stimulation and a decreased number of retrieved oocytes. Since the number of oocytes needed for the GIFT procedure is limited, pregnancy results for patients in the study group were comparable with those for patients in the control group.

Analysis of Variance↗
PubMed1993

Gamete intrafallopian transfer: ethical considerations, historical development of the procedure, and comparison with other advanced reproductive technologies.

OBJECTIVE: To report on ethical considerations regarding GIFT as well as the developmental history of the procedure and to review the literature and compare it with other advanced reproductive technologies (ARTs). DESIGN: Indications, patient screening, recent evaluations, methods of ovarian hyperstimulation and oocyte retrieval-assessment, gamete transfer and pregnancy outcome are discussed in this review. A comparison of GIFT with other ARTs is also attempted. MAIN OUTCOME MEASURES: Gamete intrafallopian transfer pregnancy determination and outcome. CONCLUSIONS: Gamete intrafallopian transfer is an ethically acceptable procedure by different religious groups. In a selected group of patients, GIFT is an acceptable and, in some occasions, a preferable procedure to other ARTs.

Biomarkers↗