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PubMed1993

Gamete intra-fallopian transfer: outcome following the elective or non-elective replacement of two, three or four oocytes.

The outcome of 807 gamete intra-Fallopian transfer (GIFT) cycles following the elective or non-elective transfer of two, three or four oocytes has been retrospectively studied. Electively replacing either three or two oocytes did not reduce the clinical or ongoing pregnancy rate when compared with replacing four oocytes. The incidence of high-order multiple gestation (triplet or more) was significantly reduced by replacing fewer oocytes, but the occurrence of twin pregnancy was not altered. Lower pregnancy rates were found when the number of oocytes available for replacement was limited and non-elective replacement was performed. It is suggested, therefore, that a higher number of oocytes available may allow selection of higher quality oocytes for transfer. We conclude that the overall expectation of pregnancy from the GIFT procedure is high (30-40%) and the number of oocytes replaced should be two in order to minimize the risk of high-order multiple pregnancies. It is not clear whether increasing the number of oocytes transferred will benefit subjects who failed to become pregnant previously with GIFT, but limited data suggest that transferring large numbers of oocytes to women > 40 years does not improve the expectation of pregnancy.

Age Factors↗
PubMed1993

A multifactorial analysis of the pregnancy outcome in a successful embryo cryopreservation program.

OBJECTIVE: To determine which factor, or factors, may influence the success of an embryo-freezing program. DESIGN: Prospective. SETTING: An established, private IVF clinic. PATIENTS: This study comprises data from 185 consecutive thaw cycles (161 patients) that resulted in embryo replacement. The influence of the following factors, with regard to pregnancy outcome, was specifically addressed: embryo quality, day of the endogenous LH surge, number of thawed embryos replaced, length of time frozen, E2 level at the time of the hCG trigger in the stimulated cycle, and patient age at the time of freezing. RESULTS: An overall pregnancy rate (PR) of 27.6% per ET was achieved in this study. Regardless of the day of the LH surge, patients who had at least one good quality embryo (the "sponsoring embryo") conceived 35% of the time. Patients who lacked a sponsoring embryo frozen conceived 15% of the time. Patients who were 39 years of age or younger had a PR of 31% per transfer. None of the 22 patients who were 40 or older conceived. No other factor examined had any effect on pregnancy outcome. CONCLUSIONS: Good quality frozen/thawed embryos are a major factor in achieving a consistently high PR. Poorer quality embryos are capable of implantation but at a significantly reduced rate. Patient age was also found to be significant in predicting pregnancy. Neither the day of the LH surge, number of embryos transferred, length of time frozen, nor the E2 level appears to have any effect on the establishment of pregnancy.

Adult↗
PubMed1993

'Blind' transvaginal gamete intra-fallopian transfer in distal tubal and peritubal pathology: an evaluation in respect to the laparoscopic approach.

Transvaginal gamete intra-Fallopian transfer (GIFT) is a new treatment modality for patients with proven tubal patency, avoiding invasive laparoscopy. In this study 79 cycles of standard laparoscopic GIFT (group 1) were analysed in comparison to 40 cycles of transvaginal intratubal gamete transfer guided by tactile sensation (group 2). GIFT in group 1 was performed for standard indications; patients with severe intra-abdominal adhesions, distal tubal pathology, peritubal adhesions or extreme obesity were included in group 2. No difference in mean age, duration of infertility, oestradiol level and number of oocytes was found. In group 1 a clinical pregnancy rate of 33% per GIFT cycle (n = 79) was achieved. The clinical pregnancy rate in group 2 was 17.5% per gamete transfer cycle. In conclusion, transvaginal GIFT offers an acceptable chance for in-vivo fertilization to patients who cannot be treated laparoscopically despite having patent tubes and who refuse in-vitro fertilization.

Adult↗
PubMed1991

A human in vivo model for the luteoplacental shift.

OBJECTIVE: To study the onset of early placental steroidogenesis in humans. DESIGN: Ovarian failure patients who were administered a constant dosage of exogenous estradiol (E2) and progesterone (P) during the luteal phase and early gestation and who conceived after transfer of donated oocytes were used to assess serum hormonal changes throughout early pregnancy. SETTING: Hormonally replaced ovarian failure patients undergoing an egg donation program in an academic research environment. PATIENTS, PARTICIPANTS: Nine human volunteers desiring egg donation. INTERVENTIONS: Replacement of E2 and P. MAIN OUTCOME MEASURE: Serum E2 and P concentrations were measured weekly throughout the patients' gestations. RESULTS: Serum E2 and P levels of these patients remained low in early gestation but significantly increased 25 +/- 1.6 and 34 +/- 1.6 days post embryo transfer, respectively. Regression lines of E2 (r = 0.99; P less than 0.01) and P (r = 0.95; P less than 0.005), intersected basal hormonal levels approximately 3 weeks after transfer. CONCLUSION: This estimate of the onset of placental steroidogenesis is equal to the 5th gestational week as calculated by the patients' last menses, approximately 3 weeks earlier than previously reported.

Corpus Luteum↗
PubMed1990

The perurethral technique for ultrasound directed follicle aspiration in an in-vitro fertilization and embryo transfer programme: a report of 636 patient cycles.

The data from 636 patient cycles from an outpatient-based in-vitro fertilization and embryo transfer programme are presented. Between 1984 and 1988, 545 women (86%) underwent ultrasound directed follicle aspiration (UDFA) exclusively by the perurethral route. The mean follicle aspiration rate was 93%, and the mean number of oocytes per procedure was 5.8. The complication rate was 6%, but none was major. From July 1985 the clinical pregnancy rate per UDFA was 17% and per embryo transfer 21%. The perurethral approach was used in combination with another UDFA route in 91 women (14%) but the need to change route decreased with increasing operator experience. Perurethral UDFA is an efficient and safe method for harvesting oocytes.

Female↗
PubMed1991

'Blind' transcervical transfer of gametes in the fallopian tube: a preliminary study.

The aim of the study was to assess, in a small number of volunteers, the feasibility of transferring gametes by blind transcervical tubal catheterization. Forty patients underwent ovarian stimulation with a combination of a luteinizing hormone-releasing hormone analogue and exogenous gonadotrophin. Twenty-six patients were submitted to echographical oocyte retrieval and subsequent blind transcervical tubal transfer of the gametes. Successful cannulation of the tube was achieved in 18 subjects, at the first attempt and in four subjects at the second attempt; in the remaining four subjects, three or more attempts were needed. No complications were recorded during the tubal transfer. Seven clinical pregnancies (27% of all transfers) were obtained: three ended in abortion (11%), one was ectopic (4%) and three were ongoing (11%). These preliminary results encourage larger studies using this approach.

Chorionic Gonadotropin↗
PubMed1993

Cumulative pregnancy rate from one gamete intra-fallopian transfer (GIFT) cycle with cryopreservation of embryos: a practical mathematical calculation.

We evaluated the cumulative pregnancy rate from one gamete intra-Fallopian transfer (GIFT) cycle plus subsequent cycles in which embryos cryopreserved at the time of the original GIFT cycle were transferred. All patients who had their first GIFT cycle in our centre between January, 1989 and March, 1991 were included. Ovarian stimulation was accomplished with leuprolide acetate (luteal phase protocol) and a combination of follicle stimulating hormone and human menopausal gonadotrophin. GIFT was performed with three to five oocytes. Excess oocytes were inseminated and good quality embryos were cryopreserved at the 2- to 4-cell stage with 1-2 propanediol. When the GIFT cycle did not result in a pregnancy, uterine transfer of cryopreserved embryos was carried out in subsequent unstimulated cycles. A total of 97 patients had GIFT and 46 pregnancies were achieved (47.4%). A total of 51 patients (52.5%) had embryos frozen; of these, 21 were from the non-pregnant group (41.1%) and 30 from the pregnant group (65.2%) (P < 0.05). Up to now, 22 of them have undergone a frozen-thawed embryo transfer cycle, and two of them achieved a pregnancy. Based on these data, patients having a GIFT could theoretically expect a cumulative pregnancy rate of 52.2%.

Cryopreservation↗
PubMed1994

Sonographic uterine predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments.

OBJECTIVE: To determine preovulatory uterine sonographic predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments. DESIGN: Prospective evaluation of uterine sonographic and vascular flow profiles in women stimulated with leuprolide acetate and hMG. SETTING: Private fertility center and tertiary-care academic center. PATIENTS: Ninety-six women underwent 102 cycles of ovulation induction for IVF (46), GIFT (20), and zygote intrafallopian transfer (36). MAIN OUTCOME MEASURES: Endometrial texture, thickness, resistance index at the first branch of uterine artery, diastolic blood flow, and pregnancy outcome (no conception, spontaneous abortion, and delivery). RESULTS: Triple-lined pattern was predominant in women who delivered liveborn infants (P < 0.005). Endometrial pattern and diastolic blood flow were the only predictive markers of term pregnancy (P < 0.001 and P < 0.05, respectively). CONCLUSION: Preovulatory triple-lined sonographic endometrial texture and the presence of end diastole blood velocities at the first branch of uterine artery are the most important uterine predictors of conception.

Adult↗
PubMed1993

Assisted reproductive technology in the United States and Canada: 1991 results from the Society for Assisted Reproductive Technology generated from the American Fertility Society Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1991. DESIGN: Data were collected on an annual summary form and submitted to the Society for Assisted Reproductive Technology generated from The American Fertility Society central registry. PARTICIPANTS: Two hundred fifteen programs submitted data on procedures performed in 1991. Data were collected in October of 1992 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURES: The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULTS: In 1991, programs reported initiation of 33,001 cycles of ART treatment, excluding frozen embryo and donor oocyte cycles. Of these, 24,671 cycles initiated were IVF with 15.2% deliveries per retrieval, 5,452 were cycles of GIFT with 26.6% deliveries per retrieval, and 2,104 were cycles of zygote intrafallopian transfer with 19.7% deliveries per retrieval, and 714 were combination cycles, combining IVF and one of the tubal transfer techniques, resulting in 19.3% deliveries per retrieval. In addition to these cycles initiated in 1991, 4,838 frozen embryo procedures were reported, either as separate procedures or in combination with another ART procedure with 11.1% deliveries per procedure, and 1,107 donor oocyte or surrogacy cycles were initiated with an overall success of 25.6% deliveries per retrieval. From all of these procedures, a total of 5,699 deliveries were reported. CONCLUSIONS: In 1991, there were more programs offering more treatment cycles of ART. Average success rates for most ART procedures exhibited a small increase compared with previously reported summaries.

Adult↗
PubMed1996

What factors predetermine the risk of having a high-order multiple pregnancy with gamete intra-fallopian transfer?

Limiting the number of oocytes transferred at gamete intra-Fallopian transfer (GIFT) has limited the incidence of high-order pregnancy but at the same time compromised the fertility potential of some patients. A review of 300 patients who have undergone GIFT using a flexible approach as to the number of oocytes transferred identifies the patients at risk of high-order pregnancy as those aged under 30 years in whom more than six oocytes are returned and whose partner's spermatozoa have high progressive motility.

Adult↗
PubMedDate not supplied

Ovarian heterotopic pregnancy after IVF and contralateral tubal ectopic pregnancy after GIFT.

One case of ovarian ectopic associated with twin intrauterine viable pregnancy after in vitro fertilization, and one case of contralateral tubal ectopic pregnancy after gamete intra fallopian transfer performed with normal fallopian tubes, are reported. The possible pathogenesis and the management are discussed. The risk of ectopic pregnancy after assisted conception can be present even when the fallopian tubes are apparently normal.

Adult↗
PubMed1994

[Evaluation of 1993 FIVNAT].

FIVNAT registry collected information on 24,921 individual assisted reproductive technology (ART) cycles in 1993 and the present analysis concerns 17,102 cycles arrived on time to be incorporated, 95.5% being in vitro fertilization (IVF) cycles. The positive ponction rate for IVF (98.5%) and the transfer rate (80.1%) were not modified. The clinical pregnancy rates progressed to 20.4% per oocyte recovery cycle and to 25.5% per transfer, they were clearly increasing from 1992. The mean oocyte number (8.8 +/- 5.5) and the mean embryo number (4.02 +/- 3.81) were slightly increasing, but the mean number of transferred embryos was not modified (2.73 +/- 1.09). That confirms the transfer strategy of clinics. In 1993, the proportion of infertilities of tubal origin decreased (56.6% vs 58.9 in 1992), and those of male origin increased (37.5% vs 32.6% in 1992). The pregnancy rate increased for all the indications, especially for cycles realised with donor semen, except for the immunological one. Most of the stimulation regimen used the GnRH analogues protocols with a long blocking period (73.5%): they obtained the highest pregnancy rate per transferred embryo (24.6%). An increasing proportion of transfers involving 3 embryos was notified (39.1% vs 37.9% in 1992); the clinical pregnancy rates per transferred embryo were increasing since the last two years for transfers involving one to three embryos. The analysis of 11,405 clinical pregnancies resulting from recoveries realised between 1986 and 1992 showed a preterm birth rate of 9.3% for singleton, but a still high rate for twins and multiple pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Adjuvant leuprolide in normal, abnormal, and poor responders to controlled ovarian hyperstimulation for in vitro fertilization/gamete intrafallopian transfer.

Fifty patients (normal responders) received either human menopausal gonadotropin (hMG) alone (control group) or leuprolide + hMG (leuprolide group). The use of leuprolide was associated with a reduction of hMG requirements (14.8 versus 17.8 ampules, P = 0.02) and the abolition of spontaneous luteinizing hormone surges (nil versus 3, P = 0.006). The rate of fertilization (87% versus 65%, P = 0.003) was higher in the leuprolide group. Pituitary and ovarian suppression was effected for 16 subjects who had previously shown a poor follicular response and a further 19 subjects who had previously responded abnormally. The poor responders required more hMG (43.9 versus 27.1 ampules, P less than 0.001), achieved a lower estradiol maximum (5.1 versus 12.1 nmol/l, P less than 0.001), and had fewer oocytes recovered (4.1 versus 11.5, P less than 0.001), than the abnormal responders.

Drug Therapy, Combination↗
PubMed1989

The effect of pneumoperitoneum gases on fertilization, cleavage and pregnancy in human in-vitro fertilization and gamete intra-fallopian transfer.

A prospective, randomized study was carried out, creating a pneumoperitoneum with 100% CO2 or with 5% CO2 in air and evaluating the effect(s) of these gas phases on fertilization, cleavage and pregnancy outcome in this in-vitro fertilization and embryo transfer programme. There was no significant difference in the fertilization rate when either 100% CO2 or 5% CO2 in air was used for insufflation during laparoscopy. Further, embryonic development and pregnancy rates also indicated no significant differences between the two groups. Similarly, the oocytes which were retrieved and replaced with spermatozoa in the gamete intra-Fallopian transfer programme using either 100% or 5% CO2, gave similar pregnancy rates. Furthermore, the fertilization and cleavage rates of the supernumerary oocytes were not significantly different in both groups.

Carbon Dioxide↗
PubMed1991

The leuprolide flare regime for in-vitro fertilization/gamete intra-fallopian transfer and embryo cryopreservation.

Gonadotrophin releasing hormone agonists (GnRHa) are now well established as adjuvant agents for in-vitro fertilization (IVF)/gamete intra-Fallopian transfer (GIFT) but several different modes of usage have been proposed. Our experience with 328 cycles of leuprolide used in a flare regime is reviewed. An endocrinologically proven flare effect was associated with a reduction of human menopausal gonadotrophin (HMG) usage (10 versus 16 ampoules) and a lower cycle cancellation/conversion rate (7.4 versus 11.3%). Overall, satisfactory rates of oocyte recovery (93%, mean number of oocytes 7.0), clinical pregnancy (24.4% per oocyte recovery) and pregnancy from frozen/thawed embryo transfers (14%) were achieved. The flare protocol appears to be a satisfactory choice for the majority of subjects but careful monitoring is required to avoid the potential for ovarian hyperstimulation.

Cryopreservation↗
PubMed1989

Intrauterine insemination and controlled ovarian hyperstimulation in cycles before GIFT.

We have combined intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH), for the treatment of infertility due to different aetiologies, prior to performing GIFT. To date, we have treated 186 patients over a total of 489 cycles. The mean age of the patients was 34.1 +/- 4 years and the mean duration of infertility was 4.8 +/- 2.8 years. Follicular development was induced with human menopausal gonatrophin (HMG). Patients were monitored using serum oestradiol determinations and ovarian ultrasound. Two intrauterine inseminations were performed 12 and 36 h after HCG injection. Semen samples were prepared utilizing one of two techniques, swim-up or Percoll gradient. A total of 33 pregnancies have occurred, the gross pregnancy rate being 17.7% per patient and 6.7% per cycle. The cumulative pregnancy rate was 30%. Thirty-one pregnancies (94%) occurred within the first four cycles of treatment. During the same period of time, the pregnancy rate per cycle in patients treated with gamete intra-Fallopian transfer (GIFT) was 32.9%. Our data suggest that IUI combined with COH can result in pregnancy in a significant proportion of patients, but that the efficiency per cycle of the technique is significantly lower than GIFT.

Adult↗