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PubMed1998

Efficacy assessment of highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotropin during pituitary suppression in patients undergoing GIFT for unexplained infertility.

The purpose of this study was to compare the efficacy of highly purified follicle-stimulating hormone (FSH-HP) alone versus the combination of FSH-HP + human menopausal gonadotropin (hMG) treatment during pituitary suppression with gonadotropin-releasing hormone (GnRH) analog on the clinical outcome and endocrine parameters in 120 randomized women undergoing gamete intra-Fallopian transfer (GIFT) for unexplained infertility. Our data did not show any significant difference between the two groups as regards dose of administered gonadotropins, duration of treatment, estradiol 17 beta 17 beta increase curves, number of follicles > 16 mm, number of recruited and transferred oocytes, and endometrial thickness. The percentages of clinical pregnancies (33.3% with FSH-HP and 31.6% with FSH-HP + hMG), of miscarriages and twin gestations were also similar in the two groups. It is concluded that, during GnRH analog suppression, FSH-HP treatment alone is effective in inducing normal follicular steroidogenesis and adequate oocyte maturation, but no detrimental effect of luteinizing hormone (LH) activity of hMG on the outcome of the outcome of ovarian stimulation was found.

Adult↗

PubMed1989

Timed oocyte collection in an assisted conception programme using GnRH analogue.

Three-hundred-and-twenty-five patients on an assisted conception programme underwent 378 cycles of oocyte retrieval (OPU) following ovarian stimulation using a GnRH analogue and human menopausal gonadotrophins (HMG), a regimen which allows programmed cycles and delayed oocyte retrieval. Eighteen cycles were excluded (failed OPU in three and failure of fertilization in 15). In 360 cycles, patients completed their treatment with either in-vitro fertilization/embryo transfer (IVF/ET) (116) or gamete intra-Fallopian transfer (GIFT) (244), of which 241 took place at the normal time and 119 were delayed for 24 h or more to avoid weekend operating. The overall pregnancy rate per OPU was 29.5%, with the IVF group being 24.1% and the GIFT group being 32.8%. In the group of patients in whom OPU was delayed, the pregnancy rate was significantly higher in each sub-group than in the corresponding non-delayed sub-group (overall, 37.0 versus 25.7%; IVF/ET, 38.5 versus 16.9%; GIFT, 36.3 versus 31.1%). There was a significantly higher number of oocytes collected, gametes/embryos transferred in the group whose OPU had been delayed. In patients receiving GnRH analogue and HMG for ovarian stimulation, delaying oocyte retrieval is not harmful, may result in an improved outcome and allows OPU to be performed on routine operating lists. This facility, together with the improved pregnancy rates associated with this protocol of ovarian stimulation should improve the cost-effectiveness of assisted conception programmes.

Adult↗

PubMed1991

General anaesthesia for gamete intra-fallopian transfer.

A retrospective survey was undertaken of all patients who had gamete intra-fallopian transfer (GIFT) under general anaesthesia at this hospital over an 18-month period. Of 47 patients, 21 (44.7%) became pregnant although only 10 (21.3%) proceeded to term. All of those who proceeded to term had had enflurane as part of their general-anaesthetic technique. Although a number of the patients who received halothane became pregnant, none proceeded beyond the second trimester. It would appear that the use of halothane may be inadvisable for general anaesthesia for this procedure.

Adult↗

PubMedDate not supplied

Current therapeutic possibilities of GIFT.

We have used GIFT in 74 couples affected with unexplained sterility, male hypofertility, endometriosis, phymosis of the fimbria and adhesions impeding oocyte pick-up. We systematically desensitized the pituitary using a GnRH analog from the 20th day of the cycle preceding GIFT. All the patients were hyperstimulated with purified FSH and hMG (Metrodin and Pergonal-Serono) from the 3rd day of the cycle. When several follicles were obtained woth a diameter greater than 16 mm together with serum estradiol values of 300 pg/ml per follicle, 10,000 IU hCG were administered intramuscularly in a single dose (Profasi-Serono). A maximum of 5 oocytes per patient were transferred (2-3 per tube). Our results confirm the validity of the GIFT method, with an average success rate of 19% in all pathological conditions and a far greater success rate in couples with unexplained sterility than in those with male hypofertility (31% and 10% respectively). The Authors stress that the best results of GIFT were achieved when the ratio between E2 and follicles with a diameter greater than 16 mm was in excess of 500 pg/ml.

Adult↗

PubMed1999

Clinical value of using an automated sperm morphology analyzer (IVOS).

OBJECTIVE: To determine the clinical value of automated normal sperm morphology outcomes. DESIGN: Prospective clinical study. SETTING: Clinical and research assisted reproduction laboratory. PATIENT(S): Two hundred seven GIFT cycles. INTERVENTION(S): The wife was induced to superovulate, laparoscopically aspirated, and the gametes were transferred laparoscopically. The husband's sperm morphology was evaluated with use of a sperm morphology analyzer using the strict criteria classification system. MAIN OUTCOME MEASURE(S): Normal sperm morphology, IVF, and pregnancy outcomes. RESULT(S): The logistic regression model showed that normal sperm morphology was significantly associated with fertilization in vitro, as dependent (age) and independent variables. Analyzing the fertilization rates across the 5% normal sperm morphology cutoff point, a fertilization rate of 39.39% (< or = 5%) compared with 62.92% (>5%) was obtained. The logistic regression model showed that normal sperm morphology was also a significant predictor of pregnancy when allowing for the number of oocytes transferred and female age. Analyzing the pregnancy rates across the 5% normal sperm morphology cutoff point, pregnancy rates of 15.15% (< or = 5%) and 37.36% (>5%) were obtained. CONCLUSION(S): Normal sperm morphology as evaluated by the automated semen analyzer (IVOS) was shown to adhere to the same fertility cutoff point (5%), as determined by the manual evaluation of sperm morphology. Automated normal sperm morphology outcomes also were found to be significant predictors of IVF and pregnancy in a GIFT program.

Adult↗

PubMed1995

Assisted reproductive technology in the United States and Canada: 1993 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1993. DESIGN: Data were collected on an annual summary form and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANTS: Two hundred sixty-seven programs submitted data on procedures performed in 1993. Data were collected in October 1994 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: Programs reported initiations of 41,209 cycles of ART treatment, excluding frozen embryo and donor oocyte cycles. Of these, 33,543 cycles initiated were IVF (standard, with micromanipulation, and for host uterus transfer) with 18.3% deliveries per retrieval; 4,992 were cycles of GIFT with 28.1% deliveries per retrieval; 1,792 were cycles of ZIFT with 24.4% deliveries per retrieval; and 882 were combination cycles, combining IVF and one of the tubal transfer techniques, resulting in 27.8% deliveries per retrieval. In addition to these cycles initiated in 1993, 6,869 frozen ET procedures were reported, either as separate procedures or in combination with another ART procedure with 13.3% deliveries per procedure, and 2,766 donor oocyte cycles were initiated with an overall success of 30.2% deliveries per retrieval. As a result of all procedures, a total of 8,741 deliveries were reported. CONCLUSIONS: In 1993, there were more programs offering more treatment cycles of ART. Overall average success rates (deliveries per procedures) exhibited only a small increase compared with previously reported summaries.

Adult↗

PubMed1989

Vaginal intratubal insemination (VITI) and vaginal GIFT, endosonographic technique: early experience.

A new technique for vaginal intratubal insemination (VITI) and transvaginal gamete intra-Fallopian transfer (TV-GIFT) using endosonography has been developed. A total of 47 infertile couples were treated using a K-JITS 1000-1100 catheter (William Cook, Australia; Jansen Anderson Intratubal Transfer Set) introduced by Jansen and Anderson in Sydney, Australia, and endosonographic control with a Kretz Combison 310 echograph and a 5/7.5 MHz vaginal sectorial transducer. In 40 couples, the VITI technique was used, and in the other seven couples, TV-GIFT was used. Fifteen pregnancies (37.5%) were obtained in 63 VITI cycles (23.8% per treatment cycle) and three with TV-GIFT (42% per treatment cycle). A review is also presented of the migration--sedimentation technique used for management of male factor in an artificial insemination programme.

Adult↗

PubMed1996

Beyond recanalizing proximal tube occlusion: the argument for further diagnosis and classification.

Proximal tube occlusion (PTO) accounts for 20% of tubal factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo occlusion (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that is already diagnosed by laparoscopy and hysterosalpingography (HSG) can be confirmed or bypassed (false PTO); patients with false PTO were placed on a temporary waiting period. Nodular and pseudo occlusion patients were pre-treated with gonadotrophin-releasing hormone analogue (GnRH-a) for at least 6 weeks to shrink the underlying pathology, after which tubal re-catheterization was performed. In a prospective study starting in July 1993, 53 patients prediagnosed as having PTO were examined by falloposcopy. Three of these patients had non-nodular occlusion and were directed to microsurgical repair (conservative treatment not possible). A total of 19 cases revealed patent tubes with healthy mucosa and no underlying pathology (false PTO). Of the remaining 31 patients, 18 were classified as nodular and 13 as pseudo occlusion. In all of these patients at least one tube was patent after GnRH-a treatment. After a 6 month period, 37% of the false PTO patients achieved a spontaneous pregnancy (6% per cycle). The spontaneous pregnancy rate in the true PTO group was significantly lower (10% per patient, 1.6% per month; P < 0.05). Using assisted reproduction techniques, in particular gamete intra-Fallopian transfer (GIFT), as a subsequent treatment for the true PTO group, a pregnancy rate of 50% per cycle was achieved. A retrospective analysis of our entire PTO population (n = 109) showed a spontaneous pregnancy rate after achieving tubal patency (using falloposcopy and GnRH-a) that was dramatically low (1.8%), with no difference between the nodular and pseudo groups. The chance for pregnancy can be enhanced significantly (P < 0.001) using assisted reproduction techniques (GIFT) following tubal re-catheterization and GnRH-a treatment.

Buserelin↗

PubMed1991

[Celioscopy with peridural anesthesia. Techniques, indications, results in 220 cases].

The authors used epidural anaesthesia to carry out laparoscopy in 220 patients. The chief indications for the laparoscopies were GIFT (intratubal transfer of gametes) and tubal sterilization. The technique used was slightly different according to the indications for the use but they had to be sure of anaesthetising up to T4. In 90% of cases the patients tolerated the procedure well. No change in ventilation or in metabolic measurements. As far as fertilization was concerned studies carried out in various parameters failed to show any untoward side effects due to the use of local anaesthetics. Finally so long as the anaesthesia is only used for a short length of time this technique seems to be suitable for day cases.

Ambulatory Care↗

PubMed1990

Gamete intra-fallopian transfer with cryopreserved donor semen following AID failure.

Results are presented of gamete intra-Fallopian transfer with cryopreserved donor semen in cases of male infertility with azoospermia or extreme oligozoospermia. The female partners had no detectable infertility problems and they had first received 10 cycles of intracervical AID without success. Forty-one GIFT cycles performed on 22 such patients gave an overall pregnancy rate of 26.8% (11/41). In 64% (9/14) of these cases, pregnancy occurred after the first GIFT attempt. From these results it is suggested that GIFT with donor semen may be a reasonable alternative after AID failure. The probable reasons for success of GIFT are discussed.

Adult↗

PubMed2001

The present status of management for infertility in Miyagi Prefecture, Japan.

To summarize the current management of infertility in Japan, a questionnaire survey was administered. A mail-survey method was used, and surveys were sent to 126 obstetrical and/or gynecological medical facilities in Miyagi Prefecture. The respondents included 86 facilities (68.3%). The majority of participants employed routine assessments, and their records included basal body temperature (98.8%), semen analysis (88.8%), and tubal patency tests (78.8%). Laparoscopic diagnosis, however, was uncommon (15.8%). With respect to treatment, surgical procedures, especially endoscopic procedures, were not generally carried out in addition to medicinal treatment. Sixty-one percent of the respondents performed intrauterine insemination, however assisted reproductive technology (ART) was provided by a few participants, for example, in vitro fertilization-embryo transfer was available at 11.3% of facilities. In self-assessment, the median pregnancy rates for the group undergoing laparoscopy and that not were significant different (30% and 20%, respectively), and those of the group undergoing ART provided and that not were significant different (35% and 20%, respectively). In conclusion, there are various differentials in the methods of diagnosis and treatment of infertility in the medical facilities today, and the outcomes are not always satisfactory. For appropriate management of infertile couples, it will be necessary to more closely manage cooperation between primary care doctors and reproductive specialists.

Adult↗

PubMed1994

The impact of maternal age on clinical pregnancy and spontaneous abortion in women undergoing in vitro fertilization and gamete intra-fallopian transfer.

The age at which women should be advised against proceeding with initial or further infertility treatment is one of the many unresolved questions in this area of women's health and was the subject of investigation in this study. One of the major difficulties in determining the impact of maternal age on outcomes is the practice of researchers (publishing in journals) and infertility practitioners (reporting to national registers) of coding age as a categorical rather than a continuous variable. In this study, groups of younger (< 30 years) and older (> 35 years) women undergoing assisted reproduction treatments were compared with regards to clinical pregnancy and spontaneous abortion rates following in vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT). Response to different ovarian stimulation protocols was also assessed for the 2 groups. The significance of the relationship between maternal age, clinical pregnancy rates, spontaneous abortion rates and the type of treatment and stimulation protocol employed, was tested using a series of binomial distributions. The results indicated that maternal age adversely affects both clinical pregnancy rates and rates of spontaneous abortion, when summed across treatments and stimulation protocols. However, while the age/outcome relationship held for IVF, the GIFT by age relationship was not significant. Stimulation protocols using clomiphene citrate (CC) or gonadotrophin agonists (GnRHa) may impact negatively on older women.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗

PubMed1991

The intra-vaginal culture technique for supernumerary oocytes from gamete intra-Fallopian transfer.

The intra-vaginal culture technique has been utilized for supernumerary oocytes produced as a result of gamete intra-Fallopian transfer therapy. This has enabled knowledge regarding fertilization to be gained and in addition, by adapting the technique to include a transportational element, it has been possible to perform embryo cryopreservation in a separate unit. Analysis of the results of 72 GIFT treatment cycles reveals that when more than four oocytes were collected at laparoscopy, 15/32 (47%) pregnancies were achieved, in comparison with 7/40 pregnancies (17.5%) when four or fewer oocytes were recovered (P less than 0.01). Whilst the GIFT pregnancy rate was higher when spare oocytes were fertilized and embryos cryopreserved (9/16; 56%), six of the 16 patients (37.5%) with failed fertilization of spare oocytes still achieved a GIFT pregnancy.

Adult↗

PubMed1994

Clinical pregnancy and male subfertility; the ESHRE multicentre trial on the treatment of male subfertility. European Society of Human Reproduction and Embryology.

Ovulation induction alone, and ovulation induction in conjunction with one of four assisted procreation methods [intra-uterine insemination (IUI), intra-peritoneal insemination (IPI), gamete intra-Fallopian transfer (GIFT) or in-vitro fertilization (IVF)] were tested as a treatment for male infertility in a prospective randomized trial. The trial when completed had generated data on 499 cycles from 346 patients. There was overwhelming evidence that some form of assisted procreation was beneficial, when compared to the spontaneous natural conception rate, which is generally assumed to be between 0.01 and 0.02 for male infertility. There was also firm evidence that IUI, GIFT or IVF (mean per cycle pregnancy rate 0.212) were superior to the remaining two treatments of IPI and ovulation induction alone (mean per cycle pregnancy rate 0.068). Duration of infertility and a diagnosis of endometriosis were the most important (adverse) pre-treatment factors detected.

Endometriosis↗

PubMed1995

The thiol reagent, thimerosal induces intracellular calcium oscillations in mature human oocytes.

The aim of this study was to investigate the effects of thimerosal on intracellular calcium in human oocytes related to the stage of nuclear maturity. A total of 20 oocytes from superovulated women undergoing gamete intra-Fallopian transfer (GIFT) were studied. The calcium-sensitive fluorescent dye Fura-2 was used to monitor intracellular calcium. Regular oscillations in the concentration of cytosolic calcium were observed in 13 out of 20 oocytes following exposure to thimerosal; five oocytes did not respond to thimerosal treatment, and spontaneous oscillations of cytosolic free calcium were recorded in two oocytes. Thimerosal induced oscillations of intracellular calcium in a significantly higher proportion of metaphase II oocytes (10/11) compared with metaphase I oocytes (3/8; P < 0.2). These findings demonstrate that thimerosal is a potentially useful agent for the study of the calcium signalling processes in human eggs and suggest that the underlying cellular mechanisms develop at a relatively late stage of oocyte maturation.

Calcium↗

PubMed1991

Microsurgery and in vitro fertilization/embryo transfer for infertility resulting from distal tubal lesions.

The live birth rates were analyzed after 688 microsurgical operations for infertility resulting from distal tubal lesions and after 885 in vitro fertilization cycles for tubal factor infertility at the Ljubljana University Department of Obstetrics and Gynecology. The cumulative live birth rate five years after surgery was 31% (17% cases lost to follow-up). The cumulative live birth rate after four in vitro fertilization cycles for tubal infertility was 40% (8% per treated cycle). With two options for treatment, operable cases had a better prognosis than did the inoperable ones. If pregnancy did not occur two to three years after surgery, the patients underwent in vitro fertilization. The complementary use of microsurgery and in vitro fertilization has substantially improved the prognosis for infertility resulting from distal tubal lesions.

Fallopian Tube Diseases↗

PubMed1991

[Ovarian pregnancy after gamete transfer (gift). A case report].

A case of ovarian pregnancy after gamete transfer (GIFT) is reported in a 33-year old women who, after intensive stimulation therapy, experienced a right tubal pregnancy in one cycle and an ovarian pregnancy on the left side in the next. The incidence of ovarian pregnancies seems to have been increasing during the past years, comprising 3.3% of all extrauterine pregnancies. This may be influenced by the possibilities of sterility therapy today. Clinical presentation, possible pathogenesis, diagnostic steps and preferred management are described. The use of transvaginal sonography has improved the diagnosis of ectopic pregnancies and should be routinely used leading to an early diagnosis and organ-preserving therapy. This case report is intended to assist and promote the sensitivity towards an early diagnosis of this rare form of ectopic pregnancy.

Adult↗

PubMed1994

Fertilization efficiency of morphologically abnormal spermatozoa in assisted reproduction is further impaired by antisperm antibodies on the male partner's sperm.

OBJECTIVE: To investigate the influence of antisperm antibodies on the sperm surface on the outcome of IVF and GIFT. DESIGN: Matched controlled retrospective review of two large series. SETTING: Reproductive endocrine divisions of two level-three academic centers. PATIENTS: Twenty-nine male factor patients (38 IVF cycles) showing positive antisperm antibodies on the sperm by immunobead test treated by IVF at the Norfolk program and 56 similar patients (57 cycles) treated by GIFT at the Tygerberg program. Twenty-nine male factor patients (29 IVF cycles) with negative antisperm antibodies screening matched by wife's stimulation protocol and baseline semen analysis characteristics were used as controls in Norfolk; 56 GIFT patients (56 GIFT cycles) matched similarly were the Tygerberg controls. Study and control groups were divided according to sperm morphology pattern in normal, good, and poor prognosis subgroups for comparison. MAIN OUTCOME MEASURES: Fertilization rate of preovulatory oocytes used in IVF in Norfolk and of GIFT supernumerary preovulatory oocytes in Tygerberg; total and term pregnancy rates (PRs) and abortion rates. RESULTS: Fertilization rate was significantly lower in the IVF (41.9% +/- 2.8%) as well as in the GIFT (26.8% +/- 3.8%) (mean +/- SE) study groups than in the respective control groups (73.1% +/- 3.9% and 61.8% +/- 3.9%). Total and term PRs in IVF per cycle (21.1% +/- 6.6%; 13.2% +/- 5.5%) and per transfer (23.5% +/- 7.4%; 14.7% +/- 6.1%), and in GIFT (25.0% +/- 5.8%; 19.6% +/- 5.3%) in the study groups were also lower when compared with their control counterparts (IVF per cycle: 62.1% +/- 6.2% and 41.4% +/- 6.0%; IVF per transfer: 41.9% +/- 2.0% and 27.9% +/- 1.9%; GIFT: 31.6% +/- 6.2% and 28.1% +/- 6.0%), but the difference did not reach statistical significance. Abortion rates were similar in the IVF study group (37.5% +/- 17.1%) and its control groups (39.9% +/- 11.5%). The abortion rate in the GIFT study group was 14.3% +/- 9.4%, and no abortions were recorded in the control group (not significant). CONCLUSIONS: The presence of antisperm antibodies on the sperm surface per se impairs the outcome of assisted reproduction, mainly in terms of fertilization rate of preovulatory oocytes, and possibly in terms of total and term PRs. This holds true regardless of the impact of other semen parameters, particularly the morphology of the sperm within the semen sample.

Abortion, Spontaneous↗