Gamete intrafallopian transfer (GIFT) as a complement to the tubal microsurgery

We accomplished a transfer of at least one oocyte and sperms in 26 microsurgically operated patients. Two patients were stimulated by clomiphene citrate only, 24 women by a combination of a clomiphene citrate and human menopausal gonadotrophin. The operation was timed 34-36 hours after application of 6,000 IU hCG i.m. After finishing the surgery we transferred maximally two oocytes and 200,000 sperms to each patent tube. Using this procedure three pregnancies occurred (11.5%). However, there was one ongoing pregnancy only. The extrauterine pregnancy was successfully treated with methotrexat and the third pregnancy was biochemical. The number of clinical pregnancies in this modification doesn't reach the referred success rate of a standard gamete intrafallopian transfer.     

Pregnancy after gamete intrafallopian transfer in a woman with primary infertility and in utero exposure to diethylstilbestrol. A case report

In utero exposure to diethylstilbestrol (DES) has an adverse effect on reproductive performance and may be associated with infertility. Gamete intrafallopian transfer (GIFT) is a new reproductive technique that has been advocated as an alternative to in vitro fertilization in women with at least one normally functioning fallopian tube. The process involves the translaparoscopic placement of oocytes and sperm into the fallopian tube. The technique has been successful in treating infertility due to endometriosis, male factors and immunologic factors as well as unexplained infertility. We accomplished the first successful GIFT procedure in a woman with significant uterine effects from prenatal DES exposure. This technique may prove to be an effective treatment for infertile women with DES exposure who have no adequate explanation for their infertility.     

Gamete intrafallopian transfer: different routes of transfer

The Authors report their own experience and results using different approaches to oocyte pick-up and gamete transfer for gamete intrafallopian transfer (GIFT). The overall pregnancy rate of GIFT is 35.86% (66 pregnancies on 184 cases of GIFT). The Protocol I (Laparoscopic oocyte retrieval and gamete transfer) is presently the more used and gives better clinical results (pregnancy rate of 37.7%); in the Author's opinion, the protocols III (echographic pick-up + IVF + laparoscopic delayed zygote intrafallopian transfer (ZIFT), and VII (Laparotomic pick-up and transfer) are interesting complementary techniques for GIFT.     

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.     

Culdoscopic gamete tubal transfer: a new approach to gamete intrafallopian tubal transfer.

Twelve infertile couples who failed to conceive by previous infertility treatments and who qualified for culdoscopy had oocyte retrieval and gamete transfer through an operative culdoscopy method. Six patients achieved clinical pregnancy. Five are ongoing pregnancies, and one patient miscarried. There were no complications of the procedures.     

Contralateral tubal pregnancy after gamete intrafallopian transfer.

A case of EP after GIFT into the contralateral tube is presented. Hydrotubation with Earle's medium immediately before the GIFT cannot be excluded as a possible cause of gamete migration. The complete demise of the CL also demonstrates that trophoblast can implant and develop without steroidal support.     

Gamete intrafallopian transfer in women who had ectopic pregnancy previously.

Eighty-seven women who had previously had ectopic pregnancy underwent 111 gamete intrafallopian transfers (GIFT). Forty-one women had moderate or severe pelvic adhesions, eight had mild pelvic adhesions, and 18 had had the fallopian tubes surgically repaired. The remaining 20 women had no obvious pelvic abnormality except for the absence of one fallopian tube. After stimulation of superovulation, between two and 22 oocytes were retrieved and two to four were transferred into the fallopian tubes after careful assessment of their condition. Twenty-eight pregnancies were achieved (25.2% per cycle), with 23 live births (20.7% per cycle), four abortions (14.3% of all pregnancies), and one ectopic pregnancy (3.6% of all pregnancies, 0.9% per cycle). This experience shows that GIFT can safely produce a reasonable pregnancy rate in carefully selected women who have had ectopic pregnancy.     

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.     

Gamete intrafallopian transfer as treatment for infertility associated with endometriosis

Forty-six patients with endometriosis-associated infertility underwent 59 GIFT cycles. The pregnancy rate per cycle was 30.5%. The presence of endometriomas in 11 patients did not affect this rate adversely. We conclude that, provided at least one fallopian tube is patent, GIFT compensates effectively for the possible causes of infertility in these patients.     

Pregnancy following gamete intrafallopian transfer: A case report

Conclusion Although more data are needed and it is still too early for a definitive conclusion, GIFT can probably offer new perspectives not only in the treatment of unexplained infertility but also in cases of persistent infertility in patients with LUF (luteinzed unruptured follicle) or a mild degree of endometriosis or when no conception occurs after surgical correction of endometriosis.Only further prospective studies will help us to determine the indications for GIFT.     

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.     

Complete hydatidiform mole coexisting with a live fetus after gamete intrafallopian transfer. A case report

BACKGROUND: Molar pregnancy with a coexisting live fetus is a rare occurrence. We report the only known case with a surviving coexistent fetus after gamete intrafallopian transfer (GIFT). CASE: After GIFT, a 28-year-old primary infertility patient was diagnosed as having a complete hydatidiform mole coexisting with a live fetus at 13 weeks of gestation. At 36 weeks of gestation, a cesarean section was performed due to elevated serum human chorionic gonadotropin (hCG) levels, and a male infant with a normal appearance and weighing 2,688 g was delivered. CONCLUSION: If the patient desires to try to carry the fetus to viability after counseling on the possible associated risks of malignancy, it is possible to achieve fetal viability if (1) there is decline in the serum hCG level after it peaks before the second trimester, (2) ultrasound reveals degeneration of the molar part, and (3) there are no complications of pregnancy.     

Gamete intrafallopian transfer vs superovulation with intrauterine insemination for the treatment of infertility

Superovulation with intrauterine insemination (SO-IUI) has been suggested as an alternative to gamete intrafallopian transfer (GIFT), despite the absence of controlled or comparative trials. We retrospectively analyzed all GIFT and SO-IUI cycles performed concurrently from January 1985 to August of 1987 at a single university center. Pregnancy rates were significantly better for GIFT than SO-IUI (P<0.001), with an odds ratio of 3.25 (P=0.001). Stepwise multiple logistic regression identifield factors that correlate with pregnancy: absence of endometriosis (P=0.05), infertility<3 years' duration (P=0.002), TMS 30×10⁶ (P=0.005), and treatment with GIFT rather than SO-IUI (P=0.001). These data give a first approximation of the increased efficacy of GIFT versus SO-IUI and provide valuable insight into significant confounding variables to be considered when planning a randomized, prospective trial to evaluate these techniques.