Comparison of unilateral and bilateral tubal transfer in gamete intrafallopian transfer (GIFT)

Gamete intrafallopian, transfer (GIFT) is traditionally performed by delivering gametes into the ampullary region of either one or two fallopian tubes. The choice is made by the surgeon at the time of laparoscopy based upon the patient's anatomy, the number of oocytes available, and clinical judgment. In this nonrandomized, retrospective review, 399 tubal gamete transfers were performed over a period of 18 months, 133 to a single tube and 266 to both tubes. A clinical pregnancy rate of approximately 24% was observed in each modality. The multiple pregnancy rate of 31.3% for one tube was not significantly different from the 25% seen for two tubes. Unilateral tubal transfer offers the distinct advantages of less gamete and tissue handling. This, along with the apparent same outcome parameters, makes unilateral tubal transfer the preferred method of returing gametes at GIFT.Presented at the 7th World Congress on IVF and Assisted Procreation, June 30-July 3, 1991, Paris, France.     

Multiple pregnancies with gamete intrafallopian transfer (GIFT): Complications of a new technique

A complication related to the gamete intrafallopian transfer (GIFT) procedure involving a sextuplet pregnancy is described. Selective reduction of the fetuses to two, with normal delivery at term, was able to be performed. Problems with regard to multiple pregnancy with this procedure are discussed as well as ways to decrease the probability of this occurring.     

Bilateral and unilateral gamete intrafallopian transfer (GIFT) are not equivalent therapies if unilateral GIFT is chosen to avoid one abnormal tube

Purpose The relative effectiveness of bilateral and unilateral gamete intrafallopian transfer (GIFT) was compared. Bilateral GIFT, where possible, was the preferred method of transfer and occurred in 328 patients. One hundred sixty-seven patients undergoing unilateral GIFT were placed into one of seven categories based on the indication for unilateral GIFT. Three categories included patients with either historical or laparoscopic evidence of unilateral tubal abnormalities, two categories included patients without tubal disease, and two categories contained patients in whom the physician could not choose between unilateral or bilateral GIFT.Results Results demonstrate that unilateral GIFT in patients with either historical or laparoscopic evidence of unilateral tubal disease had significantly lower pregnancy and implantation rates than patients undergoing bilateral GIFT or those undergoing unilateral GIFT without evidence of tubal disease (P <0.01). Conclusion The presence of unilateral tubal abnormalities predicts a lower likelihood of pregnancy in patients undergoing unilateral GIFT through the tube presumed to be normal.     

Peripheral blood platelet counts in the management of very early pregnancy failure following gamete intrafallopian transfer

Early pregnancy-associated thrombocytopenia has been described previously in the peripheral blood of in vitro fertilization (IVF) patients and is evaluated here in 26 women undergoing gamete intrafallopian transfer (GIFT). No consistent fall in platelets was seen in ongoing pregnancies. It is suggested that a fall in peripheral blood platelets in the early luteal phase may be observed only in pregnancies where more than one embryo is present.     

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 (<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 putuitary 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.     

Comparison of cycle outcome for gamete intrafallopian transfer alone and in combination with intrauterine embryo transfer

As an alternative to embryo cryopreservation, the efficacy of intrauterine transcervical transfer of a small number of embryos resulting from fertilization of supernumerary oocytes obtained during a GIFT cycle (GIFT-ET) was assessed in this investigation. Data from 72 consecutive GIFT (N =27) and GIFT-ET (N =45) cycles were retrospectively reviewed. Age and infertility diagnoses were similar among the two groups. Clinical pregnancy, ongoing pregnancy, and abortion rates per retrieval were not significantly different between the two groups. We conclude that GIFT-ET offers no advantage over GIFT alone and that cryopreservation of all supernumerary embryos with intrauterine transfer in subsequent cycles would maximize pregnancy rates from a single oocyte aspiration and GIFT procedure. Presented in part at the 47th Annual Meeting of the American Fertility Society, Orlando, Florida, October 21–24, 1991.     

Relationship between the timing of hysterosalpingography before gamete intrafallopian transfer and the subsequent fertility outcome

AIM: To investigate the prognostic significance of hysterosalpingography carried out before one-sided gamete intrafallopian transfer for unexplained infertility. METHODS: Fifty-nine first gamete intrafallopian transfer cycles in 59 couples with unexplained infertility were evaluated in two groups: 30 women with a hysterosalpingogram carried out 1-6 months prior to gamete intrafallopian transfer procedure combined with diagnostic laparoscopy, and 29 women with a hysterosalpingogram carried out during any other interval up to 2 years. The outcome measures were biochemical pregnancy, clinical pregnancy, miscarriage, preterm delivery, and term delivery. Groups were compared using Student's t-test and chi-squared tests. Logistic regression was used to predict the effects of hysterosalpingography on subsequent fertility outcomes. RESULTS: Univariate analysis yielded no significant differences across groups regarding the baseline characteristics and outcome measures. When confounding factors were controlled, carrying out hysterosalpingography at some time before 6 months of gamete intrafallopian transfer was associated with 5.2- and 3.4-fold increased clinical pregnancy and term delivery rates, respectively. CONCLUSIONS: An additional hysterosalpingography at most 6 months prior to gamete intrafallopian transfer procedure might improve fertility prospects. This effect could be attributed to proper selection of the fallopian tube for cannulation during transfer or some therapeutic effect of hysterosalpingography.     

The role of gamete intrafallopian transfer (GIFT) and tubal embryo transfer (TET) in the treatment of patients with patent tubes associated with male infertility factor

Purpose The relative effectiveness of gamete intrafallopian transfer (GIFT) and tubal embryo transfer (TET) combined with superovulation in the treatment of infertile patients with patent tubes were compared. Four hundred fifty consecutive cycles were divided into two periods. During the first period (216 cycles), the only technique employed was GIFT, couples being divided into two groups: group A, couples with normospermic partners (118 cycles); and group B, couples with male infertility factor (98 cycles). During the second period (234 cycles), 140 cycles of GIFT were performed in couples with normospermic partners (group C). TET was utilized in 94 cycles (group D), in the case of couples with male infertility factor.Results Results demonstrate that the pregnancy rate with GIFT in the case of oligoasthenospermic partners (group B) is significantly lower than that of normospermic partners (groups A and C) (P = 0.0001) and than that with TET in the case of oligoasthenospermic partners (group D) (P = 0.0001).Conclusion The implantation rate is also significantly different between these groups (B vs A, P =0.0001; B vs C, P =0.0001; B vs D, P =0.01).     

双侧输卵管同时妊娠1例及文献复习

目的:探讨临床罕见病例——双侧输卵管妊娠的诊断及治疗方法。方法:通过病例报道和相关文献复习,对双侧输卵管妊娠的病因、诊断及治疗作一分析。结果:双侧输卵管妊娠发生率较低,容易漏诊,对患者造成不良影响甚大,早期诊断和治疗尤为重要。结论:辅助生殖技术(ART)为不孕症患者带来福音的同时,在一定程度上增加了异位妊娠(EP)的发生率,尤其是某些特殊类型的EP。对于可疑患者,超声和手术应仔细探查双侧附件的情况,以便早期发现和治疗。     

A mobile oocyte incubation unit (MOIU): A device for improvement of the gamete intrafallopian transfer (GIFT) program

Forty couples with infertility due to various causes were selected for the gamete intrafallopian transfer (GIFT) program at our hospital. When the first 21 couples (Group A) had been treated in the program, the rate of pregnancy achieved was 23.8%, which did not seem satisfactory. This might have been caused by the distance between the embryo laboratory and the operating room. To eliminate this defect, a Mobile Oocyte Incubation Unit (MOIU) was designed. This is actually a compact laboratory that can be placed in the operating room. After the MOIU was utilized, the rate of pregnancy for the following 19 couples (Group B) increased to 42.1%. The MOIU has helped improved the performance of the GIFT program by increasing the stability of the pH value of the culture medium (Chetkowski R,et al.: J Vitro Fert Embryo Transfer 1985;2:207), lessening the exposure of the gametes to air and room temperature, and most importantly, shortening the time required for a GIFT procedure from 45–100 to 15–30 min. We expect that the MOIU will eventually become an integral part of the standard equipment for the GIFT program and make the program more successful and reliable in the treatment of infertility.     

Bilateral tubal pregnancies after a single‐embryo transfer

Case

To present an extremely rare case of bilateral tubal pregnancies following a single‐embryo transfer in a woman with a 4 year history of infertility prior to seeking assisted reproductive technology.

Outcome

A pregnancy resulted from the transfer of an embryo that had been thawed from a frozen blastocyst during a hormone replacement cycle. An ultrasound that was performed at 5 weeks and 5 days of gestation revealed a gestational sac, embryo, and heartbeat in the right fallopian tube and similar signs of a gestational sac in the left fallopian tube. A laparoscopy revealed clear signs of an ectopic pregnancy in the ampulla of the right fallopian tube. Signs of swelling also were seen in the ampulla of the left fallopian tube. As the possibility of bilateral tubal pregnancies could not be ruled out, both fallopian tubes were removed. Pathological tests revealed chorionic villi and trophoblasts in both the left and right fallopian tubes.

Conclusion

All previously reported cases of bilateral tubal pregnancies have been a result of multiple ovulations or multiple‐embryo transfer and no case of bilateral tubal pregnancies after a single‐embryo transfer has ever been reported. No genetic testing was performed; thus, it cannot be definitively stated that the divided chorionic villi and trophoblasts came from only one embryo.     

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.     

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.     

Fallopian replacement of eggs with delayed intrauterine insemination (FREDI): An alternative to gamete intrafallopian transfer (GIFT)

This report contains details of what is the first group of patients with nontubal infertility to undergo fallopian replacement of eggs with delayed intrauterine insemination (FREDI). Twenty-three patients suffering from idiopathic or immune infertility, polycystic ovarian disease (PCOD), or mild endometriosis underwent follicular stimulation with human menopausal gonadotropin and/or pure follicle-stimulating hormone plus human chorionic gonadotropin prior to laparoscopic pickup of eggs of varying maturity. Eggs without spermatozoa were transferred at the time of laparoscopy. Subsequent high intrauterine insemination (IUI) of washed spermatozoa at a time when egg maturation within the tubes was judged to be complete enabled a cohort of fully capacitated spermatozoa to meet fully mature eggs in a totally physiological manner. Eight clinical pregnancies arose from this group, one healthy, male infant has been delivered, and four pregnancies remain ongoing. Although based on a small population of patients, it does seem that in vivo egg maturation following replacement in the fallopian tube is an effective alternative to in vitro maturation and, with the increased control over timing of egg insemination, leads us to propose FREDI as a flexible new therapeutic approach for the treatment of nontubal infertility.     

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.     

Direct gamete uterine transfer in patients with tubal absence or occlusion

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.     

Gamete intrafallopian transfer and plasma chorionic gonadotropin dynamics: Evidence of a delayed appearance

The purpose of this study was to compare early human chorionic gonadotropin secretion in two groups of pregnancies. These pregnancies were obtained, in one group, during a natural cycle, while, in the other group, they resulted from gamete intrafallopian transfers performed in hyperstimulated cycles. A logarithmic regression analysis was chosen to allow statistical comparison of serial plasmatic evaluation as hormone determinations were obtained, among patients, at different postovulatory days. The regression lines of the two groups of patients presented similar slopes. The unpairedt test performed on calculated data for 3 different days constantly revealed significantly higher levels (P<0.005) of natural vs stimulated cycles; thus a different origin on thex axis (days of the luteal phase) is deduced. These findings support the possibility of a delay in the appearance of human chorionic hormone in the patients undergoing gamete intrafallopian transfer technique.     

A self-programmable in vitro fertilization/gamete intrafallopian transfer patient database management system for MacIntosh Computers

Purpose Our purpose was to develop a data processing system for a large in Vitro Fertilization/Gamete Intrafallopian Transfer (IVF/GIFT) practice which would (1) require minimal data entry time, (2) be easy to operate, (3) be simple to construct (no knowledge of procedural language or programming necessary), and (4) quickly collate and reduce data.Results A database management system was successfully constructed on an Apple MacIntosh computer which met the above criteria. The key elements of this database were its user-friendly features (MacIntosh-based system), adaptability (user was constantly able to update and revise the program as informational needs changed), and ability to perform complex searches and data analyses imposed by the individual operators.Conclusions The software and hardware described in this report were found to be highly effective in meeting the ever-changing administrative and clinical needs of our IVF/GIFT program.     

Factors associated with improving success rates with gamete intrafallopian transfer under thin-needle spinal anesthesia

Purpose In order to reduce the risk of major anesthetic complications associated with laparoscopic gamete intrafallopian transfer procedures, we have exclusively used thin-needle spinal anesthesia over the years 1991–1994. This paper will review complication rates in order to further establish the safety profile of GIFT under thin-needle anesthesia and report the changes in our GIFT protocol from 1991 to 1994 which have been associated with a statistical improvement in the implantation rate from 11% to 23% (P=0.01) and an increase in delivery rates from 29% to 42% per transfer procedure.Methods Sixty-eight laparoscopic GIFT procedures were done in women with at least one patent oviduct and failure to respond to less. invasive treatment. Clinical variables were analyzed to determine if similar patient populations had been treated over the study period.Results The improved delivery rates and implantation rates could not be explained by patient selection. No major perioperative complications occurred. Minor perioperative complications and difficulties included one patient requiring general anesthesia, one patient developing a spinal headache which could be managed conservatively at home, and one patient requiring a minilaparotomy to complete the GIFT procedure. The more serious complications occurred as a result of the superovulation and multiple oocyte transfer rather than the surgical or anesthetic technique. These included two patients with severe ovarian hyperstimulation requiring hospitalization, and five delivered triplet pregnancies. Factors associated with improving success rates included improvements in semen and equipment preparation as well as an increase in the number of sperm transferred from 200,000 to 500,000.Conclusions GIFT can be performed with relative safety under thin needle spinal anesthesia with high implantation and delivery rates if care is made to optimize sperm and equipment preparation. GIFT under thin-needle spinal anesthesia may be an attractive alternative for treatment of longstanding nontubal infertility in couples willing to take the risk of ovarian hyperstimulation and multiple pregnancy.Presented at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, April 3–7, 1995, Vienna, Austria.