Gamete intrafallopian tube transfer (GIFT): making laparoscopy more than "diagnostic"

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.

In vitro fertilization program based on programmed cycles monitored by ultrasound only

OBJECTIVE

Programmed oocyte retrieval was performed in order to make the in vitro fertilization (IVF) program cheaper and work of the IVF team easier.

METHOD

In a group of 77 patients included in the IVF program, the menstrual cycle was modified with estrogen-progesterone contraceptive pills. For this reason, it was possible to start the stimulation protocol in all patients on the same day. The stimulation protocol was a combination of clomiphene (100 mg) for 5 days and HMG (150 IU) every other day. Cycles were monitored by ultrasound only.

RESULT

The implantation rate per embryo transfer was 22.4%. The number of embryos per embryo transfer was low (2.6 +/- 1.4) and eliminated the need for cryopreservation. Fertilization rate (82%) and embryo transfer rate (87%) were high. The take home baby rate was 14.3%.

CONCLUSION

Seventy percent of all punctures were performed in 3 days in the middle of the week. In our conditions, programmed oocyte retrieval is associated with significant economic benefits.

Comparison between swim-up and glass wool column filtration of human semen in a gamete intrafallopian transfer program

This study compared swim-up and glass wool filtration in both pregnancy outcome and fertilization of excess oocytes in patients undergoing gamete intrafallopian transfer. Gamete intrafallopian transfer patients were retrospectively included in the study group (n = 52). The criteria for inclusion were as follows: Semen had to have been prepared by means of glass wool filtration and at least 2 metaphase II oocytes had to have been transferred. Each patient from this group was then carefully matched with another patient according to specific criteria (number of metaphase II oocytes aspirated and transferred, normal sperm morphology, wife's age, the absence of anti-sperm antibodies, semen preparation by means of the swim-up procedure). Fourteen patients were matched with themselves (groups A1 and A2) and 38 patients were matched with another patient (groups B and C). The results indicate that there was no significant difference in the fertilization and pregnancy probabilities of sperm prepared by means of glass wool filtration or swim-up procedure. The comparative pregnancy rates for the groups were A1 (7.1%) versus A2 (7.1%) and B (28.9%) versus C (31.6%). Factors other than fertilization and pregnancy potential may have a greater influence on choosing the optimum sperm preparation procedure.

Utility of in vitro fertilization at diagnostic laparoscopy

OBJECTIVE

To compare stimulation and outcome variables for IVF in stimulated cycles when ova are retrieved during diagnostic infertility laparoscopy versus transvaginal ultrasound (US) directed retrieval and to investigate the presence of unexpected failed fertilization in the diagnostic laparoscopy group, which allows an opportunity to diagnosis an etiology of infertility based on gamete interaction.

DESIGN

Consecutive patients who needed infertility diagnostic laparoscopy and agreed to combination with IVF were compared with concurrent patients undergoing transvaginal US IVF. Male factor screening parameters (semen analysis, sperm penetrating assay) and resultant fertilization were analyzed for these patients.

SETTING

The George Washington University Hospital, a tertiary referral center offering assisted reproductive technologies. Patients for diagnostic laparoscopy combined with IVF were enrolled in the Program of Oocyte Retrieval at Diagnostic Laparoscopy (PORDL).

PARTICIPANTS

One hundred twenty-four women enrolled for diagnostic laparoscopy combined with IVF; 237 women were concurrently enrolled for transvaginal US IVF.

RESULTS

Response variables (number of follicles, days of monitoring, ampules of hMG, maximum E2) between the two groups were similar. Outcome variables (ova retrieved, ova fertilized, ova cleaved, clinical pregnancy rate per embryo transferred) were similar despite a significantly higher number of embryos transferred for the transvaginal US group. The clinical pregnancy rate per cycle was similar, 26% versus 28% for the women in the transvaginal US versus those women in the PORDL group, as was the clinical pregnancy rate per ET, 31% versus 34%, respectively. The number of fertilized ova for each group was not significantly different: 5.5 +/- 0.3 for the transvaginal group versus 4.8 +/- 0.4 for the PORDL group. Patients in the PORDL group with a known male factor (group B) had a lower fertilization rate than those with no male factor (group A). Within the group A with no detectable male factor prospectively, 17.2% had unexpectedly poor fertilization (group A1), whereas the rest of the group A patients had higher fertilization rates as was expected (group A2). The clinical pregnancy rate per ET for group A1 was 0% compared with 43.4% for the group A2 patients.

CONCLUSIONS

In vitro fertilization can be successfully performed during diagnostic laparoscopy yielding comparable results to transvaginal ultrasound IVF while gaining diagnostic information concerning sperm-ova interaction (i.e., fertilization).

Successful gamete intrafallopian transfer (GIFT) in the porcine

Gamete intrafallopian transfer (GIFT) was successfully established in the pig. In Experiment 1 (6 replicates) 234 oocytes (39 +/- 5.5 per recipient) plus spermatozoa (4000 to 8000 per oocyte) were transferred bilaterally into the oviducts of synchronized gilts, and embryos were recovered 48 h thereafter. The recovery rate was 50.4% and 50% of the recovered oocytes were fertilized. A total of 55 embryos was cultured in vitro in NCSU-medium for 48 h and 63.6% developed to morula or blastocyst stages. In Experiment 2 (5 replicates) 220 oocytes (44 +/- 4.9 per recipient) plus spermatozoa (4000 per oocyte) were transferred to 5 recipients which were allowed to go to term. Three gilts delivered 16 (n = 3, 5, 8) piglets. In Experiment 3 (5 replicates) 183 oocytes (36.6 +/- 1.2 per recipient) plus flow cytometry gender sorted spermatozoa (4000 per oocyte) were transferred to 5 recipients. The recovery rate was 47.8%, and 27.6% of the oocytes were fertilized. From all cleaved oocytes 45.8% developed to expanded blastocysts, with the number of blastomeres varying from 20 to 85 (38.3 +/- 22.5). These results indicate that the GIFT procedure can be used successfully in pigs, and can be a valuable tool for the study of gamete interaction as well as in the continued development of biotechnological procedures such as sex pre-determination.