Eighty consecutive cases of gamete intra-fallopian transfer

Efficacy of treatment for unexplained infertility

OBJECTIVE

To analyze the efficacy and cost-effectiveness of alternative treatments for unexplained infertility.

DESIGN

Retrospective analysis of 45 published reports.

SETTING

Clinical practices.

PATIENT(S)

Couples who met criteria for unexplained infertility. Women with Stage I or Stage II endometriosis were included.

INTERVENTION(S)

Observation; clomiphene citrate (CC); gonadotropins (hMG); IUI; and GIFT and IVF.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy rate.

RESULT(S)

Combined pregnancy rates per initiated cycle, adjusted for study quality, were as follows: no treatment = 1.3%-4.1%; IUI = 3.8%; CC = 5.6%; CC + IUI = 8.3%; hMG = 7.7%; hMG + IUI = 17.1%; IVF = 20.7%; GIFT = 27.0%. The estimated cost per pregnancy was $10,000 for CC + IUI, $17,000 for hMG + IUI, and $50,000 for IVF.

CONCLUSION(S)

Clomiphene citrate + IUI is a cost-effective treatment for unexplained infertility. If this treatment fails, hMG + IUI and assisted reproduction are efficacious therapeutic options.

Cost-effectiveness of gamete intrafallopian transfer in comparison with induction of ovulation with gonadotropins in the treatment of female infertility: a clinical trial

OBJECTIVE

To compare the cost-effectiveness of gamete intrafallopian transfer (GIFT) with that of conventional infertility treatment in couples with female infertility, excluding tubal factors.

DESIGN

Patients were randomly divided in two groups: receiving GIFT or conventional infertility treatment. For a period of 2 years, GIFT was compared with conventional infertility treatment in couples with endometriosis, anovulation, idiopathic infertility, cervical mucus factor, female immunologic factor, or multifactorial causes of infertility in a randomized clinical trial.

SETTING

The study was performed in the Unit for Human Reproduction, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa.

PATIENTS

One hundred seventy-four successive couples with female infertility were selected for the study. All couples were from the higher socioeconomic bracket.

INTERVENTIONS

One group received GIFT and the other received conventional infertility treatment consisting of induction of ovulation with gonadotropins followed by intrauterine artificial insemination or normal intercourse.

MAIN OUTCOME MEASURES

The results were stratified according to the specific cause of infertility. Outcome was measured by the success rate per treatment cycle, as well as the cost per pregnancy.

RESULTS

Overall, GIFT proved to be successful in 26.7% of treatment cycles compared with 9.7% with conventional therapy.

CONCLUSIONS

After careful analysis, the authors came to the conclusion that GIFT is more cost-effective than conventional infertility treatment in patients with endometriosis and anovulation. In patients with idiopathic infertility, immunologic infertility, a cervical mucus factor, and multifactorial infertility, induction of ovulation followed by intrauterine artificial insemination or normal intercourse proved to be more cost-effective.

Selective reduction after gamete intrafallopian transfer

Selective reduction was performed in a patient with triplet pregnancy in the 9th week of gestation. Selective reduction of the fetuses to two was performed by puncture using vaginal ultrasound probe. No complications occurred and the patient was delivered of healthy twins.

A within-patient comparison between superovulation with intra-uterine artificial insemination using husband's washed spermatozoa and gamete intrafallopian transfer in unexplained infertility

The purpose of this study was to evaluate the success of gamete intrafallopian transfer (GIFT) and superovulation with intra-uterine artificial insemination (S-IUI) in couples with long-term unexplained infertility. Thirty-nine couples were offered three attempts at each treatment. Sixty-three IUI cycles were completed with a pregnancy rate of 1.5% per cycle. Forty-nine GIFT procedures were carried out with a pregnancy rate of 26.5% per cycle. The cumulative conception rate after three cycles of GIFT was 0.56. GIFT appears to offer a far greater chance of pregnancy than S-IUI in unexplained infertility.

Fertilization of supernumerary oocytes following gamete intrafallopian transfer (GIFT): correlation with outcome of GIFT treatment

In the course of 280 consecutive gamete intrafallopian transfer (GIFT) attempts, supernumerary oocytes in excess of those transferred were inseminated in vitro. Pregnancy resulted in 31.1% of patients following the GIFT treatment. The overall in vitro fertilization (IVF) rate of supernumerary oocytes was significantly higher in those who became pregnant (41.2%) than in patients who did not (34.9%). However, the failure to fertilize any supernumerary oocytes was not significantly different between those becoming pregnant (27.6%) and those in whom the treatment failed (37.3%). Failure to fertilize any supernumerary oocytes in vitro was of a higher rate if suboptimal sperm preparation was used or if only one oocyte was left over for in vitro insemination following the GIFT treatment. We concluded that the in vitro fertilization rate was higher in the pregnant group, but the total failure to fertilize or the fertilization of any supernumerary oocytes does not predict the outcome of GIFT. Embryos resulting following fertilization of excess oocytes may be cryopreserved for subsequent use.

The importance of egg and sperm factors in predicting the likelihood of pregnancy from gamete intrafallopian transfer

The relative contribution of factors affecting the probability of pregnancy from gamete intrafallopian transfer was estimated using data from 218 cycles performed in San Antonio, Texas, and Orange, California. Mature eggs, all of which contained an expanded cumulus, were subclassified according to the corona radiata; those with a starburst corona were considered the most fully mature. Sixty-two clinical pregnancies were established, representing a pregnancy rate of 28.4%. Excluding 49 cases of male factor infertility, the pregnancy rate was 34.9%. Pregnancy rates were not significantly different according to age, cause of female factor infertility, parity, duration of infertility, stimulation protocol, or estradiol level. The only variables having a strong association with pregnancy were sperm and egg parameters. Sperm motility and morphology were statistically more important than sperm density. Based on odds ratios calculated from multiple logistic analysis, pregnancy was 3.80 times more likely if three or more fully mature eggs were transferred, 0.34 times as likely if motility were less than or equal to 30%, and 0.22 times as likely if normal morphology was less than or equal to 50%, controlling for other egg and sperm factors. If all egg and sperm factors in a given cycle were unfavorable, the probability of pregnancy estimated by the logistic model was 4%, whereas if all were favorable the probability of pregnancy in that cycle was 59%.

Gamete intrafallopian transfer: the effect of the number of eggs used and the depth of gamete placement on pregnancy initiation

The role of the fallopian tube in initiating pregnancy was examined in 246 consecutive gamete intrafallopian transfer (GIFT) cycles. Before actual transfer, the ampulla of each tube was measured to determine the depth at which gametes could be placed. Fifty-seven transfers were made with four oocytes into a single tube; of these, when gametes were deposited deeper than 4 cm, the pregnancy rate was higher than when they were placed at between 3 to 4 cm (69.6% compared with 41.2%). Presumably, a deeper placement is more secure and decreases the likelihood of gamete displacement. The pregnancy rate also rose with the number of oocytes used: from 0% with a single oocyte to 42.9% with four oocytes.