Tubal embryo transfer as a treatment for infertility due to male factor

In vitro fertilization in Japan - early days of in vitro fertilization and embryo transfer and future prospects for assisted reproductive technology

Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and embryo transfer (ET) has been essential in the treatment of infertility. The world's first IVF-ET baby was born in 1978 based on the technique developed by Dr. Robert Edwards and Dr. Patrick Steptoe. In Japan, the first IVF-ET birth was reported in 1983 by Prof. Masakuni Suzuki at Tohoku University School of Medicine. IVF-ET is a procedure used to achieve pregnancy that consists of extracting oocytes from an infertile woman, fertilizing them in vitro, and transferring fertilized eggs into the patient's uterine cavity (Fig. 1). Since the first report of successful IVF-ET, numerous techniques related to ART, such as cryopreservation of oocytes and embryos, gamete intrafallopian transfer (GIFT), and microinsemination, have been developed and refined (Table 1). Herein we describe the history of basic research in IVF-ET that led to human applications, how the birth of the first IVF-ET baby was achieved in Japan, the current status of ART in Japan, issues related to ART, and future prospects for ART.

Successful tubal blastocyst transfer after laparoscopic cervical cerclage: cesarean delivery of a live very low-birth-weight infant and later hysterectomy for uterine rupture

OBJECTIVE

To report the management of a woman who presented with secondary infertility and amenorrhea after 2 Lletz procedures and a cone biopsy and who had cervical stenosis, a foreshortened cervix, and hematometra.

DESIGN

Case report.

SETTING

Fertility clinic and tertiary hospital.

PATIENT(S)

A 34-year-old woman who wanted further children but had had a previous cesarean delivery and then a cone biopsy for cervical intraepithelial neoplasia III that resulted in a foreshortened cervix and cervical obstruction.

INTERVENTION(S)

Laparoscopic cervical cerclage, IVF, blastocyst tubal transfer, cesarean delivery, hysterectomy.

MAIN OUTCOME MEASURE(S)

Pregnancy; morbidity for the woman and her infant.

RESULT(S)

An intrauterine pregnancy occurred after blastocyst intrafallopian transfer, but there was uterine herniation necessitating premature delivery of a very low-birth-weight infant that had lung problems but is now healthy. The mother later developed a hematometra that ruptured, requiring an emergency hysterectomy from which her recovery was protracted.

CONCLUSION(S)

This first report of a blastocyst intrafallopian transfer was associated with an intrauterine pregnancy; however, when the indication for blastocyst tubal transfer of an obstructed cervix is associated with a foreshortened cervix requiring cervical cerclage, there can be major health risks for infant and mother.

Assisted reproductive technologies do not alter mutation frequency or spectrum

Assisted reproductive technologies (ARTs) have now contributed to the birth of >3 million babies worldwide, but concerns remain regarding the safety of these methods. We have used a transgenic mouse model to examine the effects of ARTs on the frequency and spectrum of point mutations in midgestation mouse fetuses produced by either natural reproduction or various methods of ART, including preimplantation culture, embryo transfer, in vitro fertilization, intracytoplasmic sperm injection, and round spermatid injection. Our results show that there is no significant difference in the frequency or spectrum of de novo point mutations found in naturally conceived fetuses and fetuses produced by in vitro fertilization, intracytoplasmic sperm injection, or round spermatid injection. These results, based on analyses of a transgenic mouse system, indicate that with respect to maintenance of genetic integrity, ARTs appear to be safe.

Is tubal embryo transfer of any value? A meta-analysis and comparison with the Society for Assisted Reproductive Technology database

OBJECTIVE

To analyze published randomized trials of ZIFT and ET via meta-analysis and compare the results with those of the Society for Assisted Reproductive Technology database.

DESIGN

Meta-analysis and comparison to SART data sets for 1991-1996.

SETTING

University medical center.

PATIENT(S)

Patients from the literature with infertility, randomized to either tubal or uterine embryo transfer.

INTERVENTION(S)

All published articles in English were identified using an electronic database spanning January 1966 to December 1998 by keyword and text word searches, supplemented with a hand search through the references of original studies, review articles, and conference abstracts to identify randomized trials comparing ZIFT and IVF-ET. Additional data was obtained through correspondence with authors.

MAIN OUTCOME MEASURE(S)

Implantation and clinical pregnancy rates were compared. Ectopic pregnancy rate was a secondary outcome measure.

RESULT(S)

Six randomized controlled trials including 548 cycles, 514 retrievals, and 388 transfers were reviewed. Demographic and stimulation and transfer details were comparable between the groups. Implantation and pregnancy rates did not differ significantly, and there was a trend toward increased risk of ectopic pregnancy with ZIFT.

CONCLUSION(S)

Published randomized trials suggest that there is no difference in implantation and pregnancy rates between women undergoing ZIFT and IVF-ET.

Vaginal bleeding and early pregnancy outcome in an infertile population

OBJECTIVE

Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding.

STUDY DESIGN

This was a cohort study of pregnancies obtained using either assisted reproductive technology (ART) or routine infertility treatment (RIT). Two hundred twenty-eight pregnant women were divided into two groups based on the presence or absence of vaginal bleeding. Successive measurements of beta-hCG levels were obtained every 2 days, starting on day 14 after ovulation or embryo transfer. All pregnancies underwent weekly transvaginal ultrasound (UTZ) examinations beginning on day 21. The occurrence of vaginal bleeding was monitored weekly.

RESULTS

Seventy of the 228 patients (31%) had bleeding in early pregnancy, resulting in 31 (44%) pregnancy losses. Only 22 pregnancy losses (14%) were observed in 158 patients who did not have bleeding (P < 0.001). The abortion rate for the bleeding versus nonbleeding groups was 35 and 9%, respectively (P < 0.001). Vaginal bleeding was associated with a higher abortion rate in pregnancies following RIT than ART (51 vs 8%; P < 0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleeding was also associated with a higher abortion rate than that in the nonbleeding group (17 vs 4%; P < 0.001). However this higher incidence was observed only in pregnancies following RIT, not ART (28 vs 5%; P < 0.001).

CONCLUSIONS

Although bleeding significantly decreased the chance of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. However, the predictive value of fetal cardiac activity was reduced in the presence of vaginal bleeding in an infertile population treated with RIT.

Comparison between nafarelin and leuprolide acetate for in vitro fertilization: preliminary clinical study

OBJECTIVE

To evaluate the clinical effect of two different biochemical GnRH agonists (GnRH-a), nafarelin acetate and leuprolide acetate (LA), as adjunct to induction of ovulation in patients for IVF.

DESIGN

Twenty-four women were assigned randomly to either nafarelin acetate or LA during IVF cycles.

SETTING

University-affiliated clinics.

PATIENTS

Infertile women undergoing IVF cycles in an academic research environment.

INTERVENTIONS

Intranasal nafarelin at a dosage of 200 micrograms twice daily or LA at a dose of 1 mg/d SC was administered. Blood samples were collected on day 21 of previous cycle, days 2 and 8, and before hCG injection.

MAIN OUTCOME MEASURE

Patient response as indicated by follicular phase serum levels of E2, FSH, and LH.

RESULTS

Hormone profiles on cycle day 2 showed no statistical difference between both GnRH-a groups in FSH levels and a slight statistical difference for E2 levels. Patient response as demonstrated by follicular phase of E2, FSH, and LH measured on cycle day 8 and the day of hCG injection showed no statistically significant difference in both groups. Furthermore, the mean number of follicles, eggs retrieved, egg quality, fertilization rate, and number of embryos transferred and frozen were similar. The cycle cancellation rate and pregnancy rate per stimulation start were also not statistically different between the two groups.

CONCLUSION

The study shows the comparable efficacy of these two drugs in controlled ovarian hyperstimulation (COH) protocols. The easy administration of nafarelin with prompt nasal absorption and the readily achieved blood level made nafarelin an option for use in COH in assisted reproductive technology.

Prospective randomized comparison of human chorionic gonadotropin versus intramuscular progesterone for luteal-phase support in assisted reproduction

OBJECTIVE

The purpose of the study was to determine the impact of two forms of luteal-phase supplementation, human chorionic gonadotropin (hCG) and progesterone (P), during gonadotropin releasing hormone agonist (GnRh-a)/controlled ovarian hyperstimulation (COH) cycles.

DESIGN AND PATIENTS

The study was a prospective, randomized evaluation of 77 patients. Group 1 patients (n = 38) received 2000 IU of hCG, injected subcutaneously, on days 3, 6, 9, and 12 after transvaginal aspiration of the oocytes (TVA = day 0). Group 2 patients (n = 39) received 50-mg daily injections of intramuscular (i.m.) P from days 2 to 14 after TVA. Blood tests were performed on days 0, 5, 8, and 12 after TVA.

SETTING

The in vitro fertilization program of a tertiary care institution was the study setting.

MAIN OUTCOME MEASURES

The main outcome measures were (1) pregnancy and implantation rates; (2) serum estradiol (E), P, and hCG levels; and (3) occurrence of side effects.

RESULTS

Clinical pregnancy and implantation rates in group 1 versus group 2 were similar (36.7 vs 35.3 and 12 vs 14%, respectively). Regardless of pregnancy occurrence, on days 8 and 12 after TVA, serum E and P levels were higher in group 1 than group 2 but the resulting E/P ratios were similar. Five of 38 patients (group 1) developed moderate to severe ovarian hyperstimulation syndrome (OHSS) right after the first or second supplementary hCG injection. In these patients, the mean serum E level on the day of hCG trigger injection was about 3250 pg/ml and the number of follicles was between 9 and 17. In 6 of 39 patients (group 2) allergic reactions were observed at the P injection sites.

CONCLUSIONS

Based on our data, hCG administration as a form of luteal supplementation did not translate, in comparison to P, into significant benefits for the patients. At the same time, it significantly increased the risk of ovarian hyperstimulation. We suggest that whenever, during COH cycles, serum E levels are over 2500 pg/ml and the number of follicles exceeds 10, luteal support with hCG should be excluded.

Gamete intrafallopian transfer: ethical considerations, historical development of the procedure, and comparison with other advanced reproductive technologies

OBJECTIVE

To report on ethical considerations regarding GIFT as well as the developmental history of the procedure and to review the literature and compare it with other advanced reproductive technologies (ARTs).

DESIGN

Indications, patient screening, recent evaluations, methods of ovarian hyperstimulation and oocyte retrieval-assessment, gamete transfer and pregnancy outcome are discussed in this review. A comparison of GIFT with other ARTs is also attempted.

MAIN OUTCOME MEASURES

Gamete intrafallopian transfer pregnancy determination and outcome.

CONCLUSIONS

Gamete intrafallopian transfer is an ethically acceptable procedure by different religious groups. In a selected group of patients, GIFT is an acceptable and, in some occasions, a preferable procedure to other ARTs.

Transcervical tubal cannulation, past, present, and future

OBJECTIVE

To evaluate publications that introduced novel diagnostic and therapeutic transcervical procedures on the fallopian tubes.

DESIGN

Major studies that conceptually changed the therapeutic approach to the fallopian tubes were reviewed. Minor publications were also included if they introduced a new concept or contributed to the topic. Clinical publications were selected if they involved transcervical diagnosis and treatment of fallopian tubes.

RESULTS

Transcervical tubal catheterization procedures for diagnosis of tubal disease, tubal obliteration, tubal recanalization, and tubal medication are minimally invasive procedures that can improve our understanding and diagnostic accuracy of tubal disease. These procedures allow transcervical treatment of proximal tubal occlusion. Further improvements in equipment and methodology are promising. Transcervical tubal occlusion, gamete and embryo deposition, and treatment of ectopic pregnancy may all be performed using the transcervical approach.

CONCLUSION

Transcervical tubal catheterization can replace microsurgery and IVF in selected patients with proximal tubal occlusion, improve the diagnostic accuracy of tubal disease, and deliver medications to the fallopian tubes. Cumulative knowledge suggests that transcervical tubal catheterization should become a universally accepted, taught, and practiced approach in the diagnosis and treatment of the fallopian tubes.

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).

Effect of the number and depth of embryos transferred and unilateral or bilateral transfer in tubal embryo transfer (TET)

PURPOSE

Our purpose was to evaluate the possible effects of the number of embryos transferred, the depth of embryos placed within the tube(s), and unilateral or bilateral tubal transfer on pregnancy initiation in tubal embryo transfer (TET).

METHODS

One hundred eight consecutive TET cycles were analyzed. Oocyte retrievals were carried out by transvaginal ultrasound-guided aspiration of follicles. Forty-eight hours after oocyte retrieval, the developing embryos at the stage of two to four cells were transferred into the fallopian tube(s) by laparoscopy. A maximum of four embryos was transferred to each patient.

RESULTS

The pregnancy rates were similar among the cycles in which two, three, or four embryos were transferred. In addition, there was no significant difference in the pregnancy rate whether the embryos were deposited > 4 cm or between 3 and 4 cm into the tube(s). Although the pregnancy rate was greater in cycles of bilateral tubal transfer, the difference from that of unilateral transfers was not significant.

CONCLUSION

Our data indicate that when two to four embryos were transferred and the embryos were placed > or = 3 cm within the tube(s), unilateral or bilateral tubal transfer had little influence on the ultimate success of TET.

Zygote intrafallopian transfer or in vitro fertilization and embryo transfer for the treatment of male-factor infertility: a prospective randomized trial

OBJECTIVE

To compare zygote intrafallopian transfer (ZIFT) and in vitro fertilization and embryo transfer (IVF-ET) as treatments of male-factor infertility.

DESIGN

Patients were prospectively randomized to ZIFT or IVF-ET.

SETTING

In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution.

PATIENTS

One hundred fifty-seven couples were enrolled in the study. Inclusion criteria allowed only first trials of couples with long-standing infertility caused by a male factor. Female factors were excluded.

INTERVENTIONS

In ZIFT, up to three fertilized oocytes were transferred into one single patient fallopian tube by means of laparoscopy 18 hours after insemination. In IVF-ET, cleaving embryos were replaced into the uterine cavity about 48 hours after insemination.

MAIN OUTCOME MEASURES

Fertilization and transfer rates, implantation and pregnancy rates, pregnancy outcome, and cost per procedure were evaluated.

RESULTS

Implantation rates of 12.3% and 10% per replaced conceptus were achieved for ZIFT and IVF-ET, respectively.

CONCLUSIONS

This study demonstrates no therapeutic advantage of ZIFT over IVF-ET in male-factor infertility in terms of reproductive outcome or economic benefit.

After superovulation-intrauterine insemination fails: the prognosis for treatment by gamete intrafallopian transfer/pronuclear stage transfer

OBJECTIVE

To determine the prognosis for gamete intrafallopian transfer (GIFT)/pronuclear stage transfer (PROST) treatment after prior superovulation-intrauterine insemination (IUI).

DESIGN

Matched, retrospective.

SETTING

Outpatient university endocrine-infertility program.

PATIENTS, PARTICIPANTS

One hundred forty-four women matched for infertility factors and age were studied according to the following three treatment groups: superovulation-IUI only, GIFT/PROST only, or GIFT/PROST after superovulation-IUI.

MAIN OUTCOME MEASURES

Per cycle and cumulative pregnancy rates (PRs) were compared utilizing life table analysis.

RESULTS

Cumulative PRs (0.408) for superovulation-IUI only were lower than initial (0.469) and cumulative (0.802) cycle fecundity of GIFT/PROST (P = 0.002). Per cycle and cumulative PRs did not differ between GIFT/PROST only versus GIFT/PROST after superovulation-IUI.

CONCLUSIONS

Gamete intrafallopian transfer/PROST may be cost-effective when compared with superovulation-IUI. The prognosis for GIFT/PROST success is not negatively affected by earlier superovulation-IUI treatment failure.

Embryo implantation rates in oocyte donation: a prospective comparison of tubal versus uterine transfers

OBJECTIVE

To compare pregnancy and implantation rates in tubal and uterine transfers during a hormonal replacement cycle in an oocyte donation program.

DESIGN

Prospective randomized.

PATIENTS

Forty-two consecutive patients who entered an oocyte donation program.

INTERVENTIONS

Twenty-two patients were assigned for uterine transfer and 20 for tubal embryo transfer (ET).

RESULTS

Twenty-three pregnancies were achieved, 12 (54.5%) after uterine transfers and 11 (57.9%) after tubal transfers. Implantation rates in both groups are not significantly different (17.4% uterine transfers versus 21.5% tubal ETs).

CONCLUSIONS

Our results suggest that in hormonal replacement cycles (uniform endometrial stimulation) there is no advantage in transferring embryos to the fallopian tube. Furthermore, embryo quality and endometrial receptivity appear to be significantly more important than the time of entrance of an embryo to the uterine cavity in determining its chances of implantation.

Translaparoscopic tubal embryo transfer: preliminary experience at National Taiwan University Hospital

Forty-six couples with various causes of infertility were treated by tubal embryo transfer. Oocyte retrievals were carried out under ultrasound guidance transvaginally and embryos were transferred 48 hours later by laparoscopy into fallopian tubes. Totally 52 cycles were stimulated and 45 retrievals were performed with an average of 8.1 oocytes per retrieval. The average fertilization rate was 54.8%. The implantation rate was 23.8% and the pregnancy rate was 53.5% per transfer. The pregnancy rate per transfer was comparable whether 3 or 4 embryos were transferred. Nine (39.1%) of the 23 pregnancies had multiple pregnancies. Six cases (26.1%) aborted in the first trimester and the remaining 17 were ongoing or term delivery.

Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure

OBJECTIVE

Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG).

DESIGN

Prospective study.

SETTING

Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care.

PATIENTS

One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure.

INTERVENTION

Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube.

MAIN OUTCOME MEASURES

Of 155 tubal ostia, 145 (94.2%) were catheterized.

RESULTS

Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube.

CONCLUSIONS

During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.

Congenital absence of the vas deferens. The fertilizing capacity of human epididymal sperm

BACKGROUND

Congenital absence of the vas deferens has been considered a virtually untreatable cause of male sterility. Furthermore, sperm that have not passed through at least the head of the epididymis have been thought to be incapable of causing pregnancy. We attempted to determine whether human sperm that had never passed through the epididymis could fertilize eggs in vitro and whether the technique could be used for men with congenital absence of the vas deferens.

METHODS

Twenty-eight men with congenital absence of the vas deferens underwent microsurgical aspiration of sperm from the epididymis and vasa efferentia for attempted in vitro fertilization of their wives' oocytes, with subsequent transfer of embryos. Thirty-two treatment cycles were begun (four were repeat cycles).

RESULTS

The most motile sperm were found in the proximal epididymis, at or near the vasa efferentia. Embryos were obtained for transfer in 21 cases (66 percent). Ninety-three embryos resulted from 352 mature oocytes (fertilization rate, 26 percent). Clinical pregnancy was achieved in 10 of the 32 treatment cycles (31 percent). Seven women delivered normal infants, and three miscarried. One of the seven live births was of twins. There were six girls and two boys. When fewer than 10 eggs were retrieved, no pregnancy occurred. When 10 or more eggs were retrieved (20 cases), the pregnancy rate was 50 percent.

CONCLUSIONS

Sperm from the proximal caput epididymidis and even sperm from the vasa efferentia (which have never passed through the epididymis) can fertilize the human oocyte in vitro and result in pregnancy with live birth.

The role of tubal pathology and other parameters in ectopic pregnancies occurring in in vitro fertilization and embryo transfer

Contradictory findings were reported concerning the role of tubal disease in the genesis of ectopic pregnancy in in vitro fertilization and embryo transfer (IVF-ET). We report on six ectopics that occurred in 141 IVF-ET pregnancies (4.3%). All of the six cases were among 84 patients with tubal disease, and none occurred in the remaining 57 patients with other etiological factors. No correlation was found in other parameters including: ovulation induction, number of embryos transferred, and luteal support. A comparison between the ectopics and six matched controls demonstrated similar estradiol levels, but beta-hCG levels on day 15 to 17 after ET were lower. Homolateral salpingectomy was performed in all six cases, but a contralateral resection was carried out in three of them. More comprehensive studies are needed to clarify whether tubal pathology really increases the risk for ectopic gestation in IVF-ET.

Zygote intrafallopian transfer as a treatment for nontubal infertility: a 2-year study

Zygote intrafallopian transfer (ZIFT) was used as a treatment for long-standing nontubal infertility for a 2-year period. The overall clinical pregnancy rate for 114 tubal transfers was 40.4% with a delivery/ongoing rate of 34.2%. Concurrent use of in vitro fertilization and embryo transfer (IVF-ET) for tubal factor infertility gave significantly lower clinical pregnancy and delivery/ongoing rates (21.1% and 15.8%, respectively). The use of gamete intrafallopian transfer (GIFT) for nontubal infertility yielded a 32% clinical pregnancy rate and a 26% delivery rate for 53 transfers. Zygote intrafallopian transfer resulted in an implantation rate per zygote of 17% overall compared with 8.1% per embryo for IVF-ET and 11.2% per oocyte for GIFT. The transfer of three zygotes per patient gave the same clinical pregnancy rate as the transfer of four while reducing the incidence of multiple gestation from 19% to 7.8% per transfer. No significant decline in the clinical pregnancy or delivery rate was seen with ZIFT in women aged 25 through 39.

Results of tubal embryo transfer in premature ovarian failure

The transfer of embryos generated in vitro to the fallopian tubes in 11 cases of premature ovarian failure resulted in 9 clinical pregnancies. This approach may have theoretical advantages over GIFT and IVF-ET in agonadal patients.

Zygote intrafallopian transfer with "donor rescue": a new option for severe male factor infertility

Clinical pregnancies have been initiated by ZIFT using zygotes produced by reinsemination of oocytes with donor sperm ("donor rescue") after an initial 15- to 20-hour exposure to husband's sperm. A total of 54 oocytes from four couples experiencing failed fertilization by husband's sperm were reinseminated with donor sperm, resulting in 38 zygotes (70.4% fertilization). Four zygotes were transferred during ZIFT in each case and resulted in two (50%) continuing pregnancies. Additional zygotes from donor reinsemination were cryopreserved for each couple. Donor rescue expands the utility of ZIFT as a treatment for male factor infertility.

Improved pregnancy rates and outcome with gamete intrafallopian transfer when follicular fluid is used as a sperm capacitation and gamete transfer medium

Follicular fluid (FF) is a dynamic medium rich in steroids, polypeptide hormones, and growth factors. Preovulatory FF can stimulate spermatozoal acrosome reaction. Moreover short preincubation of washed sperm with FF improves sperm performance in the hamster egg penetration assay. In the current study, FF was used to capacitate sperm and as a transfer medium in 131 gamete intrafallopian transfer (GIFT) procedures. Ham's F-10 medium (GIBCO, Grand Island, NY) with 50% maternal serum was used in another 29 GIFT procedures. In the Ham's F-10 group, 29 GIFT procedures were performed in 25 patients with a pregnancy rate of 21% per laparoscopy and 24% per patient. In the FF group, 131 GIFT procedures were performed in 100 patients with a pregnancy rate of 50% per laparoscopy and 66% per patient, with a 59% ongoing pregnancy rate per patient. The most significant improvement was in the male factor group with a pregnancy rate of 0% in the Ham's F-10 group and 44% per procedure in the FF group. We conclude that the use of FF for sperm capacitation and as a gamete transfer medium significantly improves GIFT pregnancy rates and outcome.

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%.