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

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.

Controlled ovarian hyperstimulation and transvaginal intratubal insemination as an alternative to gamete intrafallopian transfer

OBJECTIVE

To evaluate the efficacy of controlled ovarian hyperstimulation (COH) followed by intratubal insemination in the treatment of infertility.

DESIGN

Retrospective analysis of 179 intratubal insemination trials in 78 women over a 48-month period.

SETTING

Reproductive endocrinology practice.

PATIENTS

Seventy-eight women, 26 to 44 years old (34 +/- 4.3 years; mean +/- SD), classified into subgroups according to diagnosis and age (< 40 or > or = 40 years).

INTERVENTIONS

Patients underwent COH and intratubal insemination.

MAIN OUTCOME MEASURES

The rates of pregnancy, delivery, spontaneous abortion, ectopic and multiple gestation, and complications were studied and analyzed statistically.

RESULTS

Overall, there were 36 pregnancies (20.1% of 179 trials), 29 deliveries (16.2%), 5 of 36 first trimester abortions (13.9%), 2 of 36 ectopic pregnancies (5.6%), and 4 twin gestations. There were no serious complications. In 43 women < 40 years without male factor the first trial resulted in 15 pregnancies (34.9%); in 27 women < 40 years with male factor the first trial resulted in 4 pregnancies (14.8%). Male factor reduced significantly the probability of conception. In 19 women < 40 years of age with either ovarian dysfunction or infertility of unknown cause, the first trial resulted in 9 pregnancies (47.4%), which was significantly better than the 10 pregnancies achieved in the first trial in the remaining 51 women < 40 years of age. Peak serum E2 levels and number of mature follicles had a significant effect on pregnancy rates.

CONCLUSIONS

Intratubal insemination yielded pregnancy rates comparable to those published for GIFT at reduced cost and with fewer complications.

Appraisal of gamete intrafallopian transfer

OBJECTIVE

To collect results of gamete intrafallopian transfer on a large scale in order to compare treatment indications, results, and factors which influence the success rates; to evaluate whether gamete intrafallopian transfer is well-established and what the real place of this procedure is among other assisted reproduction techniques.

DESIGN

Data relating to gamete intrafallopian transfer were collected from World Reports, national registries of different countries and meta-analysis of medical publications during the years 1986-1991.

SUBJECT

Official registries reported 47,200 treatment cycles and 18,759 treatment cycles were analysed from ten medical publications.

RESULTS

The procedure accounts for 13.5% of all assisted reproduction techniques but its popularity varies significantly among countries. The same indications for gamete intrafallopian transfer are followed by all countries, but great differences exist with regard to the proportional share of each etiology. Also, the share has changed considerably over the years. TREATMENT OUTCOME: 10,667 clinical pregnancies were reported which represent 24% of treatment cycles and 29% of ovum pick-up. The live birth rate was 23.3%; abortion rate, 22%; and ectopic pregnancy rate, 5.5%. The stillbirth rate was 2.3% and the malformation rate was 2.8%, not confined to specific organs or systems. There were 19.5% twins, 4.6% triplets and 0.3% quadruplets or more. The number of transferred oocytes influenced pregnancy rates: 28% for transfer of four oocytes and only 10% following transfer of one oocyte. The cause of infertility might influence the results and the poorest results are obtained for male factor infertility. In most cases correlation of success rates reported by leading units through medical publications closely resembles the overall national registries results. Indications for this treatment were broadened over the years, but its role among other assisted reproduction technologies is not agreed upon, especially for male factor and unexplained infertility.

CONCLUSIONS

Gamete intrafallopian transfer carries an overall higher pregnancy rate than in vitro fertilization. Quality control by professional or public associations should be established and more research employed over indications for treatment and results in order to establish when GIFT is the treatment of choice and when other modes of treatment should be preferred.

A randomized study of transcervical intrafallopian transfer of pronucleate embryos controlled by ultrasound versus intrauterine transfer of four- to eight-cell embryos

OBJECTIVE

To establish the value of transcervical intrafallopian transfer of zygotes and the accuracy of fallopian cannulation.

DESIGN

A prospective randomized study, comparing ultrasonically controlled transcervical intrafallopian transfer of zygotes with intrauterine transfer of cleaved embryos.

SETTING

Department of IVF of the Rotterdam Academic Hospital.

PATIENTS

One hundred forty-five patients with patent tubes entered the IVF program.

MAIN OUTCOME MEASURE

Pregnancy rates in both groups and ultrasound (US) assessment during fallopian cannulation and ET.

RESULTS

Transvaginal cannulation of the tube appears not to be sufficiently accurate when performed without US guidance. Catheter damage occurred in many cases. The previously reported superior implantation rate after intrafallopian transfer in comparison with intrauterine transfer could not be confirmed.

CONCLUSIONS

Intrauterine transfer of cleaved embryos remains the method of choice in IVF.

Transvaginal versus laparoscopic gamete intrafallopian transfer: a case-controlled retrospective comparison

OBJECTIVE

To compare pregnancy rates (PRs) obtained by transvaginal ultrasound (US)-guided GIFT with PRs from conventional laparoscopy-based GIFT.

DESIGN

Retrospective case-controlled study.

SETTING

Large, private assisted conception service.

PATIENTS

Twenty consecutive cycles of transvaginal GIFT, each matched with three cycles of laparoscopic GIFT on the basis of patient age, number of previous unsuccessful attempts at GIFT, number of eggs transferred, and total number of eggs obtained.

MAIN OUTCOME MEASURE

Probability of clinical pregnancy.

RESULTS

The PR from transvaginal GIFT was 20.0% (95% confidence limits 13% to 27%), compared with a PR from laparoscopic GIFT of 35.0% (23% to 50%).

CONCLUSION

Transvaginal GIFT with present techniques seems to be less effective than laparoscopic GIFT, but it can be considered as a practical alternative to ovarian stimulation and intrauterine insemination and to peritoneal ovum-sperm transfer.

The role of oocyte maturity in the treatment of infertility because of teratozoospermia and normozoospermia with gamete intrafallopian transfer

OBJECTIVE

To determine the effect of oocyte maturity on pregnancy rate (PR) in patients undergoing gamete intrafallopian transfer (GIFT) procedures for infertility and in whom male partners had either normozoospermia or teratozoospermia.

DESIGN

A prospective study using a combination of clomiphene citrate and human menopausal gonadotropin for ovulation induction was carried out. Five hundred thirty-seven GIFT treatment cycles were analyzed, and 423 cycles yielded four or more oocytes. Patients were divided into two groups according to the sperm morphology: those with less than 14% normal forms and those with greater than 14% normal morphology (as judged by strict criteria). These two groups were divided into a further five subcategories depending on the number of metaphase II oocytes transferred.

RESULTS

In the group less than 14% normal forms (category I; 4 metaphase I oocytes replaced), three pregnancies resulted from 33 cycles (9.09%), and in category V (4 metaphase II oocytes transferred) the PR was 15% (14/95) per cycle. In the group with greater than 14% normal forms, in category I, the PR was 16% (3/19) per cycle, and in category V, the PR was 33% (20/61) per cycle. The effect of morphology (less than 14% normal forms versus greater than 14% normal forms) on pregnancy outcome is significant (P = 0.0161). The overall effect of increasing the number of metaphase II oocytes on the pregnancy outcome was not significant (P = 0.1098). However, in the group with greater than 14% normal forms, there was a significant improvement in PR (P = 0.04) in category V.

CONCLUSION

During this prospective study, it was shown that sperm morphology plays a significant role in the pregnancy outcome in a GIFT program.