Combined Gamete or Zygote Intrafallopian Transfer (GIFT or ZIFT) and In Vitro Fertilization-Embryo Transfer (IVF-ET) in Women With Prior Failed Cycles: Significantly Improved Success Rates Compared With GIFT or ZIFT Alone

Abstract

Introduction: The roles of GIFT and ZIFT have recently been diminished as laboratory and transfer techniques in IVF-ET have improved. However, data on combination treatment of GIFT or ZIFT with IVF-ET are lacking. Objective: To assess whether combination treatment of GIFT/IVF or ZIFT/IVF offers any benefit over GIFT or ZIFT alone in women with prior failed IVF. Material & Methods: From January 1997 through December 2000, 56 patients with a prior history of at least one failed IVF cycle underwent a total of 62 tubal transfer procedures, following standard ovarian hyperstimulation and egg retrieval. Of those, 42 cycles were of combined GIFT/IVF (35 cycles in 30 patients) or ZIFT/IVF (7 cycles in 7 patients), and 20 cycles were of GIFT (11 cycles in 10 patients) or ZIFT (9 cycles in 9 patients) only. In combined procedures, laparoscopic tubal gamete or zygote transfer was followed with trans-cervical ET of day-3 embryos three or two days later, respectively. Patients underwent a GIFT or combined GIFT/IVF procedure unless intracytoplasmic sperm injection was necessary, in which case a ZIFT or combined ZIFT/IVF was performed. For the purpose of comparing the number of embryos transferred, a 75% fertilization rate was assumed for all GIFT cycles. Statistical analysis was by Chi Square and Student’s t test. Results: Mean age and number of prior failed IVF cycles were similar between patients undergoing combined GIFT/IVF or ZIFT/IVF (34.5 ± 4.1 years, 1.9 ± 1.2 cycles) and those undergoing GIFT or ZIFT alone (36.1 ± 4.1 years, 1.8 ± 1.7 cycles, p=NS). Combined procedures resulted in a significantly higher mean number of total embryos transferred (tubes + uterus), compared with GIFT or ZIFT alone (5.9 ± 1.0 versus 4.3 ± 1.6 embryos, p>0.01). Compared with GIFT or ZIFT only cycles, patients undergoing a combined GIFT/IVF or ZIFT/IVF procedure had a significantly higher clinical pregnancy rate (69.0% versus 30.0%, OR=5.2, p>0.01), delivery rate (57.1% versus 30.0%, OR=3.1, p>0.05), and implantation rate (19.4% versus 7.2%, OR=3.1, p>0.01). Combined cycles had a 37.9% twin and 10.3% triplet gestation rate. There were no multiple gestations in GIFT or ZIFT only cycles. Conclusion: In this study, in women with prior IVF failure, combined GIFT/IVF or ZIFT/IVF resulted in significantly higher clinical pregnancy, delivery, and implantation rates compared with GIFT or ZIFT alone.