Gamete Intrafallopian Transfer Procedure Research Articles

Endotoxic shock after gamete intrafallopian transfer

To report an extremely rare case of endotoxic shock due to Enterobacter cloacae that occurred after laparoscopy for gamete intrafallopian transfer (GIFT) in a nulligravid woman. Private fertility center in Cape Town, South Africa. Case report. A 34-year-old woman with primary infertility. Routine preparation for GIFT procedure, sonar aspiration to obtain oocytes, followed by GIFT. Endotoxic shock developed within hours after the procedure, followed by admission to the intensive care unit, intravenous antibiotic therapy, mechanical ventilation, and abdominal hysterectomy. Preventing patient mortality and morbidity. Discharge from the intensive care unit occurred on day 11 after GIFT, which was day 8 after surgery. A MEDLINE search (1980 to 2003) found no previous literature on endotoxic shock associated with assisted reproduction. Gram-negative infection with subsequent endotoxic shock after assisted reproductive techniques is extremely rare. As this case report shows, early diagnosis and active management of these cases are mandatory to prevent serious complications and mortality.

Relationship between the timing of hysterosalpingography before gamete intrafallopian transfer and the subsequent fertility outcome

To investigate the prognostic significance of hysterosalpingography carried out before one-sided gamete intrafallopian transfer for unexplained infertility. 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. 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. 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 and xenogenous capacitation-like changes of fresh, cooled, and cryopreserved stallion sperm as assessed by a chlortetracycline stain.

Like the human female, the mare experiences reproductive tract pathology that may sometimes be circumvented by the use of assisted reproductive technologies (ARTs). One such technology, gamete intrafallopian transfer (GIFT), may be used in mares that exhibit ovulatory, oviductal, or uterine abnormalities that limit the use of common ARTs, such as embryo transfer. Homologous GIFT has been successfully performed in the horse; however, the logistics, costs, and associated risks of surgically transferring gametes to the oviducts of a recipient mare are considerably high. Use of a less costly species in a heterologous or xenogenous procedure would therefore be beneficial. This study represents the preliminary investigation into the use of sheep as recipients for xenogenous GIFT procedures using equine gametes. We investigated the capacitation response of fresh, cooled, or frozen stallion sperm after 1) in vivo incubation in the reproductive tract of estrous and anestrous ewes as well as 2) in vitro incubation in a modified Krebs/ Ringer extender at 37 degreesC with and without the addition of heparin at 10 IU/mL for up to 8 hours. A chlortetracycline (CTC) fluorescent stain was used to assess the capacitation response of sperm. Findings indicated that oviductal fluid samples recovered from estrous ewes had significantly higher numbers of sperm exhibiting capacitation-like staining patterns when compared to samples recovered from anestrous ewes (P < .05). Fresh semen yielded higher capacitation-like staining patterns after in vivo incubation than did frozen-thawed or cooled samples. A transition from majority CTC unreacted sperm to majority CTC non-acrosome intact sperm was demonstrated for both in vivo and in vitro studies. In vitro incubation of stallion sperm with heparin did not result in an increased capacitation-like staining response over time when compared with nonheparinized samples. Results from this study suggest that xenogenous capacitation of stallion sperm may occur in the estrous ewe.

The Use of Propofol, Nitrous Oxide, or Isoflurane Does Not Affect the Reproductive Success Rate Following Gamete Intrafallopian Transfer (GIFT): A Multicenter Pilot Trial/Survey

Background Whether anesthetic agents administered during gamete intrafallopian transfer (GIFT) affect reproductive outcome is controversial. This multicenter pilot trial and survey had two purposes: to evaluate the effect of propofol, nitrous oxide, midazolam, and isoflurane on pregnancy outcome after GIFT, and to determine if a larger prospective, randomized study is warranted. Methods A written invitation was mailed to all 50 fertility programs in the United States that are members of the Society for Assisted Reproductive Technology and perform more than 30 GIFT procedures per year. They were invited to contribute information from the medical records of women who underwent GIFT during the calendar years 1993 and 1994. They were asked to document whether propofol, nitrous oxide, midazolam, a potent inhaled anesthetic agent was used during the GIFT procedure; if the woman became pregnant; and if she delivered at least one live neonate. Results Seven medical centers participated and contributed data from 455 women. The clinical pregnancy rate (number of pregnancies/total number of GIFT procedures) and the delivery rate (number of women who delivered at least one live baby/total number of GIFT procedures) were 35% and 32%, respectively. A statistically significant difference could not be found in the clinical pregnancy or delivery rates between those women who received propofol, nitrous oxide, midazolam, or isoflurane during GIFT and those who did not. Conclusions No agent-related differences in pregnancy rates were found when propofol, nitrous oxide, isoflurane, or midazolam was used as part of the anesthetic technique for GIFT. Therefore, a more extensive prospective trial does not appear to be warranted.

This Month in ANESTHESIOLOGY

This Month in ANESTHESIOLOGY

A possible effect of different light sources on pregnancy rates following gamete intra-fallopian transfer.

A retrospective study of 34 sequential gamete intra-Fallopian transfer (GIFT) procedures suggested a significant effect on pregnancy rates associated with the different laparoscopic light sources, with a pregnancy rate of 50% in 22 cycles using a halogen light source and 9% in 12 cycles using a xenon light source. Other explanatory variables were explored, but none was to have a significant effect on the pregnancy rate. Further investigation revealed that the xenon light source emitted more ultraviolet light than the conventional halogen light source--suggesting a possible detrimental effect of ultraviolet light on the gametes in the GIFT procedure.

Anaesthesia for assisted conception

Anaesthesia for assisted conception

The influence of endometriosis on the success of gamete intrafallopian transfer (GIFT).

Our purpose was to evaluate the outcomes of gamete intrafallopian transfer (GIFT) therapy in patients with endometriosis. One hundred eight GIFT cycles performed under the indication of endometriosis were compared to 156 GIFT cycles with indications of other disease entities. A maximum of seven oocytes was transferred into one or both fimbriate ends with prepared spermatozoa. Clinical pregnancy rates and outcomes were evaluated according to Mantel-Haenszel's chi-square test. Multiple logistic regression analysis was performed to determine factors influencing the success on pregnancy in the total treatment cycles. The anthropological variables, such as age of patients, duration of infertility, and semen grading, were comparable in both groups. The responses to controlled ovarian hyperstimulation (COH) were progressively decreased while increasing the severity of endometriosis conditions such as nonendometriosis, mild-form endometriosis, and advanced-form endometriosis patients. However, there were no significant differences in the clinical pregnancy rates (40.4, 36.7, and 41.7%, respectively), multiple pregnancy rates (34.9, 27.3, and 45.0%, respectively), and early pregnancy loss rates (27.0, 18.2, and 30.0%, respectively). Multivariate statistics of pregnancy rates that adjusted the effects of patients' age, tubal health, presence of active endometriosis and/or endometriomas, number of oocytes transferred, and quality of sperm exhibited no statistical significance between endometriosis and nonendometriosis groups. Our data show that patients with records of endometriosis have both a decreased ovarian response to gonadotropin stimulation and a decreased number of retrieved oocytes. Since the number of oocytes needed for the GIFT procedure is limited, pregnancy results for patients in the study group were comparable with those for patients in the control group.

The cellular activity of different sized follicles in cycles treated with gonadotrophin-releasing hormone analogue.

The activity of granulosa cells derived from different sized follicles surrounding oocytes of apparently comparable maturity was evaluated in hyperstimulated ovaries. Granulosa cells were obtained from women undergoing gamete intra-Fallopian transfer procedures who had been treated with gonadotrophin-releasing hormone analogue and gonadotrophins. Only follicles with oocytes of apparently comparable maturity were considered. Granulosa cells from large and small follicles (> or = 18 and < 15 mm diameter respectively) collected from each patient were cultured separately for up to 48 h in the presence or absence of follicle-stimulating hormone (FSH: 50 ng/ml) or insulin (at varying doses, 0.005-25 mg/ml). We found that aromatase activity was elicited by FSH plus insulin, but not by FSH alone, in granulosa cells from both large and small follicles. Progesterone production was maximal in granulosa cells from large follicles, and in these cells was insensitive to further stimuli, in contrast with those collected from small follicles. Prostaglandin oestradiol was secreted in large amounts by granulosa cells from large follicles. Cyclic adenosine monophosphate (cAMP) concentration did not differ between cells from large and small follicles. Our data demonstrate that there are significant differences in granulosa cells derived from different sized follicles with oocytes of apparently comparable maturity.

Factors associated with improving success rates with gamete intrafallopian transfer under thin-needle spinal anesthesia.

In order to reduce the risk of major anesthetic complications associated with laparoscopic gamete intrafallopian transfer procedures, we have exclusively used thin-needle spinal anesthesia over the years 1991 - 1994. This paper will review complication rates in order to further establish the safety profile of GIFT under thin-needle anesthesia and report the changes in our GIFT protocol from 1991 to 1994 which have been associated with a statistical improvement in the implantation rate from 11% to 23% (P = 0.01) and an increase in delivery rates from 29% to 42% per transfer procedure. Sixty-eight laparoscopic GIFT procedures were done in women with at least one patent oviduct and failure to respond to less invasive treatment. Clinical variables were analyzed to determine if similar patient populations had been treated over the study period. The improved delivery rates and implantation rates could not be explained by patient selection. No major perioperative complications occurred. Minor perioperative complications and difficulties included one patient requiring general anesthesia, one patient developing a spinal headache which could be managed conservatively at home, and one patient requiring a minilaparotomy to complete the GIFT procedure. The more serious complications occurred as a result of the superovulation and multiple oocyte transfer rather than the surgical or anesthetic technique. These included two patients with severe ovarian hyperstimulation requiring hospitalization, and five delivered triplet pregnancies. Factors associated with improving success rates included improvements in semen and equipment preparation as well as an increase in the number of sperm transferred from 200,000 to 500,000. GIFT can be performed with relative safety under thin needle spinal anesthesia with high implantation and delivery rates if care is made to optimize sperm and equipment preparation. GIFT under thin-needle spinal anesthesia may be an attractive alternative for treatment of longstanding nontubal infertility in couples willing to take the risk of ovarian hyperstimulation and multiple pregnancy.

A Case of Attempted IVF Surrogacy in Victoria: Breaking the Law or Breaking the Deadlock?

Summary: A 37‐year‐old Melbourne woman underwent an emergency hysterectomy for severe postpartum haemorrhage after a twin delivery in 1990 where the pregnancy resulted from a GIFT (gamete intra‐Fallopian transfer) procedure. Two additional embryos had been produced and stored frozen at the time of conception. She and her husband subsequently wished to receive their embryos for implantation into a surrogate to allow them to achieve their own genetic offspring.The 1984 Infertility (Medical Procedures) Act allowed them to either donate their embryos to another infertile couple or have them discarded. Neither of these options was acceptable to this couple. IVF (in vitro fertilization) surrogacy was their only chance of obtaining their genetic offspring, but this procedure was and is currently illegal. An IVF surrogacy procedure was carried out in 1993 but the surrogate failed to conceive.

Multiple pregnancy induction and selective fetal reduction in high genetic risk couples.

Couples at risk for an inherited disorder often have several pregnancy interruptions because of affected fetuses and difficulty in achieving their desired family. We evaluated the efficiency and acceptability of selective fetal reduction after chorionic villus sampling (CVS) of multiple pregnancy induced by ovarian stimulation and gamete intra-Fallopian transfer (GIFT). This approach has been offered to nine patients at risk of Mendelian diseases and one patient carrier of reciprocal translocation. The acceptance has been very high (90%). One patient at risk of an autosomic recessive disease opted for artificial donor insemination, one conceived spontaneously, and one was a poor responder to ovarian stimulation. Seven patients actually underwent a single GIFT procedure with six achieving pregnancy (86%), all but two being a multiple pregnancy (67%). All pregnancies concluded uneventfully at term and newborns were alive and healthy. Prenatal diagnosis, including fetal karyotyping in all cases, was performed at 8.5-11.5 weeks of gestation and confirmed either on amniotic fluid aspirated at reduction or at birth. The number of fetuses was reduced to one or two because the genetic disease was present and/or to reduce the risk of premature delivery and improve the likelihood of successful pregnancy. The new approach seems to be highly effective and might be considered a practical and useful alternative to preimplantation genetic diagnosis.

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.

Infertility: Gamete intra-Fallopian transfer: outcome following the elective or non-elective replacement of two, three or four oocytes

The outcome of 807 gamete intra-Fallopian transfer (GIFT) cycles following the elective or non-elective transfer of two, three or four oocytes has been retrospectively studied. Electively replacing either three or two oocytes did not reduce the clinical or ongoing pregnancy rate when compared with replacing four oocytes. The incidence of high-order multiple gestation (triplet or more) was significantly reduced by replacing fewer oocytes, but the occurrence of twin pregnancy was not altered. Lower pregnancy rates were found when the number of oocytes available for replacement was limited and non-elective replacement was performed. It is suggested, therefore, that a higher number of oocytes available may allow selection of higher quality oocytes for transfer. We conclude that the overall expectation of pregnancy from the GIFT procedure is high (30-40%) and the number of oocytes replaced should be two in order to minimize the risk of high-order multiple pregnancies. It is not clear whether increasing the number of oocytes transferred will benefit subjects who failed to become pregnant previously with GIFT, but limited data suggest that transferring large numbers of oocytes to women > 40 years does not improve the expectation of pregnancy.

IVF and related technology. The present and the future.

To describe the current status of in-vitro fertilisation (IVF) and related technologies, including: the indications for the procedures and the problems associated with the use of stimulated cycles; the use of frozen embryos and donor eggs; and the newer procedures of gamete micromanipulation for male infertility, immature egg collection as a possible alternative to the stimulated cycle, and preimplantation genetic diagnosis. The clinical experience and research at Monash IVF and the Centre for Early Human Development, Monash University, were reviewed in association with key original or review articles in the world literature. Cumulative pregnancy rates for IVF and the gamete intrafallopian transfer (GIFT) procedure at Monash IVF demonstrate that 29% of IVF patients and 55% of GIFT patients will have a live baby, the average number of treatments pursued being 3.4. Analogues of gonadotrophin releasing hormone (GnRH) have improved pregnancy rates, reduced blood sampling, and prevented natural ovulation. Disadvantages of stimulated cycles include a higher risk of multiple pregnancy, a higher risk of hyperstimulation, and behavioural changes due to the effects of drugs. Natural cycles or immature egg collection at incidental laparoscopy may become alternatives to the use of the stimulated cycle. In Australia the GIFT procedure is more successful than IVF and is nearly always used if the fallopian tubes are normal. Multiple pregnancies may be reduced, particularly triplets, by reducing the number of eggs or embryos transferred to two when egg or embryo quality is high. Embryo freezing has made a small but important contribution to overall pregnancy rates by enabling patients to use excess eggs and embryos. The social and legal concerns resulting from the use of frozen embryos have required new ethical and legal considerations. Donor eggs have made a small contribution to achieving pregnancy in women with absent or inappropriate eggs and increased the chance of conception in women over the age of 40. Micromanipulation of sperm and eggs has enabled fertilisation and conception when sperm are defective in quantity or quality. Sampling of cells in early embryos enables genetic diagnosis and may be used in selecting chromosomally normal embryos in IVF procedures or in couples at risk of recessive genetic disease. Assisted reproductive technology has developed over a decade to become useful for couples with infertility which cannot be cured by simpler treatments. The birth rates are comparable to natural conception and the incidence of congenital malformation is not increased. The costs and complexity of treatment have been reduced to in turn reduce the stress and social inconvenience of therapy. Problems related to the high risk of multiple pregnancy and the use of the stimulated cycle are being reduced and new techniques for severe male infertility and the detection of genetic abnormalities in the embryo are being introduced.

Comparison of pregnancy rates following gamete intrafallopian transfer (GIFT) under general anesthesia with thiopental sodium or propofol

Study Objective: To determine whether the pregnancy rate for gamete intrafallopian transfer (GIFT) patients who received thiopental sodium was different from the pregnancy rate for patients who received propofol for the induction o f general anesthesia. Design: Retrospective review of clinical records. Setting: Private outpatient infertility clinic. Patients: Two hundred eighty-two consecutive GIFT procedures performed on 230 patients with infertility. Intervention: Patients undergoing GIFT were divided into two groups on the basis of whether they received thiopental or propofol for induction of anesthesia. Measurements and Main Results: Clinical pregnancy following each GIFT procedure was assessed by multiple-serum beta human chorionie gonadotropin and ultrasound determinations. The pregnancy rates of 24.6% and 25.8% for the thiopental and propofol groups, respectively, were not significantly different. Conclusions: The pregnancy rate following GIFT for patients given propofol for induction of general anesthesia did not differ from that for patients given thiopental.

Gamete intrafallopian transfer: Assessment of the optimal number of oocytes to transfer

The optimum number of oocytes that should be transferred at the time of gamete intrafallopian transfer (GIFT) is important information. Nonessential oocytes can be inseminated and frozen for later use or the extra oocytes can be donated to another women. In this preliminary study, the results of 399 consecutive GIFT procedures were evaluated retrospectively as a function of the number of oocytes transferred. Women who received four or more oocytes were three times more likely to achieve a clinical pregnancy than those who received three or less. There was no statistically significant difference in pregnancy rates between patients who received five, six, seven, or eight oocytes. Oocytes in excess of five may be more effectively used if they are fertilized and frozen as embryos for later transfer rather than replacing them all at the time of GIFT.

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.

Gamete intrafallopian transfer: assessment of the optimal number of oocytes to transfer

The optimum number of oocytes that should be transferred at the time of gamete intrafallopian transfer (GIFT) is important information. Nonessential oocytes can be inseminated and frozen for later use or the extra oocytes can be donated to another women. In this preliminary study, the results of 399 consecutive GIFT procedures were evaluated retrospectively as a function of the number of oocytes transferred. Women who received four or more oocytes were three times more likely to achieve a clinical pregnancy than those who received three or less. There was no statistically significant difference in pregnancy rates between patients who received five, six, seven, or eight oocytes. Oocytes in excess of five may be more effectively used if they are fertilized and frozen as embryos for later transfer rather than replacing them all at the time of GIFT.

Improved pregnancy rates and outcome with gamete intrafallopian transfer when follicular fluid is used as 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.