GIFT Cycles Research Articles

Gift and transmission in teachers’ lifelong learning: what remains of those who leave

This article analyses the activity of those involved in teacher training. Learning effective techniques for action is at the heart of the process of becoming a teacher, which contributes to the general conception of lifelong learning as the transmission/construction of utilitarian knowledge. We hypothesised that this situation has other dimensions that are often unnoticed on a daily basis, only to become visible once we look for events belonging to longer time-scales. The focus on utility places value on knowledge that has immediate and visible application; yet, some meaningful facts or events cannot be explained solely in these terms, including in such fields as teacher training, which provide unfavourable ground for our hypothesis. These dimensions are analysed here using a theoretical framework incorporating gift theory and the life course of professional practice. The corpus was compiled from self-confrontation interviews with 12 individuals who had given or responded to speeches during four retirement ceremonies in two teacher training institutes of southern France. The analysis shows that these ceremonies reflect organising rituals and contribute to the anti-utilitarian dimension of lifelong learning that is both collective and individual, based on gift cycles, and related to long time-scales of activity. It reverses the traditional idea of teacher training as utilitarian knowledge transmitted by older to younger teachers in favour of lifelong learning by cycles of gift giving. Last, this study opens a research perspective in fields other than teacher training and points towards how applications can be defined according to the results.

P-274: 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 IVF alone

P-274: 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 IVF alone

O-4: Combined Gamete Intrafallopian Transfer (GIFT)/In Vitro Fertilization-Embryo Transfer (IVF-ET) Versus Zygote Intrafallopian Transfer (ZIFT)/IVF-ET in Women With Prior Failed IVF

Objective: We have previously reported significantly higher pregnancy, delivery, and implantation rates in combined GIFT/IVF or ZIFT/IVF cycles compared to GIFT or ZIFT alone. However, data comparing GIFT/IVF to ZIFT/IVF are lacking. The aim of this study was to assess whether pregnancy outcome is different between combined GIFT/IVF and ZIFT/IVF in women with prior failed IVF. Design: Retrospective study at an urban IVF center. Material and Methods: From January 1997 through July 2004, 101 infertile patients with a prior history of at least one failed IVF cycle underwent a total of 120 cycles of either combined GIFT/IVF (71 cycles in 54 patients) or ZIFT/IVF (49 cycles in 47 patients) following standard ovarian hyperstimulation and egg retrieval. Laparoscopic GIFT or ZIFT was followed by trans-cervical ET of day-3 embryos three or two days later, respectively. Bilateral tubal patency was confirmed by hysterosalpingogram prior to laparoscopy. Patients underwent GIFT/IVF unless intracytoplasmic sperm injection was necessary, in which case 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: GIFT/IVF cycles were performed for unexplained infertility (46.5%) and anovulation (35.2%), while the leading causes of infertility in ZIFT/IVF cycles were male factor (53.1%) and unexplained (30.6%). Mean age and number of prior failed IVF cycles were similar between patients undergoing GIFT/IVF (35.9 ± 4.4 years, 2.0 ± 1.5 cycles) and ZIFT/IVF (36.8 ± 4.3 years, 2.3 ± 1.7 cycles, p=NS). GIFT/IVF cycles resulted in a significantly lower mean number of embryos transferred intrafallopian compared with ZIFT/IVF cycles (3.3 ± 0.6 versus 3.8 ± 0.8, p<0.01), while mean number of embryos transferred trans-cervically and mean total number of embryos transferred (intrafallopian + trans-cervical) were similar between the two groups (2.9 ± 1.1 versus 2.7 ± 0.9 and 6.2 ± 1.4 versus 6.5 ± 1.4, respectively, p=NS). GIFT/IVF and ZIFT/IVF cycles resulted in similar pregnancy rates (59.2% versus 61.2%, OR=0.9, p=NS), ongoing pregnancy/delivery rates (40.1% versus 53.1%, OR=0.6, p=NS), and implantation rates (15.7% versus 14.8%, OR=1.1, p=NS). Twin and triplet gestation rates were similar between GIFT/IVF and ZIFT/IVF cycles (19.7% and 5.6% versus 12.2% and 10.2%, respectively, p=NS). One case of ectopic pregnancy was encountered in the GIFT/IVF group. Conclusions: In couples with prior IVF failure, combined GIFT/IVF and ZIFT/IVF result in similar pregnancy, delivery, implantation, and multiple gestation rates. In the absence of male factor, GIFT/IVF is the treatment of choice.

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

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.

A one-year experience with a capitated health care plan for infertility

Objective: To report on a one-year experience participating in a capitated healthcare plan for infertility. Design: Prospective study. Setting: University population. Patient(s): Reproductive-age women 15 to 50 years. Intervention(s): The first-generation Lewin infertility algorithm and CATHI software were used to negotiate infertility services under a capitated arrangement for $0.50 per member per month. The following reports our experience for the fiscal year 1997. Main Outcome Measure(s): Infertility services rendered, pregnancy rate, cost of services, collection rates. Result(s): Five thousand forty-six women representing 39,689 member months generated 39 new and 198 return visits. Thirty-two percent of the patients required three visits or less; six patients generated 22% of the visits. Fifty-one percent listed infertility as one of their chief complaints; 31% had mixed diagnoses. Eight (7.6%) patients required surgery, 11 (10.5%) patients underwent either IVF or GIFT cycles. Total charges submitted were $176,636; the amount assigned to specialty care was $135,277, and to IVF/GIFT, $33,433. Total capitated payments, including copayments, was $126,256 under the reproductive medicine agreement and $32,891 under the infertility rider. This resulted in a 71% gross collections rate. Conclusion(s): This study indicates that entering into a capitated health care plan to provide an infertility benefit can produce a successful result.

Clinical value of using an automated sperm morphology analyzer (IVOS)

Objective: To determine the clinical value of automated normal sperm morphology outcomes. Design: Prospective clinical study. Setting: Clinical and research assisted reproduction laboratory. Patient(s): Two hundred seven GIFT cycles. Intervention(s): The wife was induced to superovulate, laparoscopically aspirated, and the gametes were transferred laparoscopically. The husband’s sperm morphology was evaluated with use of a sperm morphology analyzer using the strict criteria classification system. Main Outcome Measure(s): Normal sperm morphology, IVF, and pregnancy outcomes. Result(s): The logistic regression model showed that normal sperm morphology was significantly associated with fertilization in vitro, as dependent (age) and independent variables. Analyzing the fertilization rates across the 5% normal sperm morphology cutoff point, a fertilization rate of 39.39% (≤5%) compared with 62.92% (>5%) was obtained. The logistic regression model showed that normal sperm morphology was also a significant predictor of pregnancy when allowing for the number of oocytes transferred and female age. Analyzing the pregnancy rates across the 5% normal sperm morphology cutoff point, pregnancy rates of 15.15% (≤5%) and 37.36% (>5%) were obtained. Conclusion(s): Normal sperm morphology as evaluated by the automated semen analyzer (IVOS) was shown to adhere to the same fertility cutoff point (5%), as determined by the manual evaluation of sperm morphology. Automated normal sperm morphology outcomes also were found to be significant predictors of IVF and pregnancy in a GIFT program.

Different influence of incongruent follicular development on in vitro fertilization–embryo transfer and gamete intrafallopian transfer pregnancy rates

Objective: To compare the influence of incongruent (asymmetric) follicular development on treatment outcome in IVF-ET and GIFT cycles. Design: A retrospective comparative study. Setting: Tertiary referral center for infertility. Patient(s): Five hundred forty-three consecutive assisted reproduction cycles (428 IVF-ET and 115 GIFT) in 422 infertile patients. Intervention(s): Controlled ovarian hyperstimulation (COH) and IVF-ET or GIFT. Main Outcome Measure(s): The incongruity ratio as a parameter of the asymmetry in follicular development and pregnancy rate (PR). Result(s): For GIFT cycles, the PRs were 37.8% and 15.7% in cycles with congruent and incongruent follicular development, respectively. However, for IVF-ET cycles, the PR was not affected by incongruent follicular development: 28.2% and 29.0%, respectively. An inverse relationship was observed between the degree of incongruity and the estimated probability of pregnancy in GIFT cycles but not in IVF-ET cycles. Neither the side of the dominant ovary nor the degree of incongruity were consistent in consecutive cycles. Conclusion(s): Incongruent follicular development during COH has a significantly negative influence on the outcome of GIFT cycles but not on the outcome of IVF-ET cycles. The reason for this difference is not clear. We recommend considering IVF-ET instead of GIFT if incongruent follicular development occurs.

Incongruent follicular development reduces gamete intrafallopian transfer pregnancy rate

To test the null hypothesis that asymmetric or incongruent follicular development does not influence GIFT pregnancy rates (PRs). A prospective comparative study. Tertiary referral center for infertility. Ninety-three consecutive infertile patients having GIFT. Controlled ovarian hyperstimulation and GIFT. The incongruity ratio as a parameter of the asymmetry in follicular development and the clinical PR. An inverse relationship was observed between the degree of incongruity and the clinical PRs. In patients with an incongruity ratio < 1.5, the clinical PR was 56.1%. In patients with an incongruity ratio > or = 1.5, the clinical PR was only 17.3%. Incongruent follicular development during controlled ovarian hyperstimulation has a marked negative influence on the outcome of GIFT cycles. Factors such as side of the gamete transfer and oocyte quality did not account for the observed differences.

High-order oocyte transfer in gamete intrafallopian transfer patients 40 or more years of age

To analyze whether a policy of high-order oocyte transfer would be effective in women > or = 40 years of age who are undergoing GIFT, and further, whether a specific subgroup of these patients could be identified where clinical pregnancy was more likely to occur. Prospective descriptive study. Patients in a university-based reproductive endocrinology and infertility practice. Infertile women > or = 40 years of age who underwent GIFT cycles between January, 1990 and December, 1993 after not having achieved pregnancy with at least three previous cycles of superovulation and intrauterine insemination. Gamete intrafallopian transfer was performed after controlled ovarian hyperstimulation with hMGs. High-order oocyte transfer was employed. Clinical pregnancy rates (PRs). The overall clinical PR was 24.5% per retrieval (12/49) and 25.5% per transfer (12/47). A significantly higher number of oocytes were retrieved in patients who became pregnant than those who did not. Patient age, cycle day 3 FSH level, E2 level on the day of hCG administration, number of oocytes transferred, and total number of motile sperm transferred did not differ significantly between the two groups. The clinical PR per transfer was significantly higher in patients with more than five oocytes transferred (10/27, 37%) versus those with five or less oocytes transferred (2/20, 10%). No multiple gestations were obtained. The number of oocytes retrieved in women > or = 40 years of age undergoing GIFT is the main determinant predicting clinical pregnancy. High-order oocyte transfer seems to lead to a favorable PR while the risk of multiple gestation is limited.

Fertilization efficiency of morphologically abnormal spermatozoa in assisted reproduction is further impaired by antisperm antibodies on the male partner’s sperm

To investigate the influence of antisperm antibodies on the sperm surface on the outcome of IVF and GIFT. Matched controlled retrospective review of two large series. Reproductive endocrine divisions of two level-three academic centers. Twenty-nine male factor patients (38 IVF cycles) showing positive antisperm antibodies on the sperm by immunobead test treated by IVF at the Norfolk program and 56 similar patients (57 cycles) treated by GIFT at the Tygerberg program. Twenty-nine male factor patients (29 IVF cycles) with negative antisperm antibodies screening matched by wife's stimulation protocol and baseline semen analysis characteristics were used as controls in Norfolk; 56 GIFT patients (56 GIFT cycles) matched similarly were the Tygerberg controls. Study and control groups were divided according to sperm morphology pattern in normal, good, and poor prognosis subgroups for comparison. Fertilization rate of preovulatory oocytes used in IVF in Norfolk and of GIFT supernumerary preovulatory oocytes in Tygerberg; total and term pregnancy rates (PRs) and abortion rates. Fertilization rate was significantly lower in the IVF (41.9% +/- 2.8%) as well as in the GIFT (26.8% +/- 3.8%) (mean +/- SE) study groups than in the respective control groups (73.1% +/- 3.9% and 61.8% +/- 3.9%). Total and term PRs in IVF per cycle (21.1% +/- 6.6%; 13.2% +/- 5.5%) and per transfer (23.5% +/- 7.4%; 14.7% +/- 6.1%), and in GIFT (25.0% +/- 5.8%; 19.6% +/- 5.3%) in the study groups were also lower when compared with their control counterparts (IVF per cycle: 62.1% +/- 6.2% and 41.4% +/- 6.0%; IVF per transfer: 41.9% +/- 2.0% and 27.9% +/- 1.9%; GIFT: 31.6% +/- 6.2% and 28.1% +/- 6.0%), but the difference did not reach statistical significance. Abortion rates were similar in the IVF study group (37.5% +/- 17.1%) and its control groups (39.9% +/- 11.5%). The abortion rate in the GIFT study group was 14.3% +/- 9.4%, and no abortions were recorded in the control group (not significant). The presence of antisperm antibodies on the sperm surface per se impairs the outcome of assisted reproduction, mainly in terms of fertilization rate of preovulatory oocytes, and possibly in terms of total and term PRs. This holds true regardless of the impact of other semen parameters, particularly the morphology of the sperm within the semen sample.

Leuprolide acetate-prepared in vitro fertilization-gamete intrafallopian transfer cycles: efficacy versus controls and cost analysis

To evaluate the effect of gonadotropin-releasing hormone agonist (GnRH-a) when given through stimulation with gonadotropins versus stopping it as stimulation was initiated versus a control group unprepared in this manner. Also, to construct a cost analysis for this type of therapy in an in vitro fertilization-gamete intrafallopian transfer program (IVF-GIFT). Prospective, consecutive, randomized, with a control group. An out-patient IVF-GIFT program. One hundred new patients entering an IVF-GIFT program. In vitro fertilization or GIFT cycles with or without preparation (pituitary suppression) by GnRH-a administration in which suppression was continued or halted as gonadotropins were begun. Cancellation rates, ampules, and days of gonadotropin use, costs, estradiol (E2) level, egg numbers and quality, and pregnancy rates. Stopping GnRH-a (leuprolide acetate) therapy as stimulation was begun did not lessen the suppressive effect in reduction of spontaneous luteinizing hormone surge as seen with continued use of agonist. In contrast, the control group had a 30.3% cancellation rate before ovum retrieval. The E2 and egg data among the groups were similar, but as expected, agonist use led to the need for more and longer duration of gonadotropin stimulation. Pregnancy rates were not different by group. Costs were approximately even by the third initiated cycle.

The Role of Hysteroscopy in Patients Having Failed IVF/GIFT Transfer Cycles

Fifty patients who had undergone 2 or more failed in vitro fertilization (IVF) embryo transfer (ET) cycles or failed GIFT cycles where fertilization had been demonstrated, underwent hysteroscopy; 28% were found to have intrauterine abnormalities which may have been responsible for the failure of the IVF-ET or GIFT. Patients with an abnormality found at hysteroscopy had undergone a significantly higher mean number of transfer cycles. These results suggest that intrauterine abnormalities may be a cause for failure of IVF-ET or GIFT and therefore hysteroscopy should be part of the infertility work-up of all patients prior to undergoing IVF treatment.

The role of superovulation with menotropins in ovulatory infertility: a review

The risks of menotropin therapy (ovarian hyperstimulation syndrome, multiple gestation, adnexal torsion) are well known and have been previously described. Superovulation should not be considered for the indications described herein until more traditional therapies for infertility have been tried and found unsuccessful and sufficient time has elapsed for conception to occur. The cost of superovulation is high: the medications are expensive, frequent E2 monitoring and US studies are costly, and pregnancy complications relating to the higher rate of pregnancy loss and multiple gestation may add substantially to the overall cost. Yet, compared with IVF and GIFT, superovulation cycles combined with IUI cost between one third to one sixth that of an IVF cycle. Protocols involving combined CC/hMG/hCG, which reduce the total number of ampules of Pergonal needed per cycle and still provide multiple follicular development, may further reduce costs. There is a growing consensus that superovulation-IUI protocols should be attempted before GIFT and IVF in couples with normal pelvic viscera. There is little doubt that IVF and GIFT cycles are more costly, stressful, and complex. No comparative data have clearly shown IVF and GIFT to be superior to superovulation protocols in ovulatory women with normal pelvic anatomy. In the only study examining this issue published to date, Kaplan et al. retrospectively analyzed all GIFT and superovulation/IUI cycles at a single university center and found GIFT to be three times more efficient. However, the inherent limitations of a nonrandomized, nonprospective study of this kind are obvious as these authors have suggested. Therefore, it may be wise to consider the use of superovulation before assisted reproductive technologies until this issue is settled. It would be interesting to determine if the high PRs reported for couples with unexplained infertility or mild endometriosis in IVF and GIFT cycles in some centers not incorporating superovulation/IUI protocols would hold up if such an approach was routinely followed. Despite the increasing acceptance of superovulation protocols, we must be aware that many of the studies suggesting a role of hMG in treating ovulatory infertile women with normal pelvic anatomy suffer from deficiencies in experimental design. In a payor-driven system, such as in the United States, the difficulties in designing and carrying out scientifically sound clinical studies examining infertility therapies are obvious. The lack of federal or outside funding for the study of infertility issues contributes to the problem. It is our hope that better designed studies examining the role of superovulation in the treatment of ovulatory infertile women with normal pelvic anatomy will be forthcoming.

Gamete intra-Fallopian transfer with cryopreserved donor semen following AID failure

Results are presented of gamete intra-Fallopian transfer with cryopreserved donor semen in cases of male infertility with azoospermia or extreme oligozoospermia. The female partners had no detectable infertility problems and they had first received 10 cycles of intracervical AID without success. Forty-one GIFT cycles performed on 22 such patients gave an overall pregnancy rate of 26.8% (11/41). In 64% (9/14) of these cases, pregnancy occurred after the first GIFT attempt. From these results it is suggested that GIFT with donor semen may be a reasonable alternative after AID failure. The probable reasons for success of GIFT are discussed.

The cryopreservation of donor semen by a simplified method: use in an IVF and GIFT programme

The cryopreservation of semen used in assisted reproduction procedures was carried out exclusively by a simplified method in which a mixture of semen and cryoprotectant was contained in 1-ml tuberculin syringes and plunged directly into liquid nitrogen. Donor semen samples halved and frozen in syringes and in straws in a controlled-rate freezer showed no significant difference in post-thaw motility (P = 0.217) or survival (P = 0.217) after 30 min. However, after 180 min the survival rate showed a significant reduction in syringes (P = 0.045). A significant difference (P less than 0.00008) in the rate of fertilization of oocytes was seen in IVF cycles using frozen-thawed donor sperm (58/142, 42%) when compared to fresh sperm from husbands (2315/3926, 59%). A significant reduction (P less than 0.00005) in fertilization rate was also observed in the case of supernumerary oocytes in GIFT cycles with the cryopreserved donor sperm (29/132, 22%) compared to the husbands' sperm (239/514, 46%). However, the pregnancy rate following IVF and embryo replacement was the same after fertilization with fresh sperm (75/351, 21%) as opposed to frozen sperm (3/14, 21%). Furthermore, a higher pregnancy rate was observed in GIFT with frozen donor sperm (9/19, 47%) than with fresh sperm from husbands (28/103, 27%), though this was not statistically significant (P = 0.079). These results show this simplified methods of semen cryopreservation to be effective when used in an IVF and GIFT programme, giving pregnancy rates comparable to fresh normospermic semen samples. The method is simple, quick and inexpensive.

9 Induction of ovulation for assisted reproduction programmes

The decision to use enhancement of the natural ovarian/menstrual cycle to attempt collection of several oocytes during IVF and GIFT cycles has dramatically increased the pregnancy rates. Furthermore, the recovery of multiple fertilizable oocytes allows for cryopreservation of extra or surplus pre-embryos (or embryos), with the consequent reduction in the risk of multiple pregnancies and the improvement of the cumulative pregnancy rate following IVF and GIFT cycles. Here, we have reviewed the underlying physiological mechanisms in the natural ovarian-menstrual cycle. Subsequently, we have analysed the more frequently utilized ovarian stimulatory regimens with special emphasis on the use of gonadotrophins. Several conclusions may be drawn from the experience to date with these methods of ovarian stimulation. Primarily, lower doses of medication, when used appropriately, may result in a more favourable outcome. Most significant, it seems to be beneficial to tailor the dosages and timing of drug administration to the patient's individual response to medication. Because ovarian stimulation therapy is difficult to manage, a major challenge in reproductive endocrinology has been to develop stimulation protocols that would 'ideally' synchronize the development of a cohort of follicles. The development of GnRH analogues (agonists and antagonists) and the experience (both in women and macaques) gained so far when these drugs are used in combination with gonadotrophins, have helped both in the understanding of the underlying physiology and in the improvement of clinical results.

Gamete intrafallopian transfer as treatment for infertility associated with endometriosis

Forty-six patients with endometriosis-associated infertility underwent 59 GIFT cycles. The pregnancy rate per cycle was 30.5%. The presence of endometriomas in 11 patients did not affect this rate adversely. We conclude that, provided at least one fallopian tube is patent, GIFT compensates effectively for the possible causes of infertility in these patients.

The Role of the New Reproductive Technologies Including IVF and GIFT in Endometriosis

In the context of the pathophysiology of endometriosis, the technology of IVF-ET and GIFT appears to offer a promising alternative for infertility associated with endometriosis in situations refractory to conventional medical or surgical therapy. The success rate of IVF with respect to follicular response, oocyte recovery, fertilization rate, and pregnancy rate in mild-to-moderate (stages I to II) disease is comparable to patients with tubal disease. However, compromise of oocyte recovery and fertilization appears to be present in severe-extensive cases (stages III to IV) implying an impairment of reproductive potential in advanced disease. In all stages of endometriosis, prior therapy, either medical or surgical, offers the best prognosis for an IVF or GIFT attempt. Surgical therapy with operative endoscopy at the time of oocyte retrieval offers a reasonable prognosis for treatment-independent pregnancy in cases of active endometriosis. The GIFT procedure bypasses an unfavorable peritoneal environment in stages I to II endometriosis without anatomic distortion or compromise of fallopian tube function. Pretreatment with GnRH analogues prior to ovulation induction is valuable in suppression of active disease as well as in inducing improved homogeneity of follicular response in IVF or GIFT cycles.

Pregnancies in cancelled gamete intrafallopian transfer cycles

Forty-four percent of started GIFT cycles were cancelled. Insemination and intercourse in the cancelled cycles yield a 23% and 10% pregnancy rate, respectively.