Zygote Intrafallopian Transfer Research Articles

Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.

Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.

Racial/ethnic disparities in infertility treatment utilization in the US, 2011–2019

With delayed child-bearing age, there has been an increase in infertility rates globally and in the United States (US). Unsurprisingly, there has been a concomitant substantial increase in the number of individuals seeking infertility treatments over the last decade. This study aimed to examine the relationship between race/ethnicity and the utilization of different infertility treatments over the previous decade. We conducted this retrospective cohort study using the United States (US) Birth data files 2011–2019. We calculated the rates of infertility treatment and its subtypes over the study period. Descriptive statistics were utilized to examine the sociodemographic and birth characteristics for overall births and those associated with any infertility treatment and each of its subtypes. We calculated the level of association between race/ethnicity and utilization of infertility treatment and the subtypes using adjusted logistic regression models. We found that the rate of infertility treatments for all subtypes considered, had steadily increased by 63.7% within the past decade. In contrast, fertility enhancing drugs or Intrauterine Insemination (IUI) increased by 134%, and in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) treatments increased by 40% over the 9-year study period. Non-Hispanic (NH) Asian women had the highest rate of any infertility treatment with a rate of 25 per 1000 births whereas Hispanic women had the lowest rate of any infertility treatment at 5.8 per 1000 births. When compared with NH-White women, NH-Asian women had a modest 7% lower likelihood (OR = 0.93, 95% CI = 0.92–0.94) of receiving any infertility treatment while NH-Black and Hispanic women had about 70% lower likelihood of receiving any infertility treatment. Our report of increased assisted reproductive technology (ART) utilization rates, and marked racial/ethnic differences in ART utilization highlight the importance of expanding knowledge of inequities that continue to impact marginalized groups, a critical step for informing actionable strategy formulations (i.e., advocacy, policy change, patient education, provider training) to address these inequities.

Anaesthesia for assisted reproductive technology (ART): A narrative review

Assisted reproductive technology (ART) is used primarily to address the treatment of infertility which includes medical procedures such as in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), gamete intra-fallopian transfer (GIFT) or zygote intra-fallopian transfer (ZIFT). IVF has revolutionised infertility treatment and is nowadays widely accepted all over the world. The IVF is carried out as a daycare procedure and many anaesthetic regimens have been studied, tried and tested so far. An anaesthesiologist's role mainly comes into play during trans- vaginal oocyte retrieval and embryo transfer (ET) process of IVF. Various techniques of anaesthesia are practised which include general or regional anaesthesia, conscious sedation or monitored anaesthesia care, patient-controlled analgesia, acupuncture and transcutaneous electrical nerve stimulation (TENS). The anaesthetic management needs careful consideration of the effect of drugs on the maturation of oocytes or embryonic development, fertilisation and pregnancy rates. In view of the Coronavirus disease-19 (COVID-19) pandemic, ART clinics have been affected and due to the ambiguity of its effects on the reproductive outcome, anaesthesiologists need to be vigilant and cautious with anaesthetic management during pandemic times. This review includes a discussion of various anaesthetic options and agents along with their advantages or disadvantages if any. The literature sources for this review were obtained via PubMed, Medline, Cochrane Library and Google Scholar. The results of 82 out of 110 articles discussing different methods of anaesthesia for ART procedures over 25 years were compiled.

Noninvasive Zygote Transfer: A Rotating Spiral Micromotor for Noninvasive Zygote Transfer (Adv. Sci. 18/2020)

In article number 2000843, Mariana Medina-Sánchez and co-workers demonstrate a spiralshaped micropropeller that can capture, transport, and release a zygote, actuated solely by an external rotating magnetic fi eld, as a noninvasive alternative concept to laparoscopy, that is, zygote intrafallopian transfer by micromotors. This procedure is envisioned to improve the embryo implantation rates, which nowadays is one of the main causes of miscarriage in assisted fertilization.

A Rotating Spiral Micromotor for Noninvasive Zygote Transfer.

Embryo transfer (ET) is a decisive step in the in vitro fertilization process. In most cases, the embryo is transferred to the uterus after several days of in vitro culture. Although studies have identified the beneficial effects of ET on proper embryo development in the earlier stages, this strategy is compromised by the necessity to transfer early embryos (zygotes) back to the fallopian tube instead of the uterus, which requires a more invasive, laparoscopic procedure, termed zygote intrafallopian transfer (ZIFT). Magnetic micromotors offer the possibility to mitigate such surgical interventions, as they have the potential to transport and deliver cellular cargo such as zygotes through the uterus and fallopian tube noninvasively, actuated by an externally applied rotating magnetic field. This study presents the capture, transport, and release of bovine and murine zygotes using two types of magnetic micropropellers, helix and spiral. Although helices represent an established micromotor architecture, spirals surpass them in terms of motion performance and with their ability to reliably capture and secure the cargo during both motion and transfer between different environments. Herein, this is demonstrated with murine oocytes/zygotes as the cargo; this is the first step toward the application of noninvasive, magnetic micromotor‐assisted ZIFT.

Development of assisted reproductive technology services in Thailand between 2008 and 2014 before the new law: Results generated from the National ART Registry, Royal Thai College of Obstetricians and Gynecologists

Abstract Background While the assisted reproductive technology (ART) relieves the burden of infertility in many couples, it presents significant public health challenges due to the substantial risk for multiple birth delivery and preterm birth, which are associated with poor maternal and fetal health outcomes. For this reason, it is important to monitor the development and effectiveness of ART services in Thailand. Objective To analyze the trends of ART services in Thailand between 2008 and 2014. Methods ART clinics in Thailand are required to submit data to the Royal Thai College of Obstetricians and Gynecologists via the National Reporting System. The data from 2008 to 2014 were collected and analyzed. Results The number of ART centers was increased from 35 to 47. The total fresh ART cycles were also increased from 3,723 to 6,516. The percentage values of intracytoplasmic sperm injection (ICSI), in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer cycles were changed from 77.87 to 95.59, 21.43 to 4.31, 0.21 to 0.09, and 0.45 to 0.05, respectively. The clinical pregnancy rates were 28.79–33.19, 22.84–51.34, 14.29–42.86, and 0.00–26.67, respectively. The clinical pregnancy rates in fresh vs. frozen-thawed cycles were 31.01–36.33 vs. 31.54–37.34 (P < 0.05). The clinical pregnancy rates in female age <35 vs. 35–39 vs. ≥40 years were 36.97–40.70 vs. 32.74–33.42 vs. 21.08–31.34, respectively (P < 0.001), and the percentage values of multifetal pregnancy rate were 18.75 vs. 13.30 and 13.69, respectively (P < 0.001). There were increasing preimplantation genetic screening (PGS) cycles, with the percentage of the clinical pregnancy rate (25.90–42.63, P < 0.05). The clinical pregnancy rates in medium-sized ART centers (100–300 cycles per year) vs. in small and large centers were 30.79–41.14 vs. 28.01–34.04 and 8.70–40.35, respectively (P < 0.001). Trends of increasing percentage of ART birth rate to total birth rate ratio were 0.24–0.34 (P < 0.05). Conclusions There were higher clinical pregnancy rates in frozen-thawed cycles. Higher multifetal pregnancy rate and clinical pregnancy rate were also found in younger females. There were increasing uses of ICSI and PGS. A trend toward increasing ART birth to total birth ratio was observed.

142 Effect of follicular size on oocyte recovery rate, quality, and in vitro developmental competency following maturation, fertilization, and culturing in Bos indicus cows

Applied reproductive technologies include AI, multiple ovulation and embryo transfer, IVF, cloning, ovum pickup, and zygote intra-fallopian tube transfer in farm animals. Modern commercialized dairy farming is ever more relying on in vitro embryo production for maximal utilisation of superior genetics of female animals. Follicular size influenced the quality of the oocytes and their in vitro developmental competence in Bos taurus cows. However, this information is lacking in Bos indicus cows. Therefore, the objectives of the present study were to determine the effect of follicular size on recovery rate, quality, and in vitro developmental competence of the oocytes in Bos indicus cows. The ovaries (n=508) of 5- to 8-years-old Bos indicus cows, body condition score 2.75±0.25, having mixed parity and clinically normal reproductive tracts, were collected. These follicles on the ovaries were divided into 2 groups based on their size: (1) <6mm diameter and (2) ≥6mm diameter. The data on recovery; quality; maturation; cleavage rates; 4-cell, 8-cell, and 16-cell stages; and morula rate were analysed by Chi-squared test using SPSS version 20 software (IBM Corp., Armonk, NY, USA, 2016) system for windows. Results revealed that oocytes with grade I+II quality (68.4v. 42.1%; P<0.05) were higher, whereas grade III+IV quality (31.6v. 57.5%; P<0.05) were lower, in ≥6mm as compared with <6mm groups, respectively. Moreover, the 4-cell (34.5v. 18.7%), 8-cell (15.4v. 7.7%), 16-cell (8.7v. 2.2%) stages and morula rate (4.5v. 0.3%) were higher (P<0.05) in ≥6mm as compared with <6mm groups, respectively. However, the maturation and cleavage rates did not differ (P>0.05) between both groups. It is concluded that oocytes having follicle size ≥6mm have better quality in terms of morphological grades and in vitro developmental competence in Bos indicus cows. It is implied that for maximum production of embryos through ovum pickup, the most appropriate follicular size for aspiration is ≥6 mm.

Zygote intrafallopian tube transfer versus intrauterine cleavage or blastocyst stage transfer after intracytoplasmic sperm injection cycles in patients with repeated implantation failure: A prospective follow-up study.

This study aimed to compare the outcomes between zygote intrafallopian transfer (ZIFT) with intrauterine day-3 (cleavage stage) embryo transfer and intrauterine day-5 (blastocyst stage) embryo transfer in patients undergoing intracytoplasmic sperm injection. This prospective study was performed at Royan Institute, Tehran, Iran, between January 2012 and January 2014. Two hundred fifty women with more than three unexplained implantation failures were divided non-randomly into three groups according to embryonic age and methods used as follows: (i) intrauterine cleavage-stage embryo transfer (n = 100); (ii) intrauterine blastocyst-stage embryo transfer (n = 50); and (iii) ZIFT (n = 100). Implantation, clinical pregnancy, miscarriage and live birth rates were our main outcomes. Patients' characteristics and ovarian response were comparable among the three groups. Implantation rate (56.1% vs 27.9%) was significantly higher in the blastocyst group as compared to the ZIFT group; however, clinical pregnancy rate (38% vs 23%) was not statistically significantly different between the two groups, but due to the significantly higher miscarriage rate (34.7% vs 5.3%) in the ZIFT group, the live birth rate was significantly higher in the blastocyst group (P = 0.04). No significant differences were found between the cleavage-stage and blastocyst-stage groups in terms of implantation, clinical pregnancy, miscarriage and live birth rates. We do not recommend the use of the ZIFT procedure for patients with repeated implantation failures. It seems that replication of cleavage- or blastocyst-stage embryo transfer is more efficient and affordable.

A Case of Cervical Agenesis in a Patient Who Desires Fertility

INTRODUCTION: The objective of this study was to understand how cervical agenesis affects fertility management. Congenital absence of the cervix with functioning endometrial tissue is extremely rare. Primary amenorrhea and cyclic abdominal pain are the usual presentation. Creation of a functional cervix is difficult as a result of a lack of cervical mucus production. Thus, women who desire pregnancy must undergo in vitro fertilization with zygote intrafallopian transfer.

Should zygote intrafallopian transfer be offered to all patients with unexplained repeated in-vitro fertilization cycle failures?

BackgroundOne of the suggest strategy for patients with repeated implantation failure (RIF) is zygote intrafallopian transfer (ZIFT). However, no data exist regarding to the issue of when and under which circumstances should ZIFT be offered to patients with RIF? We therefore aimed to examine whether repeated implantation failure (RIF) patients characteristics or their previous controlled ovarian hyperstimulation (COH) variables may differentiate between those who will conceive following a ZIFT cycle and those who will not.MethodsForty seven consecutive women admitted to our IVF unit during a 7 year period, who underwent ZIFT for RIF, were included. Ovarian stimulation characteristics, number of oocytes retrieved and number and quality of zygotes/embryos transferred were assessed and compared between the ZIFT cycle and the previous IVF/ICSI cycle and between those who conceived following the ZIFT cycle and those who did not.ResultsTwelve clinical pregnancies (clinical pregnancy rate- 25.5%) were recorded following the ZIFT cycle. Those who benefit from ZIFT were young patients (≤31 yrs), who underwent ≤6 cycle attempts, yielding over eight 2PN embryos with low (≤0.4) ratio of number of top-quality embryos to total 2PN embryos. Moreover, in those destined for a ZIFT cycle, only those with >7 2PN embryo should undergo a transfer of at least five 2PN embryos.ConclusionsFurther large prospective studies are needed to identify the specific characteristics of RIF women who may benefit from ZIFT.

Zygote intrafallopian transfer among patients with repeated implantation failure

ObjectiveTo summarize the experience of a single center with laparoscopic zygote intrafallopian transfer (ZIFT) performed exclusively among patients with high-order repeated implantation failure (RIF) following in vitro fertilization-embryo transfer (IVF-ET). MethodsA retrospective cohort study was performed at the Edith Wolfson Medical Center, a tertiary referral university hospital located in Holon, Israel. A group of 176 patients with 8.15±3.9 previously failed IVF-ET cycles underwent 280 ZIFT procedures between 1995 and 2010. The main outcome measure was the live birth rate per patient treated. ResultsIn all, there were 274 fresh and 6 frozen ZIFT cycles recorded in the study cohort, resulting in 96 clinical pregnancies per attempt (34.3%) and 72 live births (25.7%). The live birth rate per patient was 39.8%. ConclusionThe use of ZIFT remains a powerful tool in the clinical management of selected patients with high-order RIF. This procedure should be kept in mind when all other measures fail among patients with at least 1 unobstructed fallopian tube.

Altering The Primal Environment: Health Effects Associated With Assisted Reproductive Technologies

When Darine El-Chaar began her residency in obstetrics and gynecology at the University of Ottawa five years ago, she grew curious about the potential health repercussions of assisted reproductive technologies (ART), the catchall term for procedures used to help couples artificially conceive a child. ART involves surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the womb.1 Women undergoing ART take “fertility drugs” such as clomiphene citrate and gonadotropins to stimulate the production of many eggs rather than the single egg that would normally grow during their monthly menstrual cycle.2 El-Chaar wondered about the influence that ART procedures, as well as the underlying infertility itself, might have on the health of children conceived. She is one of many researchers working to answer the fundamental question of whether introducing fertility drugs and manipulating eggs and sperm in a laboratory setting—in essence, altering the primal environment—sets the stage for adverse health effects in children. Artist’s rendering of intracytoplasmic sperm injection, in which a single sperm is inserted into an egg. Although some research indicates such a risk exists, there haven’t been enough large-scale studies to ascertain if the potential effects are severe enough over the long term to deter couples from seeking infertility treatments. Meanwhile, some findings are pointing the way toward possible refinements to improve health outcomes for ART babies.

Assisted reproductive technologies in Thailand: 2001–2007 results generated from the ART Registry, Royal Thai College of Obstetricians and Gynaecologists

To present the results of assisted reproductive technology (ART) performed in Thailand during 2001-2007. All licensed ART centers are obliged to submit annual reports on the number of patients, cycles, ART techniques and treatment outcomes to the Reproductive Medicine Subcommittee of the Royal Thai College of Obstetricians and Gynaecologists. Data from all centers were aggregated and analyzed retrospectively. Cycles were categorized into fresh and frozen/thawed embryo transfer (FET) cycles. Initiated cycles in the first category for 2001 to 2007 were 2183, 2112, 2780, 2717, 3458, 3579 and 4288, respectively. FET cycles during the same period were 467, 558, 733, 768, 1136, 1210 and 1473, respectively. The average pregnancy rate for in vitro fertilization (IVF) was 28.9% per retrieval (range, 26-32.3%) or 33.8% per transfer (range, 30.7-38.6%). Multiple pregnancies (of which 89.3% were twins) from all treatment procedures during this period were 11.4% (range, 9.2-14.5%). A congenital abnormality was reported in 0.56% of live births. The number of embryos per transfer in IVF decreased from 4.1 to 2.9, with no drop in pregnancy rates. Oocyte insemination by intracytoplasmic sperm injection (ICSI) was utilized more often than standard IVF, while gamete intrafallopian transfer and zygote intrafallopian transfer were almost completely replaced by IVF/ICSI. There was a significant difference in pregnancy rates (P < 0.01) when clinics were classified by cycle volumes (<100, 100-400 and >400 cycles/year). Despite many limitations, the data provided in this report will help patients, clinicians and policy makers understand the current situation of ART practice in Thailand.

The effect of infertility and assisted reproduction on first-trimester placental and fetal development

Our investigation of differences in first-trimester placentation and/or fetal biometry in pregnancies conceived spontaneously compared with those conceived through fertility treatment, and comparing less invasive fertility treatment with in vitro fertilization found no statistically significant difference in first-trimester abnormal placentation or fetal growth between pregnancies conceived spontaneously and those conceived through fertility treatment, or between the in vivo and in vitro subgroups.

Ectopic pregnancy after assisted reproductive technology: what are the risk factors?

This review discusses recent publications that investigate risk factors associated with ectopic pregnancy after IVF. Data on the risk factors for developing ectopic pregnancy after IVF are still inconsistent. Between fresh nondonor IVF and embryo transfer cycles, the significant risk factor for ectopic pregnancy was tubal factor infertility, and endometriosis, rather than male factor infertility. Higher ectopic pregnancy rate could be associated with zygote intrafallopian transfer, assisted hatching, large embryo transfer volume, deep fundal transfer, and frozen embryo transfer. The supraphysiologic progesterone level may decrease uterine contractility and enhance implantation in the uterine cavity in fresh embryo transfer compared with frozen embryo transfer cycles. Although recent results suggest reassurance in risk of ectopic pregnancy with frozen transfer, clinicians should be remembering this possibility while performing a frozen embryo transfer. Higher implantation potential per embryo at the blastocyst stage may increase the risk of ectopic pregnancy than cleavage stage. Especially, according to numbers of embryos transferred, different risk of ectopic pregnancy after IVF was noted. Different hormonal milieu, the reproductive health characteristics of infertile women such as distorted tubal function, technical issues of IVF procedures, and the estimated embryo implantation potential are possible risk factors. How each factor contributes to the risk of occurring ectopic pregnancy after assisted reproductive technology is uncertain and needs further investigation.

Perinatal risk in singleton pregnancies after in vitro fertilization

To assess perinatal risks to singleton births after in vitro fertilization (IVF) versus spontaneous conception. Cross-sectional. A 2006 registry database of the Japan Society of Obstetrics and Gynaecology (JSOG) capturing 5.8% of total births. 53,939 singleton births from spontaneous conceptions and 1,408 singletons after IVF. None. Perinatal death, low-birth weight (LBW), small for gestational age (SGA), congenital malformation, and sex ratio assessment based on singleton birth cases versus singleton live-born cases. In this study, IVF may include intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer, or IVF followed by zygote intrafallopian transfer. In crude and adjusted analysis, perinatal death, SGA, congenital malformation, and sex ratio were not statistically significantly associated with IVF. The LBW rates were statistically significantly higher in IVF pregnancies, but the association statistically significantly decreased after adjusting for confounding factors. Placental previa, a maternal outcome, was found to be statistically significantly higher in IVF pregnancies. No evidence was implicated IVF procedures as dramatically increasing the adjusted risk of perinatal death, LBW, SGA, congenital malformation, or sex ratio when compared with spontaneous conceptions. However, because of sample size limitations, the study cannot exclude small to moderate increases in perinatal deaths or congenital malformations.

Comparison of pregnancy and implantation rates in zygote intrafallopian transfer and uterine embryo transfer for nontubal infertility

We carried out a prospective randomized trial on 220 couples with nontubal factor infertility to compare pregnancy rates and implantation rates after zygote intrafallopian transfer (ZIFT) and uterine embryo transfer (UET). The zygote was transferred by laparoscopy into the fallopian tube 24 hours after oocyst retrieval. UET was performed 72 hours after retrieval with abdominal sonography guide. Transfer was performed in 102 cycles in the ZIFT and 100 cycles in the U ET group. The pregnancy and implantation rates were significantly higher in the ZIFT group (42.1% and 11.7%) than in the UET group (21.0% and 7.8%) (P < 0.05). ZiFT could be considered for couples who have limited time and adequate financial support.

Pregnancy After Uterine Artery Embolization for Symptomatic Fibroids: A Series of 15 Pregnancies

The purpose of this study was to report on pregnancies and their outcome after uterine artery embolization for uterine fibroids. From 2001 to 2004, 102 patients (mean age, [+/- SD] 35.7 +/- 6.4 years; range, 20-48 years) with symptomatic uterine fibroids underwent uterine artery embolization with 500- to 710-microm polyvinyl alcohol particles. The mean uterine volume was 552 +/- 649 cm(3) (range, 94-4,656 cm(3)), and the dominant fibroid size was 228 +/- 359 cm(3) (range, 14-2,618 cm(3)) before the procedure. During the 2-year follow-up period, the patients were asked whether they were trying to achieve pregnancy and whether they were successful. We obtained pregnancy and obstetric records of the pregnant women from physicians' offices and hospitals. Among 102 women who underwent bilateral uterine artery embolization, 23 (22.5%) were seeking to become pregnant, and 14 of the 23 (61%) became pregnant, nine having been nulliparous. One patient had two pregnancies. Fourteen pregnancies were spontaneous, and one was achieved by zygote intrafallopian transfer. Two miscarriages occurred, one in the 12th and one in the 16th week of gestation. The other 13 pregnancies went to term, were uncomplicated, and ended in elective cesarean delivery. All of the neonates were healthy with Apgar scores greater than 8. The mean weight of the neonates was 3,274 +/- 514.4 g (range, 2,100-3,950 g). One neonate was small for gestational age (2,100 g). Uterine artery embolization can serve as a substitute for invasive operations such as hysterectomy and myomectomy. Additional studies, including prospective, randomized comparisons with myomectomy, should be performed to ascertain whether uterine artery embolization is a safe procedure for women who want to preserve their fertility.

Zygote Intrafallopian Transfer (ZIFT): A Viable Option for Women of Advanced Maternal Age

Background: Recurrent implantation failure and spontaneous abortion are more prevalent in women of advanced maternal age (AMA) primarily due to increased rates of gamete and embryonic aneuploidy. Murine models demonstrate lower live birth rates from in-vitro cultured embryos versus those developed in-vivo. It follows that in-vitro culture may contribute to abnormal human embryonic development leading to implantation failure. Zygote Intrafallopian Transfer (ZIFT) may improve implantation rates by providing optimal conditions for early embryonic development.Objective: To determine whether ZIFT improves implantation rate in patients of AMA who previously failed traditional in-vitro fertilization-embryo transfer (IVF-ET).Materials and Methods: All patients ≥36 years of age at the time of their first IVF-ET, who failed to achieve a clinical pregnancy and subsequently underwent a ZIFT procedure over a four year period from 2004-2008 were included. Cycles involving egg donation and frozen embryos were excluded. The primary endpoint of the study was implantation rate.Results: Seven patients who underwent 10 IVF-ET cycles (mean 1.4 failed IVF-ET cycles) and nine ZIFT cycles were included in the analysis. The mean age at the time of the first IVF-ET was 39.0 ± 1.2 (36-43) and at the time of the first ZIFT 39.7 ± 1.1 (36-43) (P>0.05). A total of 39 embryos (mean 3.9 ± 0.5 embryos per ET, range 1-6) were transferred in the IVF-ET group versus 43 zygotes (mean 4.8 ± 0.3) zygotes per ZIFT, range 3-6) in the ZIFT group (P>0.05). Both implantation rates, 14/43 (32.6%) and 0/39 (0%), and clinical pregnancy rate per transfer, 6/9 (66.7%) versus 0/10 (0%), were significantly higher in the ZIFT versus IVF-ET group respectively (P<0.05). The multiple pregnancy rate in the ZIFT group was 3/6 (50%). Overall, 4/7 (57.1%) of the patients undergoing ZIFT achieved a clinical pregnancy.Conclusions: ZIFT is a viable option for women of AMA with previous IVF-ET failure. These results suggest that the intra-fallopian environment may be superior to in-vitro conditions for patients with a higher tendency to embryonic aneuploidy. Larger, prospective crossover trials are needed to verify these favorable results. Background: Recurrent implantation failure and spontaneous abortion are more prevalent in women of advanced maternal age (AMA) primarily due to increased rates of gamete and embryonic aneuploidy. Murine models demonstrate lower live birth rates from in-vitro cultured embryos versus those developed in-vivo. It follows that in-vitro culture may contribute to abnormal human embryonic development leading to implantation failure. Zygote Intrafallopian Transfer (ZIFT) may improve implantation rates by providing optimal conditions for early embryonic development. Objective: To determine whether ZIFT improves implantation rate in patients of AMA who previously failed traditional in-vitro fertilization-embryo transfer (IVF-ET). Materials and Methods: All patients ≥36 years of age at the time of their first IVF-ET, who failed to achieve a clinical pregnancy and subsequently underwent a ZIFT procedure over a four year period from 2004-2008 were included. Cycles involving egg donation and frozen embryos were excluded. The primary endpoint of the study was implantation rate. Results: Seven patients who underwent 10 IVF-ET cycles (mean 1.4 failed IVF-ET cycles) and nine ZIFT cycles were included in the analysis. The mean age at the time of the first IVF-ET was 39.0 ± 1.2 (36-43) and at the time of the first ZIFT 39.7 ± 1.1 (36-43) (P>0.05). A total of 39 embryos (mean 3.9 ± 0.5 embryos per ET, range 1-6) were transferred in the IVF-ET group versus 43 zygotes (mean 4.8 ± 0.3) zygotes per ZIFT, range 3-6) in the ZIFT group (P>0.05). Both implantation rates, 14/43 (32.6%) and 0/39 (0%), and clinical pregnancy rate per transfer, 6/9 (66.7%) versus 0/10 (0%), were significantly higher in the ZIFT versus IVF-ET group respectively (P<0.05). The multiple pregnancy rate in the ZIFT group was 3/6 (50%). Overall, 4/7 (57.1%) of the patients undergoing ZIFT achieved a clinical pregnancy. Conclusions: ZIFT is a viable option for women of AMA with previous IVF-ET failure. These results suggest that the intra-fallopian environment may be superior to in-vitro conditions for patients with a higher tendency to embryonic aneuploidy. Larger, prospective crossover trials are needed to verify these favorable results.

COMPARISON OF IMMEDIATE AND DELAYED TRANSFER OF MICRO-INJECTED OOCYTES INTO FALLOPIAN TUBES: A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL

Background Transfer of micro-Injected oocytes into fallopian tubes is an alternative procedure for IVF-ET with a similar success rate. This could be either done immediately after ovum pick-up microinjected oocytes intrafallopian transfer (MIFT) or after a time interval zygote intrafallopian transfer (ZIFT). This study was designed to compare the outcomes of the two procedures. Materials and methods The study population included 149 infertile patients who needed assisted reproductive technologies (ART) and fulfilled the criteria for transfer of oocytes into tubes. 2-5 injected oocytes were transferred into normal fallopian tube either immediately (Group A) or 24 hours later (Group B). Results A total of 63 (36.9%) pregnancies were achieved. There were 33 pregnancies in the immediate transfer group and 30 pregnancies in the delayed transfer group. No significant difference was found in the implantation rate and the clinical pregnancy rate. Conclusion This study demonstrates that no difference could be observed in outcome between immediate and delayed transfer groups. Therefore, immediate transfer of microinjected oocytes into fallopian tubes or MIFT is the preferred method.