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PubMed1996

The effect of ovulation induction on the concentration of maternal serum relaxin in twin pregnancies.

OBJECTIVE: Our purpose was to determine the effects of fetal number, various ovulation induction treatments, and placental hormones on the concentration of maternal serum relaxin. STUDY DESIGN: The concentrations of relaxin, human chorionic gonadotropin, estriol, and alpha-fetoprotein were determined in blood samples drawn at 16 to 18 weeks for prenatal diagnosis in 72 singleton and 115 twin pregnancies and analyzed by one-way analysis of variance, correlation analysis, and stepwise multiple linear regression of the log-transformed data. RESULTS: The maternal serum concentrations of each of the four measured hormones were significantly higher in the twin pregnancies than in the singleton pregnancies: 1.4-fold for relaxin, 1.9-fold for human chorionic gonadotropin, 1.9-fold for estriol, and 2.2-fold for alpha-fetoprotein (all p < 0.01). The concentrations of each of the four hormones were significantly correlated with each of the others and with the number of fetuses (p < 0.01), except that estriol was not significantly correlated with human chorionic gonadotropin. The serum relaxin concentration in twin pregnancies after treatment with follicle-stimulating hormone and luteinizing hormone (menotropins) (n = 10) was 3.3-fold that in twins resulting from spontaneous ovulation (n = 89, p < 0.01). In twins resulting from in vitro fertilization or gamete intrafallopian transfer (n = 9) the serum relaxin concentration was 2.6-fold higher than in twins resulting from spontaneous ovulation (p < 0.01). The effect of clomiphene citrate (1.2-fold, n = 7) failed to reach statistical significance. CONCLUSIONS: The second fetus causes a 1.4-fold increase in the concentration of maternal serum relaxin in twin pregnancies. Induction of ovulation with menotropins causes an additional 3.3-fold increase, whereas in vitro fertilization or gamete intrafallopian transfer treatment causes an additional 2.6-fold increase over that seen in twin pregnancies that followed spontaneous ovulation.

Chorionic Gonadotropin↗
PubMed1998

Age-related pregnancy rates in GIFT patients.

OBJECTIVE: Fecundity and fertility decline with increasing age beginning as early as age 30 and decrease more precipitously after age 40. The purpose of this study was to determine if pregnancy rates of patients attempting gamete intrafallopian transfer (GIFT) are lower for women between the ages of 35 and 40. METHODS: A retrospective chart review was performed to assess the age-specific pregnancy rates for patients in our GIFT program. We report the results of GIFT at Walter Reed Army Medical Center and the National Naval Medical Center during the period from July 1, 1994, to July 1, 1995. RESULTS: Fifty-six women aged 21 to 39 underwent one to three cycles of gamete intrafallopian transfer. The 72 tubal transfers performed resulted in 25 pregnancies (34.7% pregnancy rate per transfer). CONCLUSIONS: In this series, pregnancy rates did not differ significantly in women older than 35 years versus women younger than 35 years. The number of eggs collected decreased significantly with increasing age but was not significantly different between pregnant and nonpregnant patients. Previous reports demonstrate a clear decline in fertility and poor pregnancy rates with assisted reproductive technology in older women. We did not find age-related differences in pregnancy rates among women younger than 40 years undergoing GIFT during the period studied.

Adult↗
PubMed1993

Evidence that granulosa cells inhibit interleukin-1 alpha and interleukin-2 production from follicular lymphomonocytes.

OBJECTIVE: Relationships between immune and endocrine systems seem to occur in ovarian follicular fluids (FF). Lymphomonocytes have been found in preovulatory follicles and their specific products, cytokines [interleukin-1 (IL1), IL2], were demonstrated to inhibit steroidogenesis. Ovarian steroids, in turn, reduce the cytokine production from immune-competent cells. In the present study we evaluated whether lymphomonocytes are present in FF, and if both their subset distribution and their IL1 alpha and IL2 secretions, after activation with phytohemagglutinin (PHA), are similar to those of peripheral blood. Interferences of IL1 alpha and IL2 production by FF lymphomonocytes caused by isolated granulosa cells were also evaluated. PARTICIPANTS: The study was performed on 86 FFs obtained from follicles containing mature oocytes that were aspirated at the time of ovum pickup from 27 women undergoing controlled ovarian hyperstimulation with exogenous gonadotropins for an in vitro fertilization (IVF) program [IVF-embryo transfer (IVF-ET) or gamete intrafallopian transfer (GIFT)]. RESULTS: Lymphocytes were found in FF. The distribution of CD8+ and CD3+ lymphocyte subsets is equal to that in peripheral blood, but the percentage of CD11b+, CD16+, and CD4+ cells (its trend) is higher in FF than in peripheral blood. The amount of IL2 and IL1 alpha deriving from PHA-activated FF lymphomonocytes is similar to that of peripheral blood PHA-activated lymphomonocytes. Granulosa cells significantly blunt IL2 and IL1 alpha production by FF lymphomonocytes. CONCLUSIONS: These results suggest that preovulation, a migration of lymphomonocytes from the peripheral compartment to the follicle occurs. However, unfavorable effects of IL2 and IL1 alpha, cytotoxic and antisteroidogenetic activities, are counteracted by the products of granulosa cells. The higher amounts of CD11b+, CD16+, and CD4+ in FF suggest that they could be involved in other immune processes.

Adult↗
PubMed1990

Measurement of human chorionic gonadotropin during early pregnancy: a comparison of two immunoradiometric assays.

Evidence of implantation following either in vitro fertilization and embryo transfer (IVF-ET) or gamete intrafallopian transfer (GIFT) was obtained by collecting blood on days 10, 12, 14, 16, and 18 after oocyte recovery (day 0), and retrospectively measuring human chorionic gonadotropin (hCG). This was done using immunoradiometric assays for hCG, manufactured either by Serono Diagnostics Ltd. (MAIAclone) or Diagnostics Products Corporation (IRMA-count). The analysis of 63 serum samples by both kits showed a good correlation (r = 0.99) but the Serono (y) method gave values which were consistently greater (y = 1.58x + 4.89) than those of the DPC (x) method. A comparison of the hCG profile of singleton pregnancies measured with either the Serono (n = 33) or DPC (n = 22) kits gave a similar relationship. These results suggest that great care must be taken when comparing results from different laboratories using different kits. Also, consideration must be given to the possible loss of a continuous database should a laboratory change kit.

Chorionic Gonadotropin↗
PubMed1993

Efficacy of low dose purified FSH in ovulation induction following pituitary desensitization in polycystic ovarian syndrome.

OBJECTIVES: We evaluated the efficacy of ovulation induction using purified FSH in either low dose or conventional dosage in patients with polycystic ovarian syndrome. We assessed whether gonadotrophin measurement by radioimmunoassay or immunoradiometric assay is a better indicator of whether pituitary desensitization with a GnRH agonist (Zoladex) has occurred. DESIGN: Two different protocols were used. Pituitary desensitization was carried out with a GnRH agonist (Zoladex, ICI Pharmaceuticals UK). The patients were then randomized into one of two treatment groups. Conventional dose protocol: Patients commenced with a daily FSH (Metrodin, Serono Laboratories Ltd, UK) dose of 75 units for at least 7 days. The FSH dose was then increased, if necessary, based on ultrasound scans and plasma oestradiol (E2) levels in 75-unit increments. Low dose protocol: The same protocol was used except that the starting dose of FSH was 37.5 units daily with increments of 37.5 units. RESULTS: Low dose protocol (six patients, six cycles). There was a high incidence of multiple follicular development (10.3 +/- 5.6 (+/- SD) follicles, 5.0 +/- 3.8 follicles > 14 mm in diameter). Three cycles resulted in ovulation, one was anovulatory and two patients underwent gamete intrafallopian transfer due to multiple follicular development. Conventional dose protocol (seven patients, eight cycles). Again there was multiple follicular development (10.1 +/- 8.6 follicles, 2.0 +/- 2.3 > 14 mm). Three cycles were ovulatory, one anovulatory, three abandoned due to multiple follicular development and one underwent gamete intrafallopian transfer with the development of severe hyperstimulation necessitating steroid therapy. There was no difference between the two protocols in the number of days of FSH administration (low dose protocol 26 +/- 6.5, conventional dose protocol 23 +/- 8.1 days), the total number of units of FSH given per patient was 2844 +/- 1816 vs 2635 +/- 1726. The peak E2 level (pmol/l) during FSH treatment was 3193 +/- 662 vs 2389 +/- 3099 and the rate of increase in the FSH dose in ampoules of Metrodin per day was 0.058 +/- 0.03 vs 0.057 +/- 0.03. All patients were 'downregulated' (E2 < 70 pmol/l) prior to ovulation induction. However, gonadotrophin levels (IU/l) were 4.3 +/- 1.5 (LH) and 2.8 +/- 1.2 (FSH) by radioimmunoassay and LH was unchanged throughout FSH treatment whereas LH measured by immunoradiometric assay was < 1.0 IU/l prior to ovulation induction and remained so throughout. The mean LH radioimmunoassay to immunoradiometric assay ratio was 6.2 +/- 2.1. CONCLUSIONS: We conclude that regardless of the starting dose the use of pure FSH in patients with polycystic ovarian syndrome whose LH has been completely down regulated may be associated with multiple follicular development and a poor outcome. LH measured by radioimmunoassay is not a good indicator of whether pituitary densensitization has occurred but LH measured by immunoradiometric assay appears to be. These results strongly suggest that a basic minimum amount of LH is necessary for normal ovulatory development.

Adult↗
PubMedDate not supplied

[Preparation of human semen for in vitro fertilization procedures and intra-fallopian gamete transfer].

Techniques of "In Vitro" fertilization (IFV) and gamete intrafallopian transfer (GIFT) are proving to be successful in the treatment of infertility. We report here in detail the laboratory procedures of sperm processing for these two techniques also in the present work we pointing out the media quality control methods and the incubation time for the maintenance of spermatozoa fertilizing ability.

Female↗
PubMed1994

The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence.

BACKGROUND: Although the medical complications associated with multiple-gestation pregnancies have been well documented, little is known about the effects of such pregnancies on the use of health care resources and the associated costs. This is an important issue because of the increasing use of assisted-reproduction techniques, which commonly result in multiple-gestation pregnancies. METHODS: We determined hospital charges and the use of assisted-reproduction techniques (such as induction of ovulation, in vitro fertilization, and gamete intrafallopian transfer) for 13,206 pregnant women (11,986 with singleton pregnancies, 1135 with twin pregnancies, and 85 with more than two fetuses) who were admitted for delivery to Brigham and Women's Hospital, Boston, in 1986 through 1991 and their 14,033 neonates (11,671 singletons, 2144 twins, and 218 resulting from higher-order multiple gestations). RESULTS: After we controlled for variables known to affect hospital charges, the predicted total charges to the family in 1991 for a singleton delivery were $9,845, as compared with $37,947 for twins ($18,974 per baby) and $109,765 for triplets ($36,588 per baby). Assisted-reproduction techniques were used in 2 percent of singleton, 35 percent of twin, and 77 percent of higher-order multiple-gestation pregnancies; such procedures were approximately equally divided between induction of ovulation alone and in vitro fertilization or gamete intrafallopian transfer. CONCLUSIONS: Multiple-gestation pregnancies, a high proportion of which result from the use of assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques, dramatically increase hospital charges. If all the multiple gestations resulting from assisted-reproduction techniques had been singleton pregnancies, the predicted savings to the health care delivery system in the study hospital alone would have been over $3 million per year. Although assisted reproduction provides tremendous benefits to families with infertility, the increased medical risks entailed by multiple-gestation pregnancies and the associated costs cannot be ignored. We suggest that more attention be paid to approaches to infertility that reduce the likelihood of multiple gestation.

Adolescent↗
PubMed1993

GIFT, ZIFT, and related techniques.

This review focuses on the theoretical backgrounds for tubal gamete and zygote/embryo transfer, as well as the clinical results of gamete intrafallopian transfer (GIFT), which are compared with other non-fertilization procedures in infertile women with patent fallopian tubes. While GIFT and zygote intrafallopian transfer (ZIFT) probably result in a more synchronized entry of embryos into the uterine cavity, prospective, randomized studies have not shown these methods to be preferable to conventional in-vitro fertilization and embryo transfer. Nevertheless, co-culture with various cell types seems to yield more viable embryos with a high rate of implantation. The promising results with co-culture do not seem to be a cell- or species-specific phenomenon. This non-specific positive or negative conditioning effect of co-culture on embryo quality indicates that more optimal culture media for in-vitro fertilization can probably be devised. The requirements of laparoscopy and general anesthesia with GIFT have prompted the development of simpler methods based on fertilization in vivo. Various methods of artificial insemination combined with controlled ovarian hyperstimulation yield comparable results with GIFT in unexplained infertility. In endometriosis, GIFT seems to give better results compared with insemination techniques. Less invasive transcervical gamete and embryo transfer techniques have now been established, obviating the need for operating theater facilities.

Anesthesia, General↗
PubMed1989

An 18-month survey of infertility treatment by in vitro fertilization, gamete and zygote intrafallopian transfer, and replacement of frozen-thawed embryos.

An 18-month survey of infertility treatment by in vitro fertilization (IVF) and related procedures at the Centre for Reproductive Medicine of the Vrije Universiteit Brussel is described. During this period, 1326 treatment cycles were started in patients with long-standing infertility and 1135 oocyte retrievals were performed in 771 different patients. IVF and embryo transfer (ET) after laparoscopic (N = 793) or ultrasonically guided (N = 342) ovum pickup, gamete intrafallopian transfer (GIFT; N = 284), or zygote intrafallopian transfer (ZIFT; N = 15) combined with IVF as well as the replacement of cryopreserved embryos yielded an overall pregnancy rate of 21.8% per started cycle. Echographic and laparoscopic oocyte retrieval gave similar results except for a higher fertilization rate after echographic-guided retrieval. For in vitro fertilization and embryo transfer an overall pregnancy rate of 26% per transfer was obtained. For GIFT and ZIFT the pregnancy rates were, respectively, 27.8 and 46.7% per replacement. For each procedure one-third of the pregnancies aborted. After the replacement of frozen and thawed embryos, during a natural cycle, a significantly lower fetal loss was observed.

Adult↗
PubMed1990

[Intra-tubal gamete transfer: analysis of prognostic indices based on 62 treatment cycles].

Gamete intrafallopian transfer (GIFT) was applied in 55 couples in 62 treatment cycles. The overall pregnancy rate was 38.7% (24 of 62), the highest incidence of pregnancy being obtained in the group of tubal adhesions (8 [47%] of 17), in cases of multifactorial infertility (7 [44%] of 16) and of unexplained infertility (4 [36%] of 11). The multiple pregnancy rate was 21%, 17% ended in clinical abortions and one (4%) was a tubal pregnancy. Pregnancy was correlated with the number of oocytes transferred: whereas less than or equal to 3 oocytes were replaced in only 1 (4%) of 24 pregnant women, 9 (26%) of 34 non-pregnant women had less than or equal to 3 oocytes transferred (p less than 0.005). On comparing pregnant and non-pregnant women, no significant correlation was found for 1.) the degree of maturity of oocytes transferred, 2.) the percentage of supernumerary oocytes being successfully fertilized in vitro and 3.) the hormonal pattern observed during hyperstimulation with human menopausal gonadotropin.

Adult↗
PubMed1990

Efficacy of assisted reproductive technology during diagnostic and operative infertility laparoscopy.

Women being evaluated for infertility were offered assisted reproductive technology at the time of diagnostic laparoscopy. Oocyte retrieval was performed after ovulation induction in 33 women, of whom 19 had concurrent operative laparoscopy. Gamete intrafallopian transfer (GIFT) or in vitro fertilization (IVF) and embryo transfer were performed subsequently depending on laparoscopic assessment of pelvic architecture, oocyte maturity, and semen parameters. The clinical pregnancy rate was 24% per cycle and 28% per gamete or embryo transfer (four pregnancies after GIFT and four after IVF/embryo transfer). The clinical pregnancy rate per transfer did not differ significantly between the 19 women who had therapeutic operations in conjunction with laparoscopy (lysis of adhesions and/or fulguration of endometriosis) and the 13 who did not (25 versus 30%; P greater than .05). Assisted reproductive technology can be performed successfully during diagnostic infertility laparoscopy. Operative endoscopic manipulation did not adversely influence pregnancy outcome.

Adult↗
PubMed1988

Pregnancies after intrafallopian transfer of embryos.

Six patients with a history of infertility of more than 4 years were offered in vitro fertilization (IVF) followed by translaparoscopic embryo transfer to the fallopian tubes. Three of the patients became pregnant. In one patient the oocytes did not fertilize in vitro. Intrafallopian transfer of embryos may be an alternative to gamete intrafallopian transfer (GIFT) or IVF, especially in those cases where confirmation of fertilization is wanted.

Adult↗
PubMed1989

[Combined GnRH analogs/hMG/hCG treatment].

Ovarian stimulation with human menopausal gonadotropins after Gn-RH-analogue induced pituitary desensitization has been shown to optimize the follicular maturation. This is mostly due to the avoidance of irregular endogenous LG-reactions which occur during hMG-therapy in about one third of the treatment cycles. In several studies using Buserelin or Decapeptyl as Gn-RH-analogue 282 patients were treated for in vitro fertilization, gamete intrafallopian transfer or as part of an "in vivo" therapy. Pregnancy rates were significantly improved in all groups: HMG/hCG therapy resulted in a pregnancy rate of 17% per patient whereas by the combined therapy in 25% of the patients a pregnancy was achieved.

Buserelin↗
PubMed1989

[Transurethral transvesicular follicle aspiration in the IVF and ET program].

Fifty eight ultrasound-guided transurethral aspirations for in vitro fertilization were performed from October 1987 to June 1988. At that time twenty two laparoscopic oocyte retrievals were done, mostly in patients in our gamete intrafallopian transfer (GIFT) program. All procedures were performed by the same ovarian stimulation protocol under general anesthesia. In the transurethral ultrasound-guided group 143 oocytes were recovered from 207 follicles aspirated (69.1%). The fertilization rate was 52.4% and one clinical pregnancy occurred. In the laparoscopy group 43 oocytes were recovered from 70 follicles aspirated (61.4%). The fertilization rate (because of GIFT procedures) could not be assessed. There were no statistically differences between the two groups. No major complications were noted. Transurethral transvesical ultrasound-guided follicular aspiration should be considered as an alternative route for oocyte retrieval.

Embryo Transfer↗
PubMed1990

Increasing the human menopausal gonadotropin dose--does the response really improve?

This study assesses the effects of attempts to optimize human menopausal gonadotropin (hMG) dosage in 271 patients who had at least two hyperstimulation cycles for in vitro fertilization or gamete intrafallopian transfer. In the first cycle, all patients received clomiphene citrate and hMG 150 IU/d. In the second cycle, the hMG dose was increased in 45% of patients to try to increase the egg yield. In spite of the increase, the population response was practically identical in both cycles. Median numbers of eggs retrieved (6 versus 6), no eggs retrieved (0.4% versus 1%), only one or two eggs retrieved (10% versus 10%), and canceled cycles (10% versus 10.7%). This suggests that increasing the hMG dosage above 150 IU does not increase the number of eggs retrieved. A poor response may be due to inherent differences in follicular development that cannot be overcome by increases in hMG dosage.

Dose-Response Relationship, Drug↗
PubMed1998

Assisted reproductive technology in the United States and Canada: 1995 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States and Canada in 1995. DESIGN: Data were collected in the Society for Assisted Reproductive Technology database program and cycle reporting forms and were submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Two hundred eighty-one programs submitted data on procedures performed in 1995. Data were collected after November 1996 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Procedural outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULT(S): Programs reported initiating 59,142 cycles of ART treatment, including frozen embryo and donor oocyte cycles. Of these, 41,087 cycles initiated were IVF (with and without micromanipulation) with 22.5% deliveries per retrieval; 3,741 were cycles of gamete intrafallopian transfer with 27.0% deliveries per retrieval; 1,078 were cycles of zygote intrafallopian transfer with 27.9% deliveries per retrieval. In addition to these cycles initiated in 1995, 8,453 frozen embryo thaw procedures were reported, either as separate procedures or in combination with other ART procedures with 15.2% deliveries per transfer, 3,555 donor oocyte cycles were initiated with an overall success of 36.0% deliveries per transfer, 1,028 cryopreserved embryo thaw procedures from donated oocyte procedures with an overall success of 16.8% deliveries per transfer, and 200 ART treatment cycles in which a host uterus was used were initiated with an overall success of 34.9% deliveries per ET. As a result of all procedures, a total of 11,631 deliveries were reported, resulting in 16,520 neonates. CONCLUSION(S): In 1995, there were more programs reporting ART treatment and a significant (19.3%) increase in reported cycles. In comparable cycle types, overall average success rates (deliveries per transfer) exhibited a 0.6% increase or a 2.5% increase over the rates in the 1994 reported summaries.

Adult↗
PubMed2004

Assisted reproductive technology in the United States: 2000 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 2000. DESIGN: Data were collected electronically using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/ Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred eighty-three programs submitted data on procedures performed in 2000. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULT(S): Programs reported initiating 99,989 cycles of ART treatment. Of these, 73,406 cycles involved fresh nondonor IVF (46.6% with intracytoplasmic sperm injection [ICSI]), with a delivery rate per retrieval of 29.9%; 549 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 24.7%; 763 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.9%. The following additional ART procedures were also initiated: 7,581 fresh donor oocyte cycles, with a delivery rate per transfer of 43.7%; 13,083 frozen embryo transfer procedures, with a delivery rate per transfer of 20.4%; 2,721 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.5%, and 1,200 cycles using a host uterus, with a delivery rate per transfer of 35.8%. In addition, 326 cycles were reported as combinations of more than one treatment type, 41 cycles as research, and 319 as embryo banking. As a result of all procedures, 25,394 deliveries were reported, resulting in 35,345 neonates, of which 35,031 were live born and 314 stillborn. CONCLUSION(S): In 2000, there were more programs reporting ART treatment and a significant (13.5%) increase in reported cycles compared to 1999. In comparable cycle types, overall success rate (deliveries per retrieval) exhibited an actual increase of 0.6%, which represents an increase of 2.2% when compared to the success rate for 1999.

Embryo Transfer↗
PubMed1993

The likelihood of pregnancy with IVF and GIFT in Australia and New Zealand.

OBJECTIVE: To determine the likelihood of pregnancy for couples entering the New Reproductive Technology (NRT) programs in Australia and New Zealand, by combining the data from nearly all the practising units. DESIGN: All units practising in-vitro fertilisation (IVF) and/or gamete intrafallopian transfer (GIFT) were contacted and asked to provide data on patients treated and pregnancy rates. These figures were then combined to produce life tables to determine the likelihood of pregnancy with repeated attempts. SETTING: IVF/GIFT units in five States of Australia, the Australian Capital Territory and New Zealand. Eighteen of the 22 units provided data to be analysed. PATIENTS: Data were available for analysis on 18,089 cycles of IVF resulting in 3034 clinical pregnancies, and 6308 cycles of GIFT resulting in 1724 clinical pregnancies. MAIN OUTCOME MEASURES: This was either "clinical pregnancy" (the presence of products of conception on ultrasound examination), or "viable pregnancy" (a pregnancy developing to at least 20 weeks of gestation). RESULTS: After four attempts at IVF, half the couples achieved a pregnancy, whereas four attempts at GIFT resulted in two-thirds of the couples achieving pregnancy. CONCLUSION: Both IVF and GIFT are effective and successful options for infertile or subfertile couples. New Reproductive Technology should be readily available in every advanced clinic dealing with subfertile couples in the 1990s.

Australia↗