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Increased risk of preterm birth in singleton pregnancies resulting from in vitro fertilization-embryo transfer or gamete intrafallopian transfer: a meta-analysis.

OBJECTIVE: To perform a systematic review of the literature to determine whether singleton pregnancies resulting from IVF-ET/GIFT are at higher risk for preterm birth (<37 weeks). DESIGN: Literature search and systematic review. SETTING: Medical school. INTERVENTION(S): A MEDLINE search (1965-2000) was performed using the terms "premature labor," "infertility," "pregnancy complications," "gonadotropins," "pregnancy outcome," "preterm delivery," and "in vitro fertilization." Criteria for inclusion were English language, original research article, study patients conceived using IVF-ET (with or without intracytoplasmic sperm injection) or GIFT, pregnancy outcome reported compared with a control group (e.g., naturally conceived singletons at their hospital or a national reference), and prematurity clearly defined. Incomplete articles (e.g., abstracts), reports of other studies, and studies that failed to separate multiple from singleton gestations were excluded. MAIN OUTCOME MEASURE(S): Summary of relative risks of preterm birth. RESULT(S): Twenty-seven articles met all inclusion/exclusion criteria and were analyzed by meta-analysis. The random-effects summary relative risk of preterm birth in singleton pregnancies resulting from IVF-ET/GIFT was 1.98 (95% confidence interval, 1.77-2.22). CONCLUSION(S): The risk of preterm birth in singleton pregnancies resulting from IVF-ET/GIFT is twice that of natural conceived pregnancies.

Confidence Intervals↗

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.

Adult↗

[A study of the controlled ovarian hyperstimulation using GnRH agonist and pure FSH in in vitro fertilization-embryo transfer and gamete intrafallopian transfer program].

The present study was undertaken to examine controlled ovarian hyperstimulation (COH) during an IVF-ET/GIFT program with GnRH agonist (GnRH-a) and pure FSH and with the conventional method. Pituitary desensitization was induced with a subcutaneous injection of GnRH agonist (leuprolide acetate) in 20 patients undergoing COH for oocyte recovery. These 20 patients had previously dropped out of our IVF-ET/GIFT program because of a low estradiol response or premature LH surge. Comparisons were made among the menstrual cycles of 20 drop-out patients, the same patients' cycles after GnRH-a and pure FSH administration (GnRH-a group), and the cycles of 20 non-drop-out patients (control group). After treatment with GnRH-a and pure FSH, Estradiol levels were increased (GnRH-a cycles:previous cycles, 1,520 +/- 416 pg/ml:416 +/- 209.1 pg/ml), while the premature LH surge was decreased (GnRH-a cycles:previous cycles, 2:12). Moreover, the number of follicles at the day of hCG injection was increased (GnRH-a group: control group, 4.6 +/- 1.3:3.4 +/- 1.5). However, the fertilization rates for the GnRH-a group and the control group did not differ markedly, though the pregnancy rate was increased slightly in the former (GnRH-a group:control group, 25%:15%). In conclusion, it was seen that COH using GnRH-a and pure FSH contributed to a better ovarian response and suppression of LH surge in patients who had previously dropped out of the IVF-ET/GIFT program using conventional ovarian stimulation.

Adult↗

Appraisal of gamete intrafallopian transfer.

OBJECTIVE: To collect results of gamete intrafallopian transfer on a large scale in order to compare treatment indications, results, and factors which influence the success rates; to evaluate whether gamete intrafallopian transfer is well-established and what the real place of this procedure is among other assisted reproduction techniques. DESIGN: Data relating to gamete intrafallopian transfer were collected from World Reports, national registries of different countries and meta-analysis of medical publications during the years 1986-1991. SUBJECT: Official registries reported 47,200 treatment cycles and 18,759 treatment cycles were analysed from ten medical publications. RESULTS: The procedure accounts for 13.5% of all assisted reproduction techniques but its popularity varies significantly among countries. The same indications for gamete intrafallopian transfer are followed by all countries, but great differences exist with regard to the proportional share of each etiology. Also, the share has changed considerably over the years. TREATMENT OUTCOME: 10,667 clinical pregnancies were reported which represent 24% of treatment cycles and 29% of ovum pick-up. The live birth rate was 23.3%; abortion rate, 22%; and ectopic pregnancy rate, 5.5%. The stillbirth rate was 2.3% and the malformation rate was 2.8%, not confined to specific organs or systems. There were 19.5% twins, 4.6% triplets and 0.3% quadruplets or more. The number of transferred oocytes influenced pregnancy rates: 28% for transfer of four oocytes and only 10% following transfer of one oocyte. The cause of infertility might influence the results and the poorest results are obtained for male factor infertility. In most cases correlation of success rates reported by leading units through medical publications closely resembles the overall national registries results. Indications for this treatment were broadened over the years, but its role among other assisted reproduction technologies is not agreed upon, especially for male factor and unexplained infertility. CONCLUSIONS: Gamete intrafallopian transfer carries an overall higher pregnancy rate than in vitro fertilization. Quality control by professional or public associations should be established and more research employed over indications for treatment and results in order to establish when GIFT is the treatment of choice and when other modes of treatment should be preferred.

Australia↗

Comparison between swim-up and glass wool column filtration of human semen in a gamete intrafallopian transfer program.

This study compared swim-up and glass wool filtration in both pregnancy outcome and fertilization of excess oocytes in patients undergoing gamete intrafallopian transfer. Gamete intrafallopian transfer patients were retrospectively included in the study group (n = 52). The criteria for inclusion were as follows: Semen had to have been prepared by means of glass wool filtration and at least 2 metaphase II oocytes had to have been transferred. Each patient from this group was then carefully matched with another patient according to specific criteria (number of metaphase II oocytes aspirated and transferred, normal sperm morphology, wife's age, the absence of anti-sperm antibodies, semen preparation by means of the swim-up procedure). Fourteen patients were matched with themselves (groups A1 and A2) and 38 patients were matched with another patient (groups B and C). The results indicate that there was no significant difference in the fertilization and pregnancy probabilities of sperm prepared by means of glass wool filtration or swim-up procedure. The comparative pregnancy rates for the groups were A1 (7.1%) versus A2 (7.1%) and B (28.9%) versus C (31.6%). Factors other than fertilization and pregnancy potential may have a greater influence on choosing the optimum sperm preparation procedure.

Female↗

Gamete intrafallopian transfer: different routes of transfer.

The Authors report their own experience and results using different approaches to oocyte pick-up and gamete transfer for gamete intrafallopian transfer (GIFT). The overall pregnancy rate of GIFT is 35.86% (66 pregnancies on 184 cases of GIFT). The Protocol I (Laparoscopic oocyte retrieval and gamete transfer) is presently the more used and gives better clinical results (pregnancy rate of 37.7%); in the Author's opinion, the protocols III (echographic pick-up + IVF + laparoscopic delayed zygote intrafallopian transfer (ZIFT), and VII (Laparotomic pick-up and transfer) are interesting complementary techniques for GIFT.

Adult↗

Factors affecting pregnancy rates of in vitro fertilization and gamete intrafallopian transfer.

Factors affecting pregnancy rates in gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) were evaluated. Higher pregnancy rates were found when more mature oocytes were recovered (6.2 +/- 2.5 vs 3.8 +/- 3.0) and more oocytes (4.6 +/- 1.0 vs 3.3 +/- 1.2) or zygotes (4.7 +/- 1.4 vs 3.0 +/- 1.7) were transferred. Ultrasound-guided follicular aspiration was successful for in vitro fertilization and had a pregnancy rate (14.3%) comparable to the laparoscopic approach (13.3%). Laparotomy for correction of pelvic pathology concomitant with oocyte retrieval should be used cautiously despite the high preliminary pregnancy rate (42.9%). Failed fertilization of the surplus oocytes left after gamete intrafallopian transfer did not mean a poor chance of pregnancy (27.6%). The combined treatment of gamete intrafallopian transfer and in vitro fertilization may have a higher chance of pregnancy (43.5% vs 21.4% in GIFT and 13.3% in IVF), and more multiple pregnancies (40.0% vs 22.2% in GIFT and 16.7% in IVF). Cycles with spontaneous LH (luteinizing hormone) surges, detected by daily morning urine samplings, need not be aborted and the timing of ovum recovery should be individually evaluated.

Female↗

Evaluation of leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins for in vitro fertilization or gamete intrafallopian transfer.

A prospective randomized trial was conducted to compare the efficiency of two ovarian stimulation protocols for in vitro fertilization-embryo transfer or gamete intrafallopian transfer. Protocol 1 consisted of clomiphene citrate and human menopausal gonadotropin (hMG) with 55 cycles of 42 patients being evaluated. Protocol 2 had 38 cycles of 34 patients receiving a gonadotropin-releasing hormone agonist (GnRH-a) and hMG. The incidence of a spontaneous luteinizing hormone surge was 38.2% in protocol 1 and 0% in protocol 2. Both protocols had a similar cancellation rate. The total clinical pregnancy rates per oocyte retrieval for patients receiving protocol 1 and protocol 2 were 19.5% and 10.3%, respectively. The difference was not statistically significant. Therefore, as first-line ovulation induction agents, it cannot be concluded that either protocol demonstrates a clear superiority over the other and further trials of the GnRH-a/hMG combination are indicated.

Adult↗

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.

Journal Article↗

Oocyte donation and gamete intrafallopian transfer in premature ovarian failure.

Gamete intrafallopian transfer (GIFT) was performed in eight patients with premature ovarian failure (POF), using donated oocytes. The steroid replacement protocol consisted of the administration of increasing dosages of 17 beta-estradiol (E2) and progesterone (P). Hormonal replacement was maintained until day 100 of gestation. All patients underwent an evaluation cycle in which serum levels of E2 and P were monitored and an endometrial biopsy was performed on day 21 or 22. All cases of GIFT were performed between days 12 and 15. Six clinical pregnancies were achieved in eight cycles (75% success rate). Three patients delivered and three are in their second or third trimester. No ectopics or miscarriages occurred. These results offer a promising approach for the establishment of fertility in agonadal patients.

Adult↗

[Ovum donation and gamete intrafallopian transfer (GIFT): a new reproduction concept].

Gamete intrafallopian transfer (GIFT) was performed in 11 patients with premature gonadal failure and infertility, with oocyte donation. The sustitutive estrogen therapy with Estradiol Valerinate and Progesterone was maintained up to 100 days after the transfer. In all the cases GIFT was performed between the day 13 and 70 of the cycle. There were 5 pregnancies out of 11 cycles (success rate of 45.4%), one ended with a live child and the four others are on their first, second and third trimester. We are presenting a modified and simplified new protocol for hormonal replacement and our results suggest a new and wide "endometrial window" for the management of this patients. This results offer a promising future for patients with premature gonadal failure.

Adult↗

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

Acrosome↗

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

AIM: To investigate the prognostic significance of hysterosalpingography carried out before one-sided gamete intrafallopian transfer for unexplained infertility. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Adult↗