Births after transcervical gamete intrafallopian transfer with a falloposcopic delivery system.

OBJECTIVE: To evaluate the safety and efficiency of a new delivery system to perform transcervical GIFT. DESIGN: Evaluation of pregnancy rate (PR), miscarriage rate, ectopic pregnancy rate, and delivery rate. SETTING: Institute of Obstetrics and Gynecology, Reproductive Endocrinology Unit, Infertility and IVF Center. PATIENT(S): Twenty-five patients with patent tubes documented by laparoscopy plus falloposcopy. INTERVENTION(S): Superovulation was induced with GnRH analogue and FSH. Under laparoscopic control, transcervical cannulation of the tube was done using a linear everting catheter incorporating direct falloposcopic vision of the tubal lumen. Two lengths of everting catheter (3 and 6 cm) were used providing either isthmic-ampullary or midampullary placement of the inoculum. A comparison was done in terms of ease of access and transfer, falloposcopic observations, and PRs between the groups. MAIN OUTCOME MEASURE(S): Efficacy was established by evaluating the PR, miscarriage rate, ectopic pregnancy rate, and delivery rate. RESULT(S): The PR was 28% (with no differences between the lengths of everting catheters). No ectopic pregnancies occurred. The abortion rate was 28.6% and the delivery rate was 20%. Neither tubal perforation nor other complications occurred during the procedure. CONCLUSION(S): Falloposcopic GIFT is safe and efficient and may be a less invasive alternative than laparoscopic transfer.

Initial experience with a new microlaparoscope 2 mm in external diameter.

The microlaparoscope was used for diagnostic and operative purpose in 20 patients, including 6 GIFT and 2 microoperative procedures. No complications occurred and there was only 1 failure of the technique. Microlaparoscopy was performed successfully under local analgesia in 2 patients. The microlaparoscope may be safer and less traumatic than traditional laparoscopy. The technique is simple, effective and easy to learn. Its current place is mainly in diagnosis but with planned future improvement in instrumentation it will have a place in operative laparoscopy.

Transcervical tubal transfer of gametes and embryos.

The benefit of intrafallopian transfer techniques is still disputable in assisted reproductive techniques. On this background, alternatives to laparoscopic transfer procedures are in development. Current transcervical intrafallopian transfers of gametes and embryos are lacking success and reproducibility of results. New developments in catheter techniques and optical systems are offering new concepts for more successful transcervical approaches and preparing the basis for truly prospective studies.

Transcervical tubal cannulation: a review.

Rapid progress has been made in the last 10 years regarding minimally invasive access to the human fallopian tube. Coaxial catheter systems are being used with hysteroscopy, fluoroscopy, ultrasonography, and tactile sensation to cannulate the fallopian tube transcervically with consistent success. Uterotubal obstruction viewed at the time of hysterosalpingogram can often be successfully cannulated with intrauterine pregnancies resulting. This review surveys all available published series of transcervical tubal cannulation with discussion of methodology, success in establishing patency, and the resultant pregnancy rates. It also describes how this technology has been applied to the intratubal deposition of gametes and embryos, direct visualization of the tubal epithelium, (falloposcopy), and contraception. Collectively, these techniques are defining tubal pathology more precisely, allowing us to prescribe the proper therapy.

Transferencia intratubaria de gametos: primeros 30 casos / Gamete intrafallopian transfers: first 30 cases

En la unidad de Fertilidad y Esterilidad de la Clínica Avila de Caracas (UNIFERTES), entre 1988 y 1990 se practicaron treinta transferencias intratubarias de gametos (GIFT) a veinte y seis pacientes con historias de esterilidad de dos o más años de evolución, las cuales fueron estudiadas desde el punto de vista de fertilidad sin la laparoscopia diagnóstica previa. Las pacientes fueron sometidas a estimulación ovárica con citrato de clomifeno más MG más H.C.G y monitorizada su evolución con ultrasonografía transvaginal y valores de estradiol sérico. Transferimos de 3 a 5 oocitos metafase II en una o ambas trompas, con un número de espermatozoides mótiles entre 100.000 y 150.000 por ml. Se obtuvieron nueve embarazos (30%), siendo éxito seis de ellos (20%), terminando 3 de en parto vaginal y 3 en cesárea. El peso promedio de los niños al nacer fue de 3112 g. No hubo malformaciones congénitas

[Development of a method for transuterine gamete transfer--initial results]. / Entwicklung einer Methode zum transuterinen Gametentransfer (GT)--erste Ergebnisse.

A new method for gamete intra fallopian transfer is described by which the tubes can be catheterised via vagina, through the endometrial cavity, in order to place gametes directly to the ampullary portion of the fallopian tube without the need for an operation or anaesthesia. In a first series two clinical pregnancies resulted from 8 transuterine transfers.

A Mobile Oocyte Incubation Unit (MOIU): a device for improvement of the gamete intrafallopian transfer (GIFT) program.

Forty couples with infertility due to various causes were selected for the gamete intrafallopian transfer (GIFT) program at our hospital. When the first 21 couples (Group A) had been treated in the program, the rate of pregnancy achieved was 23.8%, which did not seem satisfactory. This might have been caused by the distance between the embryo laboratory and the operating room. To eliminate this defect, a Mobile Oocyte Incubation Unit (MOIU) was designed. This is actually a compact laboratory that can be placed in the operating room. After the MOIU was utilized, the rate of pregnancy for the following 19 couples (Group B) increased to 42.1%. The MOIU has helped improve the performance of the GIFT program by increasing the stability of the pH value of the culture medium (Chetkowski R, et al.: J Vitro Fert Embryo Transfer 1985;2:207), lessening the exposure of the gametes to air and room temperature, and most importantly, shortening the time required for a GIFT procedure from 45-100 to 15-30 min. We expect that the MOIU will eventually become an integral part of the standard equipment for the GIFT program and make the program more successful and reliable in the treatment of infertility.