Gamete intrafallopian transfer (GIFT) compared with intrauterine insemination in the treatment of unexplained infertility

Article Abstract:

The effectiveness of two techniques for increasing fertility was compared in this study of 59 couples with unexplained infertility of five years' duration (median value). The techniques were gamete intrafallopian transfer (GIFT), in which eggs (oocytes) are removed from the ovaries and implanted into the fallopian tube with sperm; and intrauterine insemination (IUI), in which sperm are inserted into the uterus via a catheter. Women's ovaries were stimulated hormonally (hyperstimulation) for several days before both procedures: these regimens are described. A third group was made up of women who underwent IUI without hormonal stimulation (spontaneous cycle IUI). Twenty couples underwent GIFT; 20 underwent ovarian hyperstimulation IUI; and 19 underwent spontaneous cycle IUI. Twelve GIFT cycles were not pursued to completion because of poor follicular growth (11 cases) or blocked tubes (one case). Seventeen hyperstimulated IUI cycles were not completed because of the development of more than four follicles (12 cases) or poor follicular growth (five cases). Thirteen spontaneous IUI cycles were abandoned because of failure to ovulate (three cases) or ovulation during a weekend when treatment was not available (10 cases). GIFT was associated with the replacement of 131 oocytes; ovarian hyperstimulation led to the development of 97 follicles in 40 full treatment cycles; and one follicle developed in each of 41 spontaneous IUI cycles. Six GIFT pregnancies occurred, including twins and four singletons. Three other GIFT pregnancies did not succeed (two blighted ova and one ectopic). One twin pregnancy resulted from hyperstimulation IUI and one singleton pregnancy from spontaneous cycle IUI. Thirty couples who had undergone IUI were then given GIFT for one cycle, and 10 pregnancies occurred, of which five were clinical (evidence of a gestational sac on ultrasound). The results indicate that GIFT is more likely than IUI to result in pregnancy among couples with unexplained infertility. The authors note the importance of interpreting IUI success rates relative to the number of multiple pregnancies that occur: in this study, it was only performed when the number of follicles did not exceed four. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Artificial insemination

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Is GIFT (gamete intrafallopian transfer) the best treatment for unexplained infertility?

Article Abstract:

GIFT (gamete intrafallopian transfer) is a procedure for treating infertility in which eggs and sperm are transferred together into the fallopian tube, where fertilization and subsequent implantation in the uterus will hopefully take place. In the UK, GIFT is associated with an overall pregnancy rate of 19 percent per menstrual cycle. However, many infertile couples will become pregnant spontaneously, and it is not clear that the rate of success with GIFT exceeds the spontaneous rate. To address this issue, 76 couples who underwent GIFT for two or three cycles were then followed for as long as 21 months to observe pregnancy rates. The GIFT procedure is described, as are the diagnostic criteria for pregnancy (biochemical, anatomical, and clinical). Before GIFT, 12 pregnancies occurred in 366 cycles; during follow-up after GIFT, five spontaneous clinical pregnancies occurred in 528 cycles. Fourteen of these pregnancies led to the successful delivery of a single infant. Fifty-three couples underwent GIFT and 99 procedures were performed (for various reasons connected with the operating schedules and personal decisions on the part of the patients). The monthly pregnancy rate was 0.14, and 14 pregnancies led to live births. Another 11 pregnancies were biochemical (positive results on a pregnancy test but failure of a gestational sac to develop), ectopic (implantation outside the uterus), or associated with a blighted ovum. The cumulative probability of becoming pregnant after 24 months of spontaneous attempts was 30 percent, compared with 52 percent after GIFT. GIFT increases the probability of pregnancy and delivery, but it is maximally effective when offered for more than one cycle. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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A protocol for the routine measurement of lactate and pyruvate in cord blood

Article Abstract:

When the oxygen supply to the fetus is inadequate, the outcome of the fetus is poor. Current methods of analyzing fetal well-being, such as APGAR scoring (the status of the fetus at one and five minutes after birth) and the measurement of fetal blood gases, are incomplete assessments of oxygen compromise. Lactic acid, which is the end product of glycolysis, (energy metabolism) is converted to pyruvate with the help of the enzyme lactate. As oxygen supplies are used up, the type of metabolism changes, causing increased levels of lactate. The ratio of lactate to pyruvate can be used to indicate tissue hypoxia, decreased oxygen supply to the tissues. Traditional ways of measuring the oxygen debt can be enhanced by using the ratio of lactate to pyruvate. However, metabolism is thought to continue after the samples have been removed from the umbilical cord. The effect of time on the sampling and analysis of fetal blood lactate and pyruvate was evaluated in 30 infants. Umbilical cords obtained immediately after delivery were clamped at both ends within one minute of birth. Blood samples were removed from the cord every minute for the first five minutes, and at 10, 15 and 20 minutes after clamping. Samples removed from the umbilical artery had higher lactate concentrations than those removed from the umbilical vein. A calculation was formulated to avoid the need for immediate umbilical cord blood sampling. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Physiological aspects, Fetal blood, Glucose metabolism, Lactate dehydrogenase, Fetal anoxia

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