Factors affecting pregnancy outcome in a gamete intrafallopian transfer (GIFT) programme

Objective. To identify the factors that most significantly affected pregnancy rates in a gamete intrafallopian transfer (GIFT) programme.Methods. A total of 863 GIFT cycles were analysed retrospectively. The variables found to be associated significantly with pregnancy were then used to obtain multivariate analysis using logistical regression.Results. Overall and ongoing pregnancy rates were significantly better in patients ≤ 38 years than in patients > 38 years (37.3% and 28.4% v. 23.7% and 11.0% respectively), and age was positively associated with success after GIFT (odds ratio (OR) 1.87, 95% confidence interval (CI): 1.22- 2.85). Metaphase I (MI) oocytes were negatively associated with pregnancy (OR 1.54, 95% CI: 0.28 - 1.04). The highest pregnancy rates occurred when 3 metaphase II (MII) oocytes were transferred (39.8%, OR 7.51, 95% CI: 1.74 - 32.42). With regard to sperm morphology, overall pregnancy rates of 25.5% (≤ 4% normal forms) and 37.2% (> 4% normal forms) were obtained. Morphology of > 4% normal forms was positively associated with pregnancy (OR 1.58, 95% CI: 1.04 - 2.42).Conclusion. The results of this study suggest that the most important factors influencing pregnancy rates in a GIFT programme are the woman's age and those factors pertaining to the characteristics of the gametes. Considering the emotional and financial costs it is important to relate this information to all prospective participants in a GIFT programme

The effect of serum supplementation on the cleavage of human embryos

[No abstract available]Articl

Sperm morphologic features as a prognostic factor in in vitro fertilization

To determine whether there is a prognostic value in the percentage normal sperm morphologic features in a human in vitro fertilization (IVF) program, the authors conducted a prospective study in women with bilateral tubal damage. Based on the percentage of morphologically normal spermatozoa, the patient were divided into four groups: group I, normal morphologic features between 0% and 14%; group II, 15% to 30%; group III, 31% to 45%; and group IV, 46% to 60%. One hundred ninety successful laparoscopic cycles were evaluated. In group I, 104 oocytes were obtained, of which 37% fetilized, but no pregnancy resulted; in group II, 81% of 324 oocytes were fertilized, with a pregnancy rate per embryo transfer (ET) of 22%; in group III, 82% of 309 oocytes were fertilized, with a 31% pregnancy rate; and in group IV, 91% of 69 oocytes were fertilized, with a pregnancy rate of 12%. Probability models indicated that there was a clear threshold in normal sperm morphologic features at 14%, with high fertilization and pregnancy rate in the groups with normal sperm morphologic features > 14%.Articl

The technique for human embryo transfer at Tygerberg Hospital

From 1 May 1984 to 30 April 1985, 177 laparoscopies were performed; 684 oocytes were obtained and a fertilization rate of 85% per oocyte achieved. There was a pregnancy rate of 24,3% per embryo transfer (ET) and 20,9% per laparoscopy after 152 patients were subjected to ET. Th ET technique at Tygerberg Hospital, using the Tomcat catheter, is described. An introducer - the FT introducer - designed to overcome technical difficulties in selected patients in passing the Tomcat catheter is described. Technical problems are easily overcome with this introducer. In 26 patients (17,1%) ET was performed using this instrument and 8 pregnancies resulted (a pregnancy rate of 30,7% per ET). This pregnancy rate indicates the value of the instrument.Articl

Does the wash-up and swim-up method of semen preparation play a role in sex selection?

Because of the higher built ratio of boys to girls (1.5 : 1) by in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) at Tygerberg Hospital, the question arose as to whether the wash-up and swim-up method of semen preparation, used for our IVF procedure, plays a role in sex selection. Semen samples of 20 men were evaluated at different time intervals to determine the percentage of F-body-positive spermatozoa. It was found that the swim-up time affects the relationship between Y- and X-bearing spermatozoa, especially at time intervals of 30 and 45 min, where an optimum percentage of Y-bearing spermatozoa (p = 0.0039 and p = 0.0092, respectively) was found. Sperm obtained at these specific time intervals may influence the outcome of sex by IVF and GIFT in favor of males.Articl

The evaluation of morphological characteristics of human spermatozoa according to stricter criteria

The evaluation of the morphology of human spermatozoa varies widely between and sometimes even within laboratories. The purpose of this study was to determine whether the method that has been developed in our laboratory and which resulted in the use of stricter criteria for the evaluation of sperm morphology is a practical, reliable and repeatable method and to establish the within and between observer variations. The criteria used for a 'normal' spermatozoon are based on the appearance of spermatozoa found in the mucus of the upper endocervical canal. The results of the morphological evaluations of 26 samples by four observers were statistically analysed by various methods. The method of Barnett showed a high degree of relative accuracy between observers with error variances of between 2.89 and 19.67 as well as high Spearman rank correlation coefficients of between 0.8675 and 0.6537 (p < 0.0003). The Spearman correlation coefficient for 15 duplicate evaluations by one observer was 0.9650 (p < 0.0001) while the coefficients of variation for repeated evaluations of single samples were also within acceptable limits. Based on these results, the method described in this article allows comparable and reliable results between and within observers to be obtained. From this and other studies it can be concluded that the method also has a good prognostic value for the prediction of expected IVF fertilization, the hamster test and hemizona assay.Articl

The impact of number of metaphase II oocytes and patient age on the multiple pregnancy rate in a gamete intrafallopian transfer (GIFT) programme

ArticleThe original publication is available at http://www.samj.org.zaObjective. To study the effect of number of oocytes transferred and patient age on gamete intrafallopian transfer (GIFT) pregnancy and multiple pregnancy rates. Patients. GIFT patients from our clinical database were retrospectively analysed. They were divided into two age groups, under 38 years old and 38 and older. The patients were further divided into two subgroups, 3 oocytes and 4 or more oocytes transferred. Pregnancy rates and multiple pregnancy rates were calculated for the two groups. Statistical methods. The under-38 group's subgroups were nominated as group 1 (3 oocytes) and group 2 (s4 oocytes) and the 38-and-over group's subgroups as group A (3 oocytes) and group B (s4 oocytes). The x2 test and Fisher's exact test were used to analyse the data. Results. The ongoing pregnancy rate in group 1 was 28.8% (150/521) as opposed to 20.6% (96/465) in group 2 (P < 0.0045). The multiple pregnancy rate in group 1 was 14.0% (21/150) as opposed to 33.3% (32/96) in group 2 (P < 0.005). The triplet or higher-order pregnancy rate in group 1 was 2.7% (4/150) as opposed to 8.3% (8/96) in group 2 (not statistically significant). The ongoing pregnancy rate in group A was 11.8% (16/136) as opposed to 11.0% (8/73) in group B (NS). The multiple pregnancy rate in group A was 12.5% (2.16) as opposed to 25.0% (2/8) in group B (NS). Conclusions. These data show that transfer of more than 3 oocytes does not produce better pregnancy rates in either the under-38 or the 38-and-over group. The multiple pregnancy rate is, however, significantly higher when 4 or more oocytes are transferred in a GIFT programme. Transfer of more than 3 oocytes should therefore be restricted to carefully selected patients.Publisher’s versio

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 oocytcs 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.Articl

Effect of sperm preincubation time on GIFT pregnancy outcome

This investigation was conducted to evaluate the effect of human sperm preincubation time on the pregnancy outcome in gamete intrafallopian tube transfers. This was determined in a retrospective study on gamete intrafallopian transfer patients (ideopathic infertility) using logistic regression with the covariates, preincubation time (≤60 and >60 min) and age (≤35 and >35 years). The study included 485 consecutive gamete intrafallopian transfer cycles in which 3 metaphase II oocytes were transferred. Pregnancy outcome was evaluated by βhCG levels on days 12 and 16 and was confirmed by the presence of a fetal heart 8 weeks after the procedure by means of sonography. The wife's age and sperm preincubation time were significant covariates in the prediction of ongoing pregnancy. The odds ratio for age (≤35 years) was 2.2 in the prediction of ongoing pregnancy, while the age-adjusted odds ratios for preincubation time (≤60 min) was 1.9. There was a critical relationship between sperm preincubation time and GIFT success, which confirms the effect of the wife's age on pregnancy. Close coordination is of importance between the clinical scientist and the physician to restrict the preincubation time to 1 h. The sperm preincubation time is a significant factor that has to be considered in the prediction of ongoing pregnancy in GIFT patients.Articl