Female Infertility::

Gamete Intrafallopian Transfer (GIFT)

The GIFT technique, now widely accepted as a treatment for certain groups of infertile couples, may be thought of as both a sophisticated form of Artificial Insemination and an abbreviated form of IVF.

Indications for GIFT

GIFT can only be used to treat patients who have at least one open Fallopian tube. Patients with blocked Fallopian tubes or other pelvic anomalies i.e. pelvic adhesions, are not suitable for this technique.

A group of patients who appear to do particularly well with GIFT are those with idiopathic (unknown cause) infertility; these account for between 10% and 20% of all infertile couples.

GIFT is also being increasingly used for couples whose infertility is the result of a sperm factor. To prove the sperms ability to fertilise the egg, IVF may be the first option for these patients, however, when fertilisation has occurred and a pregnancy is not achieved, the GIFT procedure is usually the preferred choice in a subsequent treatment cycle.

Preparation for a treatment cycle

During the initial consultation all aspects of the treatment cycle are discussed and a decision as to the couples suitability of the GIFT method is reached. However, it may be necessary to carry out certain investigations, which determine the functioning capacity of the Fallopian tubes before a treatment cycle is commenced i.e.:

(i) Assessment laparoscopy and/or hysteroscopy – determines to what extent the Fallopian tubes are open and detects any abnormalities of the pelvic region.

(ii) Hysterosalpingogram (HSG) - a special X-ray of the Fallopian tubes and uterus highlighting their patency.

Once the preliminary investigations are complete (including routine and specialized blood test) the treatment cycle may commence with the onset of the patient’s menses.

Management of a GIFT treatment cycle

In order to obtain the best results, it is necessary to stimulate the development of multiple ovarian follicles using a combination of medications tailored to individual requirements. The subsequent growth of the follicles and the developing endometrium are monitored by regular ultrasound scans. Once the follicles are considered mature and the endometrium of optimal development, arrangements are made for the patient to receive an injection of Pregnyl (Human Chorionic Gonadotrophin – HCG), which completes the maturation and preparation stages. The GIFT procedure is booked to take place 36 hours after the injection of Pregnyl has been given.

The technique of egg collection

General anaesthetic is required for the GIFT procedure as the eggs are recovered using the laparoscopic technique. The uterus, tubes and ovaries are visualised through the laparoscope and a fine needle is passed through the abdomen into each ovarian follicle. The contents are then aspirated and placed in a special culture medium. Once all of the eggs have been collected, a preparation of sperm is taken up into a fine tube and together with the selected eggs, inserted into the outer end of one or both of the Fallopian tubes.

Occasionally, when the ovaries are not accessible to the laparoscope, ultrasound visualisation may be used for the initial egg collection, with the laparoscopic technique utilised to place the eggs and sperm into the fallopian tubes.

After the GIFT procedure

Patients are usually able to return home the same afternoon; on discharge progesterone vaginal Pessaries are prescribed to support the lining of the uterus until the result of the pregnancy blood test (BhCG) – usually taken 12 days later – is known.

Embryo freezing

Eggs not utilised during the GIFT procedure may be mixed with sperm in the laboratory and any suitable resulting embryos cryo-preserved (frozen) for future use.

The success rates

Success rates for IVF/GIFT vary depending on the different types of problems requiring treatment and the different factors existing in individual patients. Factors predominantly influencing success are (i) the age of the woman producing the eggs (ii) the number of eggs produced (iii) the quality of the semen (iv) the number of eggs transferred and (v) the normality of at least one Fallopian tube. GIFT is generally tube provides a more satisfactory physiological environment for fertilisation than a laboratory culture dish.