Gamete Intra-Fallopian Transfer (GIFT)
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Gamete Intra-Fallopian Transfer (GIFT) is another assisted conception procedure. It is very similar to In Vitro Fertilisation (IVF) in the way eggs and sperm are collected. However, GIFT is seen as a more natural process because fertilisation of the egg occurs in the fallopian tubes as it does naturally in couples with no fertility problems. As standard IVF procedures become more refined and success rates increase, GIFT is being used less often than in the past.
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Description of Gamete Intra-Fallopian Transfer (GIFT)
Gamete Intra-Fallopian Transfer (GIFT) starts as in IVF with the collection of eggs and sperm (female and male gametes) using the methods described in IVF. Hormones are used to stimulate the ovaries and eggs collected. In the meantime, sperm from the male partner or sperm donor is made available. The healthiest and best examples of both eggs and sperm are then mixed together and immediately placed into one of the fallopian tubes.
This is the key difference between GIFT and IVF. In IVF, the egg and sperm mix are incubated for just under 1 day until fertilisation takes place in the laboratory. The fertilised eggs (embryos) are taken aside and incubated for another 1 or 2 days and then inserted directly into the uterus through the vagina and cervix. But in GIFT, no fertilisation occurs in the lab. Instead, unfertilised eggs and sperm are placed into a fallopian tube by a laparoscopic procedure under general anaesthetic. Fertilisation then takes place naturally in the fallopian tubes.
The success rates vary from couple to couple and from clinic to clinic. But on average, they are around 20-30%. As with all assisted conception techniques success rates are better in: younger women, women with certain causes of infertility and when GIFT is carried out at centres with the necessary expertise.
For GIFT to be successful, the clinic must ensure that the females fallopian tubes are undamaged and patent as fertilisation takes place there. If tubal damage exists, then other methods must be considered.
What causes of Infertility can GIFT Treat?
GIFT can be used for the following problems;
* low sperm counts (oligozoospermia)
* poor sperm movement (poor motility)
* in unexplained infertility: providing the fallopian tubes are undamaged and it has been shown the sperm are capable of fertilising the egg.
If no sperm or eggs are available from the couple, donor sperm or donor eggs can be used for GIFT.
How is GIFT done?
As in IVF, GIFT is most often carried out in an induced cycle, i.e. ovulation is artificially induced using hormone drugs. Please read "Drugs Used in Infertility" for further details regarding this subject. Using induced cycles, a number of eggs may be harvested from the ovaries at the same time.
To understand GIFT fully, including it's similarities to IVF, it is best to divide the whole process into stages as follows;
1. Investigation
Before anything else can be done, the clinic needs to assess both the male and female in the couple to ascertain the reason for the lack of conception. This is done in the ways described in the previous pages and may take several days or weeks to complete depending on where the various investigations are carried out. For the purposes of GIFT, it is essential to ensure the tubes are undamaged and are patent. This is done in a number of ways such as with a hysterosalpingogram.
2. Ovarian Stimulation.
Various drugs are used to take control of the menstrual cycle. Other hormonal drugs are then used to stimulate the ovaries into starting the egg maturation process. Several eggs will start to develop simultaneously.
3. Developmental Checks
Blood tests and vaginal ultrasound scans are carried out regularly to assess the development of the eggs. From here on, timing is crucial as an injection of another hormone is given approximately 36 hours before egg collection. This injection forms the final phase of egg maturation, at the end of which, eggs will be ready for harvesting.
4. Egg Collection
This is done immediately after Step 3. If done too early or too late, the chances of successful conception are greatly reduced. Collecting eggs can be done in 2 ways;
* Ultrasound guidance: this can be done with a local or general anaesthetic and takes around 30-60 minutes. A vaginal ultrasound scan is used to guide a needle through the vagina and into each ovary in turn. The needle is guided to each egg sac and the eggs are sucked into the needle and retrieved. Generally, this is the favoured approach these days.
* By laparoscopy: this is done using a general anaesthetic. A thin telescope like instrument containing a light and camera is inserted through a tiny incision, into the abdomen to view the pelvic organs. A needle is then inserted to the egg sacs to suck out the eggs. This procedure is used less often these days.
5. Sperm Collection
This can be done in 2 ways;
* Using your own sperm: a sample is produced by masturbation very close to the time of egg collection. This is done either close to or at the clinic. This is vital as the laboratory requires immediate access to the sperm. Sperm may also be collected using various surgical sperm extraction procedures. They can be extracted directly from the epididymis using methods such as Percutaneous Epididymal Sperm Aspiration (PESA) or Microsurgical Sperm Aspiration (MESA), or from the testicles using Testicular Sperm Extraction (TESA).
* Using a sperm donor: if this option is chosen, then sperm will already be available to the clinic. Many samples may be kept by the clinic and a suitable sample is selected. The discussion about donor sperm and which sample to use is usually had at the outset of treatment. Clinics may try to match certain characteristics of the sperm donor to the male partner in the couple. Traits such as hair colour, eye colour, height and build can be matched. These sample are kept frozen for 6 months and tested for various sexually transmitted infections such as Hepatitis B and HIV before being deemed suitable for use.
Once a semen sample is obtained, sperm are separated from the plasma (consisting of seminal fluid), washed to remove chemicals and infections and spun using a centrifuge at high speed so that the "best" sperm can be selected.
6. Fertilisation and Transfer
The collected eggs and selected sperm are mixed together in a catheter and immediately placed into one of the fallopian tubes. This is done using a laparoscope under general anaesthesia. A small incision in the abdomen is made through which the laparoscope is inserted. This enables the surgeon to view the location of the tubes. The catheter containing the eggs and sperm mix is then inserted into the abdomen. The contents of the catheter are then deposited inside one of the tubes, usually on the side of the uterus and are left. It is then hoped that at least one egg will become fertilised naturally and a pregnancy will then follow. This procedure is usually done as a day case, outpatient procedure.
Because there is no way to test for fertilisation in the fallopian tubes, usually, more eggs are used in each GIFT cycle than in standard IVF cycles.
7. Preparing the Womb
Women are given a dose of progesterone by pessary, gel or injection. This starts the process of preparing the womb (uterus) to receive the embryo by thickening the womb lining (endometrium).
8. Dealing with the Remaining Embryos
Once the correct number of eggs have been used, a decision is made on any that remain. The choices include;
* discarding the eggs if no further attempts at GIFT or other types of procedures are to be made,
* freezing the eggs for use in another GIFT/IVF cycle.
* the eggs are donated to another couple.
9. Confirming Pregnancy
A pregnancy test can be performed 2 weeks after GIFT, either at home by using a urine pregnancy test or at the clinic by either a urine pregnancy or blood test. If pregnancy is confirmed, the usual antenatal care will be initiated in most cases. In some, there will be extra input and closer monitoring of the pregnancy if it is deemed to be at higher risk. Higher risk cases include;
* women aged 40 years of over,
* multiple pregnancy,
* a history of previous complications of pregnancy including recurring miscarriage, stillbirths or developmental anomalies,
* a history of maternal complications such as pre-eclampsia.
The risks of GIFT are very similar to those of IVF.
Medical Facts
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