Treatment Overview
Some
infertile couples are affected by conditions that
prevent the sperm and egg from traveling through a
fallopian tube. (This is where fertilization and the first
stage of cell division take place.) The following are
assisted reproductive technology (ART) procedures that
are rarely used but may improve the chances of conception in the fallopian
tubes. The first step of each of these treatments is
superovulation. This uses hormone injections to stimulate the ovaries to produce multiple eggs.
Gamete intrafallopian transfer (GIFT) uses multiple eggs
collected from the ovaries. The eggs are placed into a thin flexible tube
(catheter) along with the sperm to be used. The gametes (both eggs and sperm)
are then injected into the fallopian tubes using a surgical procedure called
laparoscopy. The doctor will use
general anesthesia.
Zygote intrafallopian transfer (ZIFT) combines
in vitro fertilization (IVF) and GIFT. Eggs are
stimulated and collected using IVF methods. Then the eggs are mixed with sperm in the
lab. Fertilized eggs (zygotes) are then laparoscopically returned to the
fallopian tubes where they will be carried into the uterus. The goal is for the
zygote to implant in the uterus and develop into a fetus.
Pronuclear stage tubal transfer (PROST), similar to ZIFT, uses
in vitro fertilization. But it transfers the fertilized egg to the fallopian tube
before cell division occurs.
These procedures have higher costs and risks related to laparoscopy. And they do not provide as much useful information about embryo development as IVF does. For these reasons, these procedures are rarely used.
What To Expect After Treatment
Overall, having the assisted reproductive
technology (ART)-related injections, monitoring, and procedures is emotionally
and physically demanding. Superovulation with hormones
requires regular blood tests and frequent monitoring by your doctor. It also requires daily shots. (Some of the shots are quite
painful.)
You can expect
to return to daily activities after a routine laparoscopic procedure in less
than a week.
Why It Is Done
GIFT may be appropriate when:
- A couple has religious objections to
fertilization taking place outside the body.
- A couple with
unexplained infertility only has insurance benefits for GIFT.
For GIFT or ZIFT, a woman must have at least one functional
fallopian tube.
How Well It Works
ZIFT and GIFT are used rarely enough that specific success
rates aren't nationally available. But what is known about assisted
reproductive technology (ART) includes the use of ZIFT and GIFT.
Risks
Risks from laparoscopy (which may be
used to collect eggs) include pelvic infection, puncture of internal organs,
and side effects from general anesthesia.
Assisted reproductive
technologies-including GIFT and ZIFT-increase the risk of multiple
births. A
multiple pregnancy is high-risk for both the mother
and the babies.
ZIFT success versus the risk of multiple pregnancy
For a woman over age 35 to have the best chance of conceiving
with her own eggs and carrying a healthy pregnancy, she must have more embryos
transferred than a younger woman would. This increases her risk of multiple
pregnancy.
Because of the risks to the babies of multiple
pregnancy, experts recommend limiting the number of embryos transferred. Based on your age and your situation, your doctor will recommend a certain number of embryos to be transferred.
Women over 40 have a high rate of embryo loss
when using their own eggs. Instead, older women can choose to use
more viable donor eggs.
What To Think About
ART birth rates can be misleading. As a woman
ages past her mid-30s, her egg quality and quantity decline. This makes it
increasingly unlikely that an ART procedure using her own eggs will result in
pregnancy and a healthy baby. Many women over age 40 choose to use donor eggs. It greatly improves their chances of giving birth to a healthy child.
ZIFT requires two separate procedures. The first is to
collect the eggs from the woman's ovaries. The second is done several
days later when the fertilized egg (zygote) is placed in her fallopian tube.
If GIFT fails, a doctor does not learn anything about the sperm's
ability to fertilize the eggs. With in vitro fertilization, the sperm
fertilizes the egg in the laboratory. In that case, a health professional can tell
whether fertilization has occurred and can follow embryo development.
ZIFT and GIFT may not be available in all areas. These procedures cost approximately $15,000 to $20,000 for each
attempt. In vitro fertilization usually costs less.
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Credits
ByHealthwise Staff
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerFemi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Current as ofMarch 16, 2017