Jeffrey R. Nelson

Predicting success of gamete intrafallopian transfer.

OBJECTIVES To examine seminal parameters predictive for success in a cycle of GIFT and to construct an algorithm using pertinent seminal data as well as easily obtained historical data to predict pregnancy and viable pregnancy rates. DESIGN A retrospective study of 544 cycles in 376 couples. SETTING A private IVF-ET and GIFT center. PATIENTS Couples in a GIFT program with a mean of 53.6 months of infertility who had failed to conceive with other therapies. INTERVENTIONS Gamete intrafallopian transfer. MAIN OUTCOME MEASURES Pregnancy as a function of laboratory historical data with emphasis on seminal parameters. RESULTS Motility was the only seminal parameter that was predictive. Success was correlated with the number of oocytes returned and inversely related to female age. An algorithm to predict pregnancy in a GIFT cycle as well as viable pregnancy was constructed. CONCLUSIONS Motility is the only seminal parameter predictive for success in a GIFT cycle. An easily programmable algorithm can be constructed to help patient and physician decide on the appropriateness of GIFT for each couple.

Leuprolide acetate-prepared in vitro fertilization-gamete intrafallopian transfer cycles: efficacy versus controls and cost analysis *

OBJECTIVE To evaluate the effect of gonadotropin-releasing hormone agonist (GnRH-a) when given through stimulation with gonadotropins versus stopping it as stimulation was initiated versus a control group unprepared in this manner. Also, to construct a cost analysis for this type of therapy in an in vitro fertilization-gamete intrafallopian transfer program (IVF-GIFT). DESIGN Prospective, consecutive, randomized, with a control group. SETTING An out-patient IVF-GIFT program. PATIENTS One hundred new patients entering an IVF-GIFT program. INTERVENTIONS In vitro fertilization or GIFT cycles with or without preparation (pituitary suppression) by GnRH-a administration in which suppression was continued or halted as gonadotropins were begun. MAIN OUTCOME MEASURES Cancellation rates, ampules, and days of gonadotropin use, costs, estradiol (E2) level, egg numbers and quality, and pregnancy rates. RESULTS Stopping GnRH-a (leuprolide acetate) therapy as stimulation was begun did not lessen the suppressive effect in reduction of spontaneous luteinizing hormone surge as seen with continued use of agonist. In contrast, the control group had a 30.3% cancellation rate before ovum retrieval. The E2 and egg data among the groups were similar, but as expected, agonist use led to the need for more and longer duration of gonadotropin stimulation. Pregnancy rates were not different by group. Costs were approximately even by the third initiated cycle.

IVF-Surrogates of Donated Oocytes

Parenthood through surrogacy has been used throughout history as a treatment of infertility as noted in both Old and New Testaments.1 Increasing numbers of couples are utilizing surrogate parenting to establish their families.1,2 Utian and associates3 were the first to report in 1985 on a successful in vitro fertilization (IVF)-surrogacy pregnancy in a woman who gestated a genetically unrelated embryo. This form of assisted reproduction appears best described as IVF-surrogacy and this nomenclature will be used hereafter.