Comparison of Tubal Transfer and Transcervical Uterine Embryo Transfer of Immediate Injected Oocytes and 2 - 3 Days Old Cultured Embryos

Abstract

Objective:The aim of this study was to assess the outcomes of laparoscopic intrafallopian transfer of injected oocytes rapidly (1 hour at most) after intracytoplasmic sperm injection (rapid ICSI-ZIFT). Materials and Methods: Data on 58 cycles in 58 couples, who underwent rapid ICSI-ZIFT treatment over a 12-month period were retrospectively investigated. The control group included 28 patients, who underwent intrauterine embryo transfer (ET) after ICSI. Following down-regulation with goserelin acetate, step-up ovulation induction with recombinant gonadotropins was carried out. After oocyte retrieval and ICSI, a maximum of 4 injected oocytes with intact cytoplasmic membrane and clear cytoplasm were replaced within 1 hour into a unilateral fallopian tube under laparoscopic guidance. Biochemical pregnancy, clinical pregnancy, implantation, miscarriage, and takehome baby rates were our outcome measures. Rapid ICSI-ZIFT and conventional ICSI-ET groups were compared using univariate and multivariate analyses. Results: After controlling for confounding factors by logistic regression, none of the outcome variables were found to be improved with rapid ICSI-ZIFT. Implantation rates were also comparable (17.2 % for rapid ICSI-ZIFT and 17.1 % for ICSI-ET) with no significant differences (p = 0.9). The multiple pregnancy rate in the ICSI-ZIFT group was exceedingly high (34.8 % versus 0%, p = 0.07). Conclusions: Immediate tubal transfer of microinjected oocytes is associated with similar imZusammenfassung Ziel: Zu untersuchen, ob der intratubare Transfer frisch injizierter Eizellen (ca. 1 Stunde nach der intrazytoplasmatischen Spermieninjektion [r-ICSI-ZIFT]) mit einem besseren Erfolg korreliert als der herkömmliche intrauterine Transfer 2 -3 Tage nach ICSI. Methode: 58 Zyklen von 58 Paaren mit r-ICSI-ZIFT innerhalb eines Zeitraums von 12 Monaten wurden retrospektiv ausgewertet. Die Kontrollgruppe beinhaltete 28 Patientinnen, die einen herkömmlichen intrauterinen Embryotransfer nach ICSI erhielten. Die Ovulation wurde nach "Downregulation" mit Goserelinacetat und aufsteigender Stimulation mit rekombinantem FSH induziert. Nach der Eizellgewinnung mit anschließendem ICSI wurden innerhalb einer Stunde maximal 4 injizierte Eizellen mit intakter Zytoplasmamembran und klarem Zytoplasma unter laparoskopischer Überwachung intratubar transferiert. Die biochemische und klinische Schwangerschaftsrate, die Implantationsrate, die Abortrate und die Geburtenrate wurden ermittelt. Die statistische Auswertung erfolgte mit univariater und multivariater Analyse. Ergebnisse: Die Regressionsanalyse ergab für keine der Variablen einen Vorteil für die r-ICSI-ZIFT. Die Implantationsrate betrug 17,2% für die r-ICSI-ZIFT und 17,1 % für ICSI-ET (nicht signifikanter Unterschied, p = 0,3). Die Mehrlingsschwangerschaftsrate war für r-ICSI-ZIFT signifikant erhöht (34,8 versus 0%, p = 0,06). Schlussfolgerung: Sofortiger tubarer Transfer von mikroinjizierten Eizellen führt im Vergleich zu dem herkömmli-Originalarbeit 377 Institutsangaben

Zygote intrafallopian tube transfer versus intrauterine cleavage or blastocyst stage transfer after intracytoplasmic sperm injection cycles in patients with repeated implantation failure: A prospective follow‐up study

“…The effect of the ZIFT procedure in the management of patients with RIF was evaluated in several studies with compatible results. Although a better outcome was reported in some studies, others did not demonstrate the beneficial effect of ZIFT in these patients . Most of the previous studies in these regards were performed at infertility centers in Israel because ART costs in that country are covered by government health insurance, so seven or even more attempts of ART cycles are common among infertile couples living in that country.…”

“…Elsewhere, Ozkaya et al . reported that rapid ICSI + ZIFT is associated with similar implantation and take‐home baby rates compared to intrauterine ET after ICSI in unexplained infertile couples, so according to the risk of laparoscopy and the unavoidable higher risk of multiple pregnancies, rapid ICSI + ZIFT seems unsuitable for clinical use …”

“…Although a better outcome was reported in some studies, 5-7 others did not demonstrate the beneficial effect of ZIFT in these patients. 2,3,9,10 Most of the previous studies in these regards were performed at infertility centers in Israel because ART costs in that country are covered by government health insurance, so seven or even more attempts of ART cycles are common among infertile couples living in that country. In a recent study by Weissman et al, the authors suggested that the ZIFT procedure is a powerful tool in the management of patients with high-order RIF, but the results cannot be extrapolated as the benefit of ZIFT, due to the lack of a control group.…”

“…On the other hand, in studies by Ozkaya et al . and Aslan et al ., the authors could not find any superiority of the ZIFT procedure compared to transcervical uterine embryo transfer (ET) . Recent advances in embryo culture systems and laboratory conditions have provided a better environment for embryo development .…”

“…8 On the other hand, in studies by Ozkaya et al and Aslan et al, the authors could not find any superiority of the ZIFT procedure compared to transcervical uterine embryo transfer (ET). 9,10 Recent advances in embryo culture systems and laboratory conditions have provided a better environment for embryo development. 11 Potential advantages of blastocyst transfer are a better selection of viable embryos and synchronization of embryonic stage with the endometrium in the presence of reduced uterine contractions.…”