Gamete Intrafallopian Transfer (GIFT)
The GIFT procedure is one of 3 advanced «tubal transfer» minimally invasive laparoscopic procedures aimed at maximizing your fertility potential through assisted reproductive technology (ART): GIFT, ZIFT, and TET. Laparoscopic tubal transfer (intrafallopian transfer) allows for the transfer of gametes (eggs and sperm) or early-stage embryos (day 1 zygotes or day 2 cleavage-stage embryos) directly into the fallopian tube(s). Embryos conceived and/or grown in the fallopian tube have the advantage of being in their natural environment, the tube, at the critical early stages of their development, making the tube the optimal «incubator» for embryo culture to the blastocyst stage. In fact, prior to the advent of advanced culture solutions in the IVF laboratory, tubal transfer achieved superior pregnancy success rates over standard IVF. However, as IVF technology evolved, improved IVF culture conditions and techniques allowing embryos to be grown from day 0 to day 6 in the IVF laboratory and the less invasive nature of IVF, favored the IVF lab over the fallopian tube as the preferred site for early embryo development.
Today, the role of tubal transfer has been reestablished in ART for specific clinical scenarios. Despite improvements in standard IVF techniques, some couples may experience IVF failure due to poor embryo development in the laboratory. This may manifest itself with poor development at the cleavage stage (failure of embryos to reach the 6-8 cell stage by day 3 after egg retrieval, or poor quality embryos on day 3 despite reaching the 6-8 cell stage), or at the blastocyst stage (failure of embryos to reach the blastocyst stage by day 5 after egg retrieval, or poor quality blastocysts on day 5). For such couples, after repeated IVF and standard trans-cervical embryo transfer (IVF/ET) failure, transferring eggs and sperm or early embryos directly into their natural environment, the fallopian tube, may be the ideal solution. For some couples, a clear explanation for repeated implantation failure after routine trans-cervical embryo transfer of good quality day 3 or day 5 embryos may not exist, making a GIFT, ZIFT, or TET an excellent alternative as means of improving embryo implantation rates. Additionally, for some women, prior cervical surgery (LEEP procedure or cervical conization for abnormal Pap smear) or damage to the cervix following various gynecological procedures, or a congenital birth defect affecting the cervix, may make a standard trans-cervical embryo transfer following IVF impossible or exceedingly difficult. In such cases, bypassing the cervix with a tubal transfer technique is the preferred choice when performing ART.
In a GIFT procedure, patients first undergo standard controlled ovarian hyperstimulation (COH = ovarian stimulation with injectable hormones to stimulate the growth of multiple eggs) followed by egg retrieval. Immediately following egg retrieval, while still under anesthesia in the operating room, a laparoscopy is performed by introducing a small camera through an umbilical incision (typically smaller than 5 mm in length) to visualize the pelvic contents. A second small incision is introduced above the pubic bone (suprapubic) in the lower abdomen, which allows for the insertion of a non-traumatic grasping instrument for gentle manipulation of the fallopian tube. Finally, a third 2 mm incision is introduced between the umbilical and suprapubic incisions, which allows insertion of a small catheter (containing eggs and sperm) into the pelvic region. Under direct visualization with the laparoscope, the fallopian tube is grasped with forceps and the midline catheter is advanced into the distal opening of the tube. Next, 1-2 eggs mixed with thousands of sperm are deposited into the distal portion of the tube. The tube is gently placed back into its anatomical location. The procedure may be repeated on the opposite tube.
The entire procedure (egg retrieval + GIFT) is typically completed in less than 45 minutes, which allows for rapid recovery without the need for bed rest. GIFT relies on the ability of sperm to naturally fertilize eggs and is therefore not suitable for couples with male factor infertility. Naturally, all tubal transfer techniques rely on healthy fallopian tubes for a successful outcome.
The California Center for Reproductive Health employs nothing but the finest expert microsurgical techniques in performing laparoscopic GIFT procedures, providing for safe and effective surgical treatments with excellent outcome.