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A major disadvantage with conventional GIFT is that a surgical procedure, namely, laparoscopy, is needed to transfer the eggs and sperm into the fallopian tube. Recently, a non-surgical method has been described by Dr. Robert Jansen and Dr. John Anderson from Sydney IVF, Australia, in which the gametes can be transferred into the fallopian tubes through the vagina and cervix under ultrasound guidance. This requires a special set of catheters, which allow the doctor to enter the uterine ends of the fallopian tubes through the cervix. Once the catheters have been accurately positioned and ultrasound can help in this the gametes are injected into the tubes. Since this method does not involve surgery, the benefits to the patient are obvious - less expense, no hospitalization, no scar and no anesthesia. However, the technique does require much more technical expertise and is still being investigated more thoroughly. Also, the pregnancy rates with the method are less than with conventional laparoscopic GIFT.
The cost of a GIFT treatment cycle varies from one program to another, falling within the same basic range of Rs 30000 to Rs 70000 plus range, which is typical for IVF.
Variations of GIFT include procedures with names like ZIFT, PROST, and TET - an alphabetic potpourri!
ZIFT, i.e. zygote intrafallopian transfer, is also called PROST, which stands for pronuclear stage transfer. When a sperm penetrates an egg, the sperm introduces its nuclear material into the egg. Approximately 14 hours after penetration, two distinct pronuclei, one from the sperm and one from the egg, are visible under the microscope. Pronuclei are taken as indicators that fertilization has occurred. The fertilized egg before cell division begins is also called a zygote. During ZIFT, eggs are removed by transvaginal aspiration and fertilized in a laboratory dish. The next day, when the fertilized eggs have reached the pronuclear stage, the embryos are transferred to the fallopian tubes during laparoscopy.
Approximately 24 hours after a fertilized egg reaches the pronuclear stage, it divides for the first time and becomes a two = a cell embryo. This cell division is called cleavage. It is at this stage or later that TET, tubal embryo transfer is performed. The embryos are transferred to the fallopian tube during laparoscopy.
PROST, ZIFT, and TET differ from GIFT in that fertilization takes place in a laboratory dish instead of the fallopian tube. Moreover, they differ from IVF in that the fertilized egg is transferred to the fallopian tube instead of to the uterus. They offer the best of both IVF and GIFT, namely, documentation of fertilization in vitro and also higher pregnancy rates because of tubal transfer. However, the cost of ZIFT, PROST, or TET is usually greater than IVF or GIFT.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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