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Another innovation in this field has been the concept of encapsulated gamete intrauterine transfer in which the eggs and sperm are transferred into the uterine cavity after placing them in a biodegradable semipermeable matrix. The capsule acts functionally like a temporary incubator chamber which prevents the egg from being damaged as a result of direct contact with the endometrium. After fertilization has occurred in the cavity, the capsule dissolves and releases the embryos for implantation. If this technique lives up to its promise, then many more centers will be able to provide assisted conception services to their patients.
While the standard technique for women with blocked tubes has been IVF, the method of GIFT (gamete intrafallopian transfer) developed by Asch is the method of choice for women with non-tubal infertility. In this method the eggs and sperm (gametes) are transferred directly into the fallopian tubes (which is where they ‘belong’). Pregnancy rates with GIFT are higher than IVF because the human fallopian tube provides a more physiological milieu for the gametes. GIFT also requires less laboratory expertise than IVF since gamete handling in vitro is minimized. A major limitation with GIFT was the need to perform a laparoscopy in order to transfer the gametes into the tubes. However, Jansen has now developed special catheter sets that allow the gametes to be introduced into the tubes under ultrasound guidance - thus making ‘vaginal GIFT’ a non-surgical procedure and reducing its expense.
In developing countries, IVF clinics need to try to keep IVF as simple and cheap as possible. They should be willing to accept lower pregnancy rates per attempt, but since patients will be able to afford many more attempts, the cumulative conception rate will be quite good. If the cost-effectiveness of treatment is considered (the number of ‘take-home babies’ per dollar spent) then the cost-effectiveness is likely to be comparable to the best in the world. While it may be true that patients may take longer to get pregnant, they spend much less money in the long run. Most importantly, this approach will make IVF services available to couples who could never have even dreamed of making a single attempt because of the expense involved.
Simplified protocols are also much more ‘patient-friendly’. Since conventional IVF is so expensive, going through the process is very stressful for patients. The monitoring is very intensive and disrupting. Since so much money is at stake, patients are very apprehensive of the outcome, and are distressed if the cycle fails.
Moreover, since the treatment cycle is so expensive, few patients can afford to repeat it - so most have to drop out without succeeding in getting pregnant. If on the other hand, treatment was simplified and inexpensive, patients could be counseled to view each attempt much as an insemination cycle is viewed today - something to be repeated as needed, till the goal is reached. This is a much more realistic option for most patients - and one more of them. This would reduce stress and anxiety considerably, and make treatment much more manageable for the patient.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
