Donation of fertilized uterine ova to infertile women.

Nonsurgical recovery of a preimplantation conceptus from the uterus of a fertile donor woman with transfer to an infertile recipient woman and subsequent pregnancy has been described previously. In this report, we describe the performance of 56 nonsurgical uterine lavages, recovery of 23 ova, and transfer of 17 ova with production of 8 viable pregnancies. Four pregnancies resulted in healthy infants, two aborted, and two are progressing normally. We describe a case of a woman donating an ovum to her sister, with birth of a healthy child. We also describe a viable pregnancy resulting from nonsurgical ovum transfer to a woman with no ovaries. Donation of ova by uterine lavage is a new method of overcoming human infertility; it is nonsurgical, has a low complication rate, and may be repeated several times until it produces pregnancy.

Gamete intrafallopian transfer in a woman with tubal occlusion. A case report.

Gamete intrafallopian transfer (GIFT) is usually performed when at least one fallopian tube is normally patent. We used GIFT in a case of bilateral tubal occlusion. The patient, who had primary ovarian failure, was enrolled in our GIFT program since it was assumed that her tubes were normally patent. Unexpectedly, at laparoscopy both tubes turned out to be distally occluded; nevertheless, GIFT was carried out by piercing the tubal wall. At this writing the patient had reached the 11th week of a normal intrauterine gestation and was still undergoing hormone replacement therapy.

Non-surgical flushing of the uterus for pre-embryo recovery: possible clinical applications.

Growing interest in preimplantation genetic diagnosis has indicated uterine flushing as one method for obtaining human preimplantation embryos. To date, our institution has performed non-surgical uterine flushing to donate the recovered embryos to infertile recipients. We performed 127 flushings in 127 cycles using a modified urinary bladder catheter. Using the donors' natural cycles, a single ovum was recuperated in 37 out of 88 flushings. In 17 flushings, clomiphene citrate was given to the donors and 14 ova were found in nine positive recoveries. Human menopausal gonadotrophins were administered to the donors in 22 flushings and 22 ova were located in 14 positive recoveries. In total, 22 blastocysts, 11 morulae and 13 pre-embryos at the 2- to 16-cell stages were found. When transferred, these embryos gave rise to 18 clinical pregnancies in the recipients (40.9% of the transfers; 14.1% of the flushings). In comparison with natural cycles, superovulation of donors did not significantly increase the recipients' pregnancy rate. At present, non-surgical recovery of uterine pre-embryos does not seem to carry much potential as a tool for infertility treatment, or for genetic diagnosis. This is because currently available alternative methods are more successful.

Transfer of pre-embryos donated and fertilized in vivo to recipients given a steroid replacement therapy.

This study describes eleven procedures of non-surgical recovery of preimplantation conceptuses from the uteri of eight fertile donor women and the transfer of the recovered pre-embryos into the uteri of infertile recipients with primary ovarian failure, or with hypothalamic--pituitary failure. Conjugated oestrogens and progesterone were administered to recipients as replacement steroids during the first 20 weeks of pregnancy, in order to produce a secretory endometrium allowing nidation and development of the transferred conceptuses. Five pre-embryo transfers resulted in two viable pregnancies and one early abortion. Non-surgical pre-embryo transfer is a simple and practical method for providing donated ova to women lacking efficient ovarian function.

Semen analysis and in vitro fertilization.

Thirty-seven patients underwent ultrasonographic, clinical, and hormonal monitoring of superovulated cycles in order to time HCG administration in an attempt to schedule the laparoscopy at the optimal time for oocyte recovery. Superovulation was induced by Clomiphene in patients under the age of 35, with both ovaries; Clomiphene and HMG were administered in women over age 35 and/or with only one or half an ovary. Twelve patients were excluded because of poor oestradiol values or LH rise prior to HCG administration. Four patients were excluded at laparoscopy because of inadequate ovarian access (a preliminary laparoscopy was not performed). In 21 patients follicular aspiration was performed: 33 mature, 15 immature, and 5 degenerated oocytes were obtained (1.5 mature oocyte per patient). Thirty eggs were fertilized on a total number of 48 eggs (mature and immature)-fertilization rate of 63%. Twenty-nine embryos cleaved and were transferred to 13 patients at the 4- to 8-cell stage.

One-hundred-and-six gamete intra-fallopian transfer procedures with donor semen.

A single attempt of gamete intra-Fallopian transfer was performed in 106 patients, who had previously failed to become pregnant after a certain number of artificial donor inseminations. A maximum of six unselected oocytes were transferred into the tubes. Fifty-five clinical pregnancies (51.9%) were obtained. There were 11 multiple pregnancies (20%) and 10 miscarriages (18.1%). Only one ectopic pregnancy occurred (1.8%). The age of the patients and the previous number of failed inseminations did not have any significant influence on the outcome of the procedure, whereas the number of transferred oocytes had a proportional, significant correlation with the pregnancy rate.

Oocyte donation by gamete intra-fallopian transfer to amenorrhoeic and cycling patients given replacement steroids.

Thirteen procedures of oocyte donation by the gamete intra-Fallopian transfer (GIFT) technique are described. The patients included six women with premature ovarian failure, four normally cycling women with unexplained infertility who responded poorly to super-ovulation induction in preparation for GIFT, and lastly one woman carrier of a 16/21 balanced translocation. Two patients had oocytes donated on two occasions. Oocyte donors were recruited either among the patients' relatives (n = 4), or among GIFT or IVF patients (n = 8), who altruistically donated their extra oocytes. Donors were superovulated and oocytes collected laparoscopically or vaginally under ultrasound guidance. Donors did not suffer any complications. Recipients were given exogenous estrogens, and exogenous progesterone was added from the day of donation. Seven clinical pregnancies were obtained (53.8% per attempt); one set of triplets aborted at 14 weeks. Donation took place on replacement day 12-18 and pregnancies were obtained in patients receiving oocytes throughout this temporal window. The increasing availability of embryo-freezing facilities will probably reduce the number of ova available for donation. Therefore, the patients' families may become a precious source of donated eggs, especially for those patients having large families, with strong family ties.

Surrogate human fallopian tubes for overcoming tubal infertility.

A procedure has been devised in order to establish a pregnancy in a patient with severe, untreatable tubal infertility who had unsuccessfully undergone tubal reconstructive surgery and repeated in-vitro fertilization procedures. This technique, which involves a volunteer, fertile woman, results from the combination of two infertility treatments: namely gamete intra-Fallopian transfer and uterine flushing. The gametes of the infertile couple were introduced into the distal tube of a synchronized volunteer woman; after 5 days, the embryos, recovered by lavage of the volunteer's uterus, were transferred into the patient's uterus with a resulting pregnancy and delivery.