Infertile patients cannot afford to wait for treatment while their eggs get older.
Dr. Sherman Silber, Infertility Center of St. Louis, is offering free video consultations for patients who need to plan now for their treatment while stay-at-home orders are in place. He is talking to and evaluating patients in their home via to comply with social distancing measures.
Dr. Silber is discovering that patients actually prefer this method of telemedicine consultation over the conventional office visit. Patients have conveyed that “it is so much more convenient and less stressful” to have a free telemedicine personal consultation than to take a day off from work to travel to the doctor’s office and sit with other nervous patients in the waiting room.
The COVID-19 pandemic is thus changing much of the way we will do things in the future, and for the better. "Our patients are surprisingly much happier with this approach. Of course, at some point we need to perform hands on treatment. But with this new manner of seeing patients, we can come to the right diagnosis and treatment plan for most patients more efficiently, quickly, and painlessly, with no loss of personal one-on-one communication.” This is a very welcome new era of telemedicine that has been forced on us by the current difficult times.
If you have any questions, you may call us at(314) 576-1400.
GIFT (Gamete Intra-Fallopian Transfer)
GIFT is an early, and very simple ART (Assisted Reproductive Technology) technique devised in the 1980s to achieve pregnancies in most couples who have not been able to conceive using conventional treatments for infertility (despite having good sperm and normal fallopian tubes). Most infertility patients will have their best chance of pregnancy with some sort of ART procedure, and GIFT is the only ART approach that is completely acceptable to the Roman Catholic Church. The success rate with GIFT is even somewhat higher than with standard IVF (in vitro fertilization), but GIFT can be performed only if the patient has normal fallopian tubes and adequate sperm. For cases with abnormal fallopian tubes, IVF is mandated. For cases with poor sperm, we recommend the ICSI procedure pioneered by us and our Belgian collaborators.
GIFT stands for “Gamete Intra-Fallopian Transfer.” Gametes, i.e., the female’s eggs and the male’s sperm, are washed and placed via a catheter directly into the woman’s fallopian tubes. This usually involves a minor surgical procedure which allows you to go home the same day with a minor degree of pain that lasts for just a few days. With GIFT, fertilization occurs inside the woman’s body (not outside), and mimics the way a normally fertilized egg would begin its journey to the uterus for implantation. Understanding this older and more “natural” ART treatment is helpful for understanding the newer, more complex treatments.
How Does Gift Work?
In a fertile couple, pregnancy begins with the release of an ovum (egg) from the woman’s ovaries. The egg enters the fallopian tube where it meets with sperm that have traveled there, following intercourse, from the vagina. The sperm normally fertilize the egg in the fallopian tube. The fertilized egg, now called an embryo, begins to divide and in four days, contains many cells. At this time, the embryo moves from the fallopian tube to the uterine cavity where it “floats” for another two days. The embryo then implants in the uterine wall, and becomes a pregnancy.
The GIFT technique follows nature by allowing the eggs to fertilize and develop in the natural environment of the fallopian tube, and then to make their way to the uterus for implantation according to a normal timetable. In contrast, in vitro fertilization (IVF) places fertilized eggs directly into the uterus. One of GIFT’s major advantages over IVF is that the technique relies to a far greater degree on the body’s natural processes and timetable to produce pregnancy, and is acceptable to those religious groups which avoid the more embryo invasive technologies. In technical IVF terms, we would say that it is the best of all methods of “co-culture”.
The fluid containing the eggs is placed in a laboratory dish and observed under a microscope. The egg is located and its stage of maturity noted. It is then carefully cultured in a special nutrient. Sperm and eggs are sequentially loaded into the catheter, which is then introduced into the patient’s fallopian tubes through a tiny incision in her abdomen.
Prior to any GIFT, IVF, or ICSI procedure, the woman receives hormones to stimulate development of the ovarian follicles, which are sac-like structures that contain the eggs. Administering these hormones allows us to retrieve many ripened eggs, and thus increase the chance of pregnancy.
Approximately three hours before the procedure, a semen sample from the husband is obtained. The sperm is washed and prepared for loading into the same catheter into which several of the wife’s best eggs will be placed. The eggs are obtained by transvaginal needle aspiration (no surgical incision) via an ultrasound guide.
The fluid containing the eggs is placed in a laboratory dish and observed under a microscope. The egg is located and its stage of maturity noted. It is then carefully cultured in a special nutrient. Sperm and eggs are sequentially loaded into the catheter, which is then introduced into the patient’s fallopian tube through a tiny incision in her abdomen.
The eggs and sperm are then released into the fallopian tube. The number of eggs returned to the patient depends on the wife’s age and egg quality. This procedure can be performed surgically either through laparoscopy or a small, one-inch “mini-lap” incision in the lower abdomen, under general anesthesia. It takes place in our technologically advanced operating room and lab, with a highly controlled environment to prevent any inadvertent toxicity to the eggs, sperm, or embryos.
Chance for Pregnancy
GIFT is not nearly as popular as IVF today; nonetheless there is still a 50% pregnancy rate per retrieval cycle for GIFT. In older women the pregnancy rate is lower. If an older woman is fortunate enough to yield many eggs, her pregnancy rate can be made equivalent to that of a younger patient by putting in more eggs. GIFT or ZIFT (a variation of GIFT whereby embryos are first fertilized in vitro, and then transferred to the fallopian tubes) actually gives a considerably higher pregnancy rate in older women with cervical abnormalities.
If any ART cycle — GIFT, ZIFT, IVF, etc. — fails to achieve pregnancy, you should consider undergoing more cycles in the future. If you don’t get pregnant in your first cycle (and there are no egg problems) you can still get pregnant in subsequent cycles, and the pregnancy rate still remains just as high.
If your fallopian tubes are damaged, you would require IVF even if GIFT or ZIFT would have been your preference otherwise. If your sperm is poor, that is no problem whatsoever. You would then undergo an amazing procedure called IVF/ICSI, which we actually helped develop with colleagues in Brussels, Belgium.