Abstract
Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development.
Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used.
Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration.
Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation.
Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.
Key words: gamete uterine transfer, preovulatory progesterone, tubal occlusion
Full Text
The Full Text of this article is available as a PDF (415.5 KB).
References
- 1.Craft I, McLeod F, Green S, Djahanbakhch O, Bernard A, Twigg H. Human pregnancy following oocyte and sperm transfer to the uterus. Lancet. 1982;1:1031–1033. doi: 10.1016/S0140-6736(82)92096-7. [DOI] [PubMed] [Google Scholar]
- 2.Bohrer M, Kemmann E. Risk factors for spontaneous abortion in menotropin-treated women. Fertil Steril. 1987;48:571–575. doi: 10.1016/s0015-0282(16)59466-7. [DOI] [PubMed] [Google Scholar]
- 3.Estes WL. Ovarian implantation. The preservation of ovarian function after operation for disease of the pelvic viscera. Surg Gynecol Obstet. 1924;38:394–398. [Google Scholar]
- 4.Veersema S, Bernardus RE, Veersema D, Vermeiden JPW, Schoemaker J. Pregnancy following transcervical transfer of oocyte and sperm. N Engl J Med. 1989;320:1499–1499. doi: 10.1056/NEJM198906013202221. [DOI] [PubMed] [Google Scholar]
- 5.Sterzik K, Rosenbusch B, Grab D, Lauritzen C. Pregnancies following direct oocyte-sperm transfer (DOST): A simple alternative to conventional in vitro fertilization (IVF) J Vitro Fert Embryo Transfer. 1991;8:241–242. doi: 10.1007/BF01130815. [DOI] [PubMed] [Google Scholar]
- 6.Kubik C, Guzick DS, Berga SL, Anthony AJ. Establishment of pregnancies in humans after transcervical transfer of gametes immediately after oocyte retrieval. Fertil Steril. 1990;54:1174–1176. doi: 10.1016/s0015-0282(16)54025-4. [DOI] [PubMed] [Google Scholar]
- 7.Campagnoli C, Brigante C, Busacca M, Sario MM, Doldi N, Peris C, Vigano P, Vignali M. Pregnancies following gamete intrauterine transfer (GIUT) in patients with tubal infertility. Gynecol Endocrinol. 1991;5(Suppl 1):40–40. [Google Scholar]
- 8.Rizk B, Bekir JS, Avery S, Smith S, Edwards RG. Intrauterine replacement of oocytes with bound sperms: A pilot study. Hum Reprod. 1990;5(Suppl 1):5–5. [Google Scholar]
- 9.Quinn P, Steinberg J, Schein S. Greenberg P: Direct ovumsperm transfer (DOST) to the uterus as a mode of treatment following failed IUI but preceding IVF or GIFT. 44th Annual Meeting of the Pacific Coast Fertility Society, April 17–21, 1996. Fertil Steril (Suppl) A26.
- 10.Ben-Nun I, Ghetler Y, Jaffe R, Siegal A, Kaneti H, Fejgin M. Effect of preovulatory progesterone administration on the endometrial maturation and implanatation rate after in vitro fertilization and embryo transfer. Fertil Steril. 1990;53:276–281. doi: 10.1016/s0015-0282(16)53281-6. [DOI] [PubMed] [Google Scholar]
- 11.Howles CM, Macnamee MC, Edwards RG. The effect of progesterone supplementation prior to the induction of ovulation in women treated for in vitro fertilization. Hum Reprod. 1987;2:91–94. doi: 10.1093/oxfordjournals.humrep.a136507. [DOI] [PubMed] [Google Scholar]
- 12.Gonen Y, Casper RF. Sonographic determination of a possible adverse effect of clomiphene citrate on endometrial growth. Hum Reprod. 1990;5:670–674. doi: 10.1093/oxfordjournals.humrep.a137165. [DOI] [PubMed] [Google Scholar]
- 13.Garcia JE, Acosta AA, Hsiu J-G, Jones HW. Advanced endometrial maturation after ovulation induction with human menopausal gonadotropin/human chorionic gonadotropin for in vitro fertilization. Fertil Steril. 1984;41:31–35. doi: 10.1016/s0015-0282(16)47536-9. [DOI] [PubMed] [Google Scholar]
- 14.Lui JH, Yen SSC. Induction of midcycle gonadotropin surge by ovarian steroids in women: A critical evaluation. J Clin Endocrinol Metab. 1983;57:797–802. doi: 10.1210/jcem-57-4-797. [DOI] [PubMed] [Google Scholar]
- 15.Nader S, Berkowitz AS, Maklad N, Wolf DP, Held B. Characteristics of patients with and without gonadotropin surges during follicular recruitment in an in vitro fertilization/embryo transfer program. Fertil Steril. 1986;45:75–78. doi: 10.1016/s0015-0282(16)49100-4. [DOI] [PubMed] [Google Scholar]
- 16.Schorderet-Slatkline S, Baulieu EE. Induction by progesterone and a “maturation promoting factor” of soluble protein in Xenopus laevis occyte in vitro. Ann NY Acad Sci. 1977;286:421–433. doi: 10.1111/j.1749-6632.1977.tb29434.x. [DOI] [PubMed] [Google Scholar]
- 17.Edwards RG. In vitro fertilization and embryo replacement. Ann NY Acad Sci. 1985;442:1–24. doi: 10.1111/j.1749-6632.1985.tb37501.x. [DOI] [PubMed] [Google Scholar]
- 18.Whitman GF, Luciano AA, Maler DB, Peluso JJ. Human chorionic gonadotropin localization and morphometric characterization of human granulosa-luteal cells obtained during in vitro fertilization cycles. Fertil Steril. 1989;51:475–479. doi: 10.1016/s0015-0282(16)60557-5. [DOI] [PubMed] [Google Scholar]
- 19.Silverberg K, Martin M, Olive DL, Burns WN, Schenken RS. Elevated serum progesterone levels on the day of human chorionic gonadotropin administration in in vitro fertilization cycles do not adversely affect embryo quality. Fertil Steril. 1994;61:508–513. doi: 10.1016/s0015-0282(16)56584-4. [DOI] [PubMed] [Google Scholar]