Gamete Intra-Fallopian Transfer

GIFT is a technique devised 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. GIFT stands for “Gamete Intra-Fallopian Transfer”. Gametes (i.e., the female's eggs and the male's sperm) are washed and placed via catheter directly into the women's fallopian tubes. This usually involves a minor surgical procedure that allows you to go home the same day with a minor degree of pain. With GIFT, fertilization occurs inside the women's body (not outside, as in IVF) and mimics the way a normally fertilized egg would begin its journey to the uterus for implantation. About 70% of infertility patients will have their best chance of pregnancy with this approach. The success rate with GIFT is higher than with standard IVF (In Vitro Fertilization) but can only be performed if the woman has normal fallopian tubes and the man has adequate sperm. For serious male infertility cases we recommend the ICSI procedure combined with IVF, ZIFT, or TET.

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 the 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 to three days. The embryo then implants in the uterine wall with a resultant pregnancy.

The GIFT technique follows nature by allowing the eggs to fertilize and develop in the natural environment of the fallopian tube, and then make their way to the uterus for implantation according to a normal timetable. In contrast, IVF places fertilized eggs (embryos) 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. Another advantage to GIFT is due to the revolutionary technique developed by Dr. Fakih and his staff. Previous to 1987, washed eggs and sperm were placed together in a sterile, synthetic, culture solution before they were returned to the fallopian tubes. Dr. Fakih has pioneered a technique where the nutrient rich fluid aspirated from the follicles during the egg retrieval process is used as the culture medium for the sperm and eggs. This new method for culturing sperm and eggs doubled the success rate for GIFT and is now used by clinics all around the world.

To prepare her body for the GIFT procedure the woman receives hormone injections to stimulate development of the ovarian follicles, the sac-like structures that contain the eggs. Administering hormones increases the chances of retrieving many ripened eggs, each one capable of being fertilized and producing a pregnancy. HMG (human menopausal gonadotropin) and recombinant FSH (follicle-stimulating hormone) are the hormones used to stimulate the production of follicles.

Up to four or more eggs are returned to the patient depending on her age and egg quality. If you have extra eggs from the GIFT procedure we can perform IVF on them and then freeze the resulting embryos for future attempts at pregnancy via a FET procedure.

To begin a cycle of GIFT you will monitor for ovulation using an ovulation kit the cycle before your procedure month. Approximately 10 days after ovulation you will receive a .94 mg. or a 1.25 mg. D-Lupron injection IM. The administration of Lupron prevents a premature surge of LH (luteinizing hormone) from triggering ovulation before the eggs can be retrieved. You should begin your menstrual cycle within two weeks after this injection. Alternatively, you may also begin this part of your GIFT cycle on day one of your menstrual period. Within the first few days of your cycle you will be examined by transvaginal ultrasound to check the status of your ovaries and pelvis in preparation for your hormone injections. You will also have baseline bloodwork performed at this time. The hormone injections (HMG or FSH) are administered for approximately 10 days (depending on the patient's response) beginning day 3 to 10 of your cycle. Approximately four days after starting these injections you will begin periodic monitoring by ultrasound examination and blood estrogen level. Later that day you will be informed how much HMG or FSH you will be receiving until your next monitoring appointment. The dosage and timing will depend on your age, previous response, and the estrogen level and ultrasound results demonstrated that day. When the monitoring shows the eggs are ripe and ovulation is imminent, an injection of HCG (human chorionic gonadotropin) is administered to the patient to complete the egg maturation process and prepare the eggs for retrieval. The patient is admitted for the outpatient GIFT surgical procedure the next day.

A semen sample from the husband is obtained approximately two to three hours before the surgery. It is then washed and prepared with the most active and healthy sperm being selected for loading into the catheter. Eggs are retrieved by transvaginal needle aspiration (no surgical incision) via an ultrasound guide while the patient is under light sedation. The aspirated follicular fluid (containing the eggs) is observed under a microscope and the eggs are examined for maturity and quality. Mature eggs are pooled with a carefully measured quantity of sperm in the fluid drawn from the follicles. The egg and sperm mixture is loaded into a catheter which is then placed into the patient's fallopian tubes through a very small incision in her abdomen while she is under general anesthesia. The sperm and eggs are then released into the fallopian tubes where fertilization will take place. The resulting embryos are nurtured there and then move down into the uterus for implantation approximately seven days later. GIFT is intended to be an outpatient procedure and the patient almost always goes home the same day. She will be asked to limit her activity for the next week and get plenty of rest.

Progesterone support by IM injection and/or vaginal suppository will begin the day of your procedure. The hormone progesterone supports a pregnancy by preparing the endometrial lining so it is receptive to implantation. In one week you will have a blood test to check your hormone levels and further instructions for hormone supplementation will be given later that day. Two weeks after your procedure you will have a blood pregnancy test, a quantitative beta HCG. If the test is positive you will continue hormone supplementation for four to eight weeks.

If you do not get pregnant you will discontinue these hormones. You should consider undergoing another cycle in the future as subsequent cycles will also have a very high pregnancy rate. Another option is to go through a FET if your GIFT cycle yielded extra eggs for IVF fertilization and freezing.

We have a 40-50% success rate per retrieval cycle for GIFT. In younger women (under 35) with good quality sperm the pregnancy rate is somewhat higher. In older women the pregnancy rate is lower. If an older woman can yield many eggs her pregnancy rate can be made equivalent to that of a younger patient by returning more eggs. Please see our Success Rate page for more information.

Contact one of our clinics for more information or to arrange a consultation appointment to see if GIFT or one of our many other procedures will help you fulfill your dream of parenthood.