GIFT is very invasive as compared to IVF because of the surgical procedure - laparoscopy - involved with tubal transfers.
Some "strict" Catholic couples are still interested in GIFT because the Catholic church is (apparently) OK with it. This issue is brought up at our clinic by a Catholic couple about once a year. Therefore, GIFT may be the best fertility treatment option for a small minority of patients due to their strict religous beliefs.
What is GIFT?
GIFT involves placement of unfertilized eggs from the woman and her partner's sperm in the fallopian tubes of the woman with laparoscopy.
Who should be treated with GIFT?
GIFT can be used as an effective treatment for infertility of all causes except for women with infertility caused by tubal blockage or significant tubal damage or an anatomic problem with the uterus, such as severe intrauterine adhesions. It also should not be used for any significant male factor infertility cases.
Very mild male factor infertility has been treated with GIFT in some programs, but this is controversial. In general, in vitro fertilization (IVF) is a much better approach for couples with male factor infertility. With IVF, fertilization of the eggs can be documented in the lab prior to embryo transfer.
GIFT can be used in couples who have failed to conceive after at least one year of trying and who have failed at least 3 cycles of ovarian stimulation with intrauterine insemination, IUI.
GIFT vs. IVF
Although some programs report higher pregnancy rates for GIFT than for IVF, this does not mean that GIFT is a better procedure.
1. The patients that have GIFT might be more likely to become pregnant for other reasons (selection bias). For example, the more severely infertile women are usually treated with IVF rather than GIFT.
2. GIFT does not involve embryo culture. A poor quality IVF lab might demonstrate better pregnancy rates with GIFT than with IVF because the embryos are being damaged as they are cultured. In this situation, pregnancy rates may be better if the embryos develop in the woman's tubes rather than in the laboratory.
3. For high quality IVF labs with reproductive endocrinologists that are skilled at uterine embryo transfer, there is no good evidence that pregnancy rates are better with GIFT as compared with IVF.
4. As IVF labs advance embryo culture techniques and physicians maximize the embryo transfer procedure, it may be that IVF will demonstrate higher pregnancy rates than GIFT.
5. IVF allows us to select only the best quality embryos on day 3 or day 5 for transfer. GIFT places unfertilized eggs and sperm in the tubes - we do not know how many eggs fertilize or develop normally after that.
How is GIFT performed?
1. Consents are signed by all parties.
2. The woman is stimulated with medications to develop multiple egg development.
3. When the woman's follicles are mature, an aspiration procedure is performed to remove the eggs from her ovaries.
4. Immediately after the aspiration, eggs (usually 3-4) are mixed with about 200,000 motile sperm in a very small droplet of medium in a special catheter.
5. The transfer procedure is then done with laparoscopy. The catheter is placed deep in the lumen of the tube and the egg/sperm mixture is injected. Laparoscopy is a surgical procedure that utilizes a scope to see inside the abdominal cavity.
6. Fertilization and early embryo cleavage is then expected to occur in the woman's tubes.
7. The resulting embryos will hopefully divide normally and move down to the uterus, implant, and develop to result in a live birth.
GIFT costs much more than IVF because of the surgical procedure involved and the resulting operating room and hospital fees involved.