Direct gamete uterine transfer in patients with tubal absence or occlusion.
OBJECTIVE
Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development.


METHODS
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.
Ransom
M X
MX
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA.
Garcia
A J
AJ
Doherty
K
K
Shelden
R
R
Kemmann
E
E
D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D015925:Cryopreservation; D004624:Embryo Transfer / Q000379:methods*; D005184:Fallopian Tube Diseases / Q000628:therapy; D005187:Fallopian Tubes / Q000473:pathology*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D008297:Male; D018587:Oocyte Donation / Q000379:methods*; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000627:therapeutic use; D013094:Spermatozoa; D014599:Uterus / Q000502:physiology*
D006063:Chorionic Gonadotropin; D011374:Progesterone; D005640:Follicle Stimulating Hormone