The purpose of prelaparoscopy transvaginal retrieval and evaluation of oocytes in a modified GIFT procedure

To minimize the risk of submitting the patient to an 'unnecessary' laparoscopy in cases of unsuccessful oocyte retrieval and to reduce gamete exposure to the probable adverse effects of the CO2 pneumoperitoneum and anaesthetic agents, we have performed transvaginal oocyte recovery prior to performing the laparoscopy for gamete intra-Fallopian transfer (GIFT). When the recovered oocytes had a low potential for fertilization, the GIFT laparoscopy was cancelled and fertilization in vitro and zygote intra-Fallopian transfer (ZIFT) were attempted instead. By introducing this modified, two-stage GIFT procedure, the laparoscopy time was reduced to a quarter of that required for the more time-consuming, conventional GIFT method (18 +/- 4 min and 76 +/- 13 min respectively in the same unit). Of the 35 cases selected for this modified GIFT treatment, only 26 were considered suitable to proceed to laparoscopy, resulting in eight clinical pregnancies (30.7%). The remaining nine (25.7%) GIFT cases were cancelled, due either to the absence of oocytes in four or to their poor quality in five (oopenia). The latter were diverted to IVF and out of five cases, only two oocytes were fertilized and proceeded to ZIFT. No clinical pregnancy resulted. In conclusion, we propose that securing the retrieval of oocytes of appropriate quality seems to be a logical and necessary preliminary step before embarking upon laparoscopy for GIFT or ZIFT, depending upon the biological status of the gametes. By employing this procedure, unnecessary and costly laparoscopy can be avoided in certain cases.