FACTORS ASSOCIATED WITH IMPROVING SUCCESS RATES WITH GAMETE INTRAFALLOPIAN TRANSFER UNDER THIN-NEEDLE SPINAL-ANESTHESIA

Purpose: In order to reduce the risk of major anesthetic complications associated with laparoscopic gamete intrafallopian transfer procedure s, we have exclusively used thin-needle spinal anesthesia over the yea rs 1991-1994. This paper will review complication rates in order to fu rther establish the safety profile of GIFT under thin-needle anesthesi a and report the changes in our GIFT protocol from 1991 to 1994 which have been associated with a statistical improvement in the implantatio n rate from 11% to 23% (P = 0.01) and an increase in delivery rates fr om 29% to 42% per transfer procedure. Methods: Sixty-eight laparoscopi c GIFT procedures were done in women with at least one patent oviduct and failure to respond to less invasive treatment. Clinical variables were analyzed to determine if similar patient populations had been tre ated over the study period. Results: The improved delivery rates and i mplantation rates could not be explained by patient selection. No majo r perioperative complications occurred. Minor perioperative complicati ons and difficulties included one patient requiring general anesthesia , one patient developing a spinal headache which could be managed cons ervatively at home, and one patient requiring a minilaparotomy to comp lete the GIFT procedure, The more serious complications occurred as a result of the superovulation and multiple oocyte transfer rather than the surgical or anesthetic technique, These included two patients with severe ovarian hyperstimulation requiring hospitalization,and five de livered triplet pregnancies. Factors associated with improving success rates included improvements in semen and equipment preparation as wel l as an increase in the number of sperm transferred from 200,000 to 50 0,000. Conclusions: GIFT can be performed with relative safety under t hin needle spinal anesthesia with high implantation and delivery rates if care is made to optimize sperm and equipment preparation. GIFT und er thin-needle spinal anesthesia may be an attractive alternative for treatment of longstanding nontubal infertility in couples willing to t ake the risk of ovarian hyperstimulation and multiple pregnancy.