DIRECT GAMETE UTERINE TRANSFER IN PATIENTS WITH TUBAL ABSENCE OR OCCLUSION

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospect ive IRE-approved protocol for patients fulfilling study eligibility cr iteria 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 lap aroscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and men otropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of ovulatory hCG administration, prog esterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and sir oocytes were returned to the uterine cavity, admired with sperm, immediately following retr ieval. Luteal support consisted of daily P4 administration. Results: O f the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achi eved, with one early first-trimester loss, one late first-trimester lo ss (Trisomy 14), and two healthy term infants delivered. IVF of surplu s oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage f ollowing cryopreservation. Conclusions: Human fertilization cart be ac hieved through direct uterine transfer of gametes. Furthermore, admini stration of P4 prior to the ovulatory dose of hCG is compatible with i n vitro or in vivo fertilization and implantation.