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Tubal Embryo Transfer

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In gamete intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), or tubal embryo transfer (TET), gametes (eggs and sperm) or early embryos are transferred into the fallopian tube rather than the transfer of embryos into the uterus, as in standard IVF (in vitro fertilization). These procedures are similar to IVF because all steps, from down-regulation to ovarian stimulation to egg retrieval, are identical to IVF. However, several important differences exist.

In a GIFT procedure, retrieved eggs and sperm are mixed together and transferred into one or both fallopian tubes (where natural fertilization normally occurs). In a ZIFT procedure, on the other hand, fertilization is allowed to take place in the laboratory just like in standard IVF, however when day-one embryos are formed (called zygotes), they are transferred into the fallopian tube(s) instead of the usual transfer of day-three embryos into the uterus through the cervix, as in IVF. In a TET procedure, day-two embryos are transferred into the fallopian tubes. The transfer of gametes, or early embryos into the fallopian tubes requires a surgical procedure called a laparoscopy.

The TET procedure involves the transfer of embryos that are more advanced in development than those in ZIFT i.e. cleaved embryos. The aim is to achieve fertilization in-vitro (in the laboratory) and then replace the cleaved embryos in the Fallopian tube, the normal site for fertilization. It is suitable only for women who have at least one healthy Fallopian tube.

TET is carried out as a day-case procedure under a general anesthetic, using laparoscopy. You may experience some abdominal discomfort and pain for a few days after the procedure, but painkillers can relieve this.

The transfer of embryos to the fallopian tubes for purposes of achieving a pregnancy. Embryos may be transferred at the fertilized oocyte (zygote) stage in a ZIFT (Zygote Intrafallopian Transfer) procedure or 24 hours later at the 2- to 6- cell stage in a TET procedure.

The TET procedure

The woman is given fertility drugs beforehand to stimulate ovulation. These will take the form of hormone injections which help with this stimulation. The effect of these drugs on oestrogen levels will be monitored via blood and ultrasound tests.

She will also be given an injection of human chorionic gondadotropin (HCG) which aids with egg development.

Eggs are extracted from the woman in the same way as IVF, GIFT and other fertility procedures. They are placed in a Petri dish (culture dish used in a laboratory) along with sperm and allowed to fertilise. This usually takes a couple of days.

The next stage is the insertion of the embryos into the fallopian tubes. This is performed as a laparoscopy and involves making a small incision in the abdominal area before inserting a slim tube with a camera attached. This camera gives the specialist a clear view of the fallopian tubes.

The embryos are inserted into the fallopian tubes (or tube).

These are monitored over the next few days to check for signs of pregnancy. A blood test can confirm or reject a diagnosis of pregnancy.

If pregnancy has been confirmed then hormone injections are given to support this.

Success rates are higher in younger women than those over 35.

The risks of TET are similar to those for IVF, GIFT or ZIFT.

How are TET and ZIFT 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. The eggs are then fertilized in the laboratory with her partner's sperm.
  4. The embryos are cultured in the laboratory for 1 day for ZIFT and 2 days with TET. At that time, a tubal transfer procedure (surgery with laparoscopy) is done which places the embryos in the woman's fallopian tubes.

Advantages and Disadvantages of TET

TET's are mainly used for patients who have a difficult transcervical intrauterine transfer and/or patients who have failed previous IVF and FET cycles due to poor embryo quality. The theoretical advantage of a ZIFT or TET procedure over GIFT or IVF is that fertilization is known to occur, however, embryo development can take place in the natural tubal environment with no possibility of trauma to the endometrial lining caused by a difficult embryo transfer. TET has the advantage over ZIFT of allowing selection of the best quality embryos while giving patients additional time for recovery from the egg aspiration. The majority of TET procedures are performed on male-factor patients with difficult transcervical intrauterine transfers.

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