Surgical techniques of oocyte collection and embryo transfer

In the decade since the birth of the first child conceived as a result of in vitro fertilization and embryo transfer much has been achieved in the field of assisted conception. Although in vitro fertilization (IVF) was successful first for the treatment of tubal disease, the indications for its use have now widened to include unexplained infertility, oligozoospermia, endometriosis and infertility due to immunological disorders. Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) are now used commonly for the treatment of couples where the woman has patent fallopian tubes. The huge increase in the demand for therapy using these techniques of assisted conception places considerable strain on the finances available for health care, and has led some to question the wisdom of such use of limited resources. To reduce the cost of treatment, and because repeated IVF-ET attempts may be necessary before achieving pregnancy, the initial laparoscopic approach for oocyte recovery has been largely replaced by ultrasound-guided techniques. Non-surgical embryo transfer techniques have changed little since originally described. However, where the tubes are patent, one-cell zygotes or cleavage stage embryos may be transferred into the fallopian tube (ZIFT and tubal embryo stage transfer respectively). On the other hand if the tubes are blocked, surgical embryo transfer (SET) may be performed. Most recently, some success has been achieved following the transfer of embryos into the fallopian tube by the technique of retrograde fallopian tube catheterisation.