JEDDAH, 1 January — A recent medical success in Jeddah has attracted widespread attention.
A 42-year-old woman married for 18 years was unable to have children. She had failed to conceive by various techniques of assisted reproductive technology (ART) given to her at various medical centers both in and outside the Kingdom. One procedure that was not tried was gamete intrafallopian transfer (GIFT) which was almost forgotten after the invention of invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
The woman sought help at the Arab Fertility Center (AFC) at Jeddah's Khalid Idriss Hospital and delivered a healthy female baby after 36 weeks. No complications were recorded, according to Dr. Walid K. Idriss, who headed a team of experts that supervised the procedure.
"We concluded that GIFT might be an option for older women. " Dr. Idriss stated that the work had been published in a recent issue of 'The Kuwait Medical Journal.' A case report published therein is authored by Dr. Idriss, Dr. Anwar Masri and Dr. K. Sambasivarao, all from the department of gynecology and obstetrics at the department of AFC's assisted reproductive technology.
The study, whose main purpose was to explore the use of GIFT in an older woman who failed to achieve pregnancy by other methods of ART, says that the tubal environment is considered the best for gamete survival and embryo development. "The invitro culture of oocytes may not provide an optimum condition equivalent to a natural environment despite how well these cultures are maintained. While the ICSI method supersedes both GIFT and IVF in some aspects of male infertility, GIFT remains the method of choice to solve some infertility problems. In general, an age-dependent decrease in human fertility begins by the late thirties and becomes total by the late forties," the study says.
The experts stated that baseline ultrasound (US) scanning and diagnostic laparoscopy were conducted at the AFC to exclude any pathological abnormalities of pelvis, ovaries, fallopian tubes and uterus. They referred to the help rendered by Dr. Ahmad Mohiuddin, chief sonologist of the hospital, in the ultrasound assessments in the study.
The study reports that the significant impairment of the rate of pregnancy in women over 40 years of age is attributed to a poor oocyte quality and reduced endometrial receptivity. Some investigators feel that the oocyte quality rather than uterine receptivity is the principal factor for the age related conception decline. The hardening effect of zona pellucida is likely to be the major factor in this age group.
The study concludes: "The natural environment of fallopian tube helps prevent the zona hardening effect of oocyte and promotes fertilization and embryo development, particularly in older patients. GIFT has an additional advantage of synchronization between embryonal and endometrial development which can be better utilized in the older women."
