Transcript Microinjection and Fallopian Transfer (MIFT)-

Microinjection and Fallopian
Transfer (MIFT) - an effective
form of Assisted Reproductive
Technology(ART) for the
treatment of severe male
infertility
Dr. Milton Leong
IVF Centre
Hong Kong Sanatorium & Hospital
2-4 Village Road, Happy Valley
Hong Kong
url: http://www.ivf.com.hk
email: [email protected]
GIFT vs IVF Result-1
GIFT
IVF
Pregnancy per cycle
29.5%
19.8%
Delivery per cycle
19.8%
16.0%
Source: Dawood MY, Am J Obstet Gynecol 1996 Apr;174 (4):1208-17
GIFT vs IVF Result -2
GIFT
IVF
Pregnancy per transfer
35.1%
33.3%
Delivery per transfer
29.3%
27.9%
Source:SART Registry, Fertility and Sterility 1996 May;71 (5):798-807
• 1992
1st ICSI Pregnancy report on
Lancet by Palermo et. al.
• 1995
TESE-ICSI pregnancy report on
Hum Reprod by Siber et. al.
• 1999
1st MIFT case report on
J Assist Reprod Genet by Allan et. al.
Indications of MIFT
•
•
•
•
Male Factor
Idiopathic
Antibodies
Previously failed IVF
83%
13%
1%
3%
MIFT Jan 98--May 00
<40
>=40
semen
Normal
AbN
Sub-total
Normal
Abn
Sub-total
oocyte retrievals
29
176
205
6
47
53
# of oocytes
266
1712
1978
36
309
345
MTII
204
1277
1481 74.9%
27
241
268 77.7%
MTI
29
191
220 11.1%
4
24
28 8.1%
GV
23
183
206 10.4%
1
20
21 6.1%
atretic
10
61
71 3.6%
4
24
28 8.1%
ICSI'd
216
1321
1537
28
262
290
survived
204
1283
1487 96.7%
26
255
281 96.9%
2pn of spare eggs
48
354
402 67.0%
1
33
34 53.1%
average # of transfer
5
4.8
9.8
4.2
4.4
8.6
B-HCG preg
8 27.6%
70 39.8%
78 38.0%
1 16.7%
10 21.3%
11 20.8%
ectopic preg
0
0
0
0
0
0
On going preg
8
55
63 80.8%
1
4
5 45.5%
multiple preg
4
17
21 26.9%
0
0
0
0%
twins
4
10
14 17.9%
0
0
0
0%
triplet
0
7
7 9.0%
0
0
0
0%
Reduction
4
4
Vanishing sac
3
3
average age
35.3
34.5
34.7
41.0
41.3
41.4
Oocytes Retrieval
<40
Cases
205
Oocytes retrieved
1978
MT II
1481
74.9%
MT I
220
11.1%
GV
206
10.4%
71
3.6%
Atretic
Oocyte Retrieval
<40
Semen
Normal
Abnormal
Total
Cases
29
176
205
1712
1978
Oocytes Retrieved 266
MT II
204(76.7) 1277(74.6)
1481(74.9)
MT I
29(10.9)
191(11.2)
220(11.1)
GV
23(8.6)
183(10.7)
206(10.4)
Atretic
10(3.8)
61(3.6)
71(3.6)
Survival and Fertilization Rate
<40
ICSI’d oocytes
1537
Survived oocytes
1487
Spare oocytes
553
2PN
402
96.7%
72.7%
Survival & Fertilization Rate
<40
Semen
Normal
Abnormal
Total
Cases
29
176
205
ICSI’d oocytes
216
1321
1537
Survived oocytes
204(94.4)
1283(97.1)
1487(96.7)
Spare oocytes
72
481
553
2PN
48(66.7)
354(73.6)
402(72.7)
Age <40 MIFT Pregnancy Rate
B-HCG
pregnancy
Normal sperm Abnormal
sperm
Total
27.6%
38.0%
39.8%
# of Oocytes MIFT’d vs Multiple Pregnancy
<40
MIFT’d oocytes
Pg/cases
%
Twins
Triplet
<=2
3/12
25.0%
0
0
3
9/21
42.9%
1
1
4
9/33
27.3%
1
0
5
22/31
71.0%
3
4
6
35/69
50.7%
9
2
# of MT II Retrieved vs Pregnancy
<40
# of MT II Retrieved
Pregnancy
%
<=2
0/3
0%
3
5/8
62.5%
4
1/9
11.1%
5
5/13
38.5%
6
7/23
30.4%
>=7
61/149
40.9%
Oocytes Retrieval
>=40
Cases
53
Oocytes retrieved
345
MT II
268
77.7%
MT I
28
8.1%
GV
21
6.1%
Atretic
28
8.1%
Oocyte Retrieval
>=40
Semen
Normal
Abnormal
Total
Cases
6
47
53
Oocytes retrieved 36
309
345
MT II
27(75.0)
241(78.0)
268(77.7)
MT I
4(11.1)
24(7.8)
28(8.1)
GV
1(2.8)
20(6.5)
21(6.1)
Atretic
4(11.1)
24(7.8)
28(8.1)
Survival and Fertilization Rate
>=40
ICSI’d oocytes
290
Survived oocytes
281
Spare oocytes
57
2PN
34
96.9%
59.6%
Survival and Fertilization Rate
>=40
Semen
Normal
Abnormal
Total
Cases
6
47
53
ICSI’d oocytes
28
262
290
Survived oocytes 26(92.9)
255(97.3)
281(96.9)
Spare oocytes
3
54
57
2PN
1(33.3)
33(54.1)
34(53.1)
Age >=40 MIFT Pregnancy Rate
B-HCG
Pregnancy
Normal sperm Abnormal
sperm
Total
16.7%
20.8%
21.3%
# of Oocytes MIFT’d vs Multiple Pregnancy
>=40
MIFT’d oocytes
Pg / cases
<=2
0/7
3
%
Twins Triplet
0%
0
0
2/11
18.2%
0
0
4
1/8
12.5%
0
0
5
4/11
36.4%
0
0
6
4/16
25.0%
0
0
# of MT II Retrieved vs Pregnancy
>=40
# of MTII retrieved
Pregnancy
%
>=2
1/5
20.0%
3
3/9
33.3%
4
0/4
0%
5
2/8
20%
6
3/7
42.9%
>=7
2/20
10.0%
Age vs Pregnancy
Age
Pg / cases
%
<36
40/114
35.1%
>=36, <40
39/90
43.3%
>=40
11/53
20.8%
MIFT Multiple Pregnancy
<40
Total
21/78
26.9%
Twins
14/78
17.9%
Triplet
7/78
9.0%
Reduction
4
Vanishing sac
3
Twins prevalence
14/21
66.7%
• Evaluation l’copy augmented by MIFT
• L’copic minor surgery augmented by MIFT
• Philosophical or religious reasons
MIFT vs ICSI/IVF Results
Jan 98 - May 00
<40
>=40
MIFT
78/205(38.0)
11/53(20.8)
ICSI/IVF
43/157(27.4)
3/33(9.1)