Comparison of Tubal Transfer and Transcervical Uterine Embryo Transfer of Immediate Injected Oocytes and 2 - 3 Days Old Cultured Embryos

Objective: The aim of this study was to assess the outcomes of laparoscopic intrafallopian transfer of injected oocytes rapidly (1 hour at most) after intracytoplasmic sperm injection (rapid ICSI-ZIFT). Materials and Methods: Data on 58 cycles in 58 couples, who underwent rapid ICSI-ZIFT treatment over a 12-month period were retrospectively investigated. The control group included 28 patients, who underwent intrauterine embryo transfer (ET) after ICSI. Following down-regulation with goserelin acetate, step-up ovulation induction with recombinant gonadotropins was carried out. After oocyte retrieval and ICSI, a maximum of 4 injected oocytes with intact cytoplasmic membrane and clear cytoplasm were replaced within 1 hour into a unilateral fallopian tube under laparoscopic guidance. Biochemical pregnancy, clinical pregnancy, implantation, miscarriage, and take-home baby rates were our outcome measures. Rapid ICSI-ZIFT and conventional ICSI-ET groups were compared using univariate and multivariate analyses. Results: After controlling for confounding factors by logistic regression, none of the outcome variables were found to be improved with rapid ICSI-ZIFT. Implantation rates were also comparable (17.2% for rapid ICSI-ZIFT and 17.1% for ICSI-ET) with no significant differences (p=0.9). The multiple pregnancy rate in the ICSI-ZIFT group was exceedingly high (34.8% versus 0%, p=0.07). Conclusions: Immediate tubal transfer of microinjected oocytes is associated with similar implantation and take-home baby rates compared to rates for intrauterine ET after ICSI. Given the risk of laparoscopy and the unavoidable higher risk of multiple pregnancy, intratubal transfer of injected oocytes seems unsuitable for clinical use.