Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies.

Objective: To evaluate the limits of the conservative management of relatively advanced ectopic pregnancies (EPs) with local methotrexate given at a higher than standard dose.

Design: Nonrandomized prospective study.

Setting: A tertiary teaching hospital and an affiliated infertility center.

Tubal catheterization for intrafallopian insemination and transvaginal gamete (GIFT) or zygote intrafallopian transfer (ZIFT): our experience in a total of 1128 treatment cycles.

Purpose: Our purpose was to increase the number of fertile spermatozoa at the natural site of fertilization by retrograde tubal insemination (TV-IFI; transvaginal intrafallopian insemination) and also to perform transvaginal GIFT or ZIFT (TV-GIFT or TV-ZIFT) avoiding the laparoscopic procedure, especially in selected high-risk cases.

Results: The method was used in a total of 1128 treatment cycles (948 for TV-IFI and 180 for TV-GIFT or TV-ZIFT). TV-IFI was possible in 882 of the 948 cycles, resulting in 108 clinical pregnancies (12.

The purpose of prelaparoscopy transvaginal retrieval and evaluation of oocytes in a modified GIFT procedure.

To minimize the risk of submitting the patient to an 'unnecessary' laparoscopy in cases of unsuccessful oocyte retrieval and to reduce gamete exposure to the probable adverse effects of the CO2 pneumoperitoneum and anaesthetic agents, we have performed transvaginal oocyte recovery prior to performing the laparoscopy for gamete intra-Fallopian transfer (GIFT). When the recovered oocytes had a low potential for fertilization, the GIFT laparoscopy was cancelled and fertilization in vitro and zygote intra-Fallopian transfer (ZIFT) were attempted instead. By introducing this modified, two-stage GIFT procedure, the laparoscopy time was reduced to a quarter of that required for the more time-consuming, conventional GIFT method (18 +/- 4 min and 76 +/- 13 min respectively in the same unit).