TET involves taking eggs from the woman, fertilizing them in the laboratory with her partner's sperm and transferring the resulting embryos back to her fallopian tubes 2 days after fertilization (at the 2-cell to 4-cell stage).
ZIFT involves taking eggs from the woman, fertilizing them in the laboratory with her partner's sperm and transferring the resulting embryos back to her fallopian tubes the day after fertilization (at the one-cell or zygote stage).
Both of these procedures require a surgical procedure called laparoscopy to transfer the embryos.
Who should be treated with TET and ZIFT ?
TET and ZIFT can be used as an effective treatment for infertility of all causes except for women with infertility caused by tubal blockage or significant tubal damage, or an anatomic problem with the uterus, such as severe intrauterine adhesions.
It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following: Failed 3-6 cycles of ovarian stimulation with intrauterine insemination
TET and ZIFT vs IVF
Some studies have shown higher implantation rates with ZIFT/TET as compared to in vitro fertilization (IVF) with uterine embryo transfer or GIFT.
Patient selection is usually a potential confounding issue. Few randomized trials have been done. Those that have either show no difference or a benefit to tubal transfers.
Outcome can potentially be very physician dependent: ome physicians have much lower IVF - uterine transfer rates than others. The best setting for a randomized trial would be a program with all physicians having high pregnancy rates for uterine transfers.
Tubal assisted reproduction procedures (GIFT, ZIFT, TET) are unlikely to ever be cost-effective because of the additional cost of laparoscopy.
Although some programs report higher pregnancy rates for TET and ZIFT than for IVF, this does not mean that they are actually better procedures:
The patients that have TET and ZIFT might be more likely to become pregnant for other reasons (selection bias).
For high quality IVF labs with reproductive endocrinologists that are skilled at uterine embryo transfer, there is no good evidence that pregnancy rates are better with TET or ZIFT as compared with IVF (which costs less and is much less invasive for the woman).
As IVF labs advance embryo culture techniques and physicians maximize the embryo transfer procedure, it may be that IVF will demonstrate higher pregnancy rates than TET and ZIFT.
Some physicians are not skilled at transcervical uterine embryo transfer. When the very highest quality embryos are transferred improperly, few pregnancies result. This has been demonstrated in many ART programs.
A physician that is inept with uterine transfers may have a much higher pregnancy rate when he or she does tubal transfers. However, this does not mean that tubal transfer is better. It sometimes is simply the result of poor skills with the uterine embryo transfer procedure - leading to a reduced pregnancy rate.
ZIFT only allows 1 day of development in the lab and TET 2 days - therefore, we do not have as much opportunity to select the best quality embryos for transfer as we do on day 3, or day 5 of in vitro culture.
IVF allows us to transfer only the best quality embryos on day 3, and we also can perform assisted hatching at that time. Hatching is generally not done in conjunction with tubal transfer procedures.
How are TET and ZIFT performed ?
Consents are signed by all parties.
The woman is stimulated with medications to develop multiple egg development.
When the woman's follicles are mature, an aspiration procedure is performed to remove the eggs from her ovaries. The eggs are then fertilized in the laboratory with her partner's sperm.
The embryos are cultured in the laboratory for 1 day for ZIFT and 2 days with TET. At that time, a tubal transfer procedure (surgery with laparoscopy) is done which places the embryos in the woman's fallopian tubes.
Cost of TET and ZIFT in India
TET and ZIFT cost more than IVF because of the surgical procedure involved in the transfer. They also cost more than GIFT because of the additional expenses involved with embryo culture and because the transfer procedure is done on another day - as compared to GIFT where the aspiration and transfer procedures are done on the same day.
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