Prospective evaluation of blastocyst stage transfer vs. zygote intrafallopian tube transfer in patients with repeated implantation failure

Objective: To compare extended culture with blastocyst stage transfer and zygote intrafallopian transfer (ZIFT) in the management of IVF patients with repeated implantation failure. Design: Prospective. nonrandomized study. Setting: An IVF unit at a university hospital. Patient(s): Sixty-four infertile patients with more than three previous failed IVF-ET attempts. Intervention(s): Patients were allocated to undergo either blastocyst stage transfer (Group 1: n = 32) or ZIFT (Group 2: n = 32). Main Outcome Measure(s): Implantation, clinical pregnancy, and live birth rates. Result(s): Patient characteristics and response to stimulation were comparable for both groups, Totals of 84.3% and 97% of the patients underwent blastocyst transfer and ZIFT, respectively. Significantly more embryos were transferred through ZIFT (5.5 +/- 0.8) as compared with blastocyst transfer (2.3 +/- 1.4). and there were significantly more cycles with embryo cryopreservation in the ZIFT group as compared to the blastocyst transfer group (15/32 vs. 4/32. respectively). Implantation rate (13.6% vs. 1.4%). clinical pregnancy rate (40.6% vs. 3.1%). and live birth rates (38.7% vs. 0%) were all significantly higher in the ZIFT group as compared to the blastocyst transfer group. respectively. Conclusion(s): Zygote intrafallopian transfer is a powerful clinical tool in the management of patients With RIF. In contrast. blastocyst stage transfer fails to improve the outcome in this poor-prognosis group. The pathophysiology of RIF should be the subject of intense investigation to allow the introduction of appropriate therapeutic measures earlier in the course of treatment. (Fertil Steril((R)) 2002 77:971-7. (C)2002 by American Society for Reproductive Medicine).