Sequential media and single step medium are the most widely used for embryo cultures in human IVF. The amino acid concentrations of most these media are the concentrations set by Dr. Eagle on the basis of somatic cell requirements such as HeLa cells and L cells in 1959, which don't reflect the requirement of embryos. This may have caused to limit the ability of human embryos in vitro. Efficacy of media composed of amino acid concentrations of human oviductal fluid has yet to undergo analysis because there is no medium with the amino acid concentrations similar to human oviductal fluid. In this study, we confirm whether human oviductal amino acid medium is more effective in human IVF compared with current single step medium. randomized control study. Human oviductal fluid samples were collected laparoscopically from 28 women aged 26-39 years, and were analyzed in helping to formulate new embryo culture media. In 2017, medium composed of amino acid concentrations of human oviductal fluid has become available in Japan. We conducted an RCT to evaluate the medium using 762 embryos obtained from 212 cycles of patients who underwent IVF or intracytoplasmic sperm injection (ICSI) between September 2017 and February 2018. Before fertilization, the oocytes were divided into two groups: cultures using the new medium composed of human oviductal amino acid (OVIT); and cultures using current medium (CSC). The embryo grade during culture period (day 0 to day 5) and clinical outcome after embryo transfer were compared between OVIT group and CSC group. Patient characteristics including women's age, men's age, the number of previous IVF-ET failure cycles were not different significantly. The number of embryo which was transferred to the uterus or cryopreserved was larger in OVIT group compared with CSC group (46.0% (247/537) versus 36.3% (195/537), respectively; P<0.01). The implantation rate after transfer of vitrified-warmed embryos was higher in OVIT group compared with CSC group (38.5% (35/91) versus 28.9% (22/76), respectively; the difference was not statistically different). The miscarriage rate was 25.7% (9/35) versus 40.9% (9/22), respectively, thus, the on-going pregnancy rate was 28.6% (26/91) versus 17.1% (13/76), respectively; P<0.05. Medium composed of human oviductal amino acids enhances embryonic ability more than the current single step medium, and it may make a contribution to clinical success in IVF treatment.

We used laparoscopy to treat endometriosis and other causes of infertility in women to help improve chances for pregnancy. In 2013, we conducted a retrospective analysis using anti- müllerian hormone (AMH) serum to investigate the effects of laparoscopic treatment on ovaries. The aim of this new study was to determine the impact of laparoscopic ovarian treatment on ovarian reserve as measured by AMH in a prospective analysis. Prospective study This study involved 357 infertile women who received laparoscopic examination and treatment of ovaries prior to in-vitro fertilization (IVF) treatment at St. Luke Clinic, between March 2013 and October 2016. The patients were divided into four groups according to the kind of laparoscopy treatment conducted: 1) Ovarian drilling for polycystic ovary syndrome (LOD) (n=48); 2) Ethanol Sclerotherapy for chocolate cyst of the ovary (ES) (n=32); 3) Removal of ovarian endometriosis with electrocautery (EC) (n=213); and 4) No treatment to ovaries(some had laparoscopic procedures on areas other than ovaries) (Control) (n=64). From the previous study, we found that AMH levels were higher during the follicle phase than the luteal phase. Therefore, we measured AMH levels immediately prior to laparoscopic procedures, and during the follicle phase 2 days, 1 month, 3months, 6months post procedure. The AMH levels in the serums among the four groups were compared pre and post laparoscopy. The decreased ratio of AMH levels was evaluated [pre-operative AMH level]-[post-operative AMH level] / pre-operative AMH level, and compared among the four groups. In all four groups, the mean AMH levels after laparoscopy were significantly lower than before the laparoscopy (the mean AMH level prior to laparoscopy, and 2 days, 1, 3, and 6 months post laparoscopy, AMH levels: LOD: pre 9.4ng/ml and 7.1ng/ml, 5.6ng/ml, 5.4ng/ml, 6.1ng/ml; ES: pre 4.2ng/ml and 3.6ng/ml, 2.9ng/ml, 2.8ng/ml, 2.2ng/ml; EC: pre 3.4ng/ml and 2.9ng/ml, 2.5ng/ml, 2.8ng/ml, 2.7ng/ml; Control: pre 4.1ng/ml and 3.8ng/ml, 3.1ng/ml, 3.3ng/ml, 2.7ng/ml). The mean decrease ratio of the AMH levels 2 days post laparoscopy were significantly different between LOD and Control, and EC and Control (LOD: 23.5%, EC: 15.4%, Control 5%; there was no significant difference between ES:16.1% and Control). There was no significant difference between the mean decrease ratio of AMH levels at 1, 3, and 6 months post laparoscopy (1month; LOD: 38%, ES: 21.1%, EC: 13.5%, Control: 8%, 3month; LOD:34.6%, ES: 36.3%, EC: 8.9%, Control: 7.5%, 6month; LOD: 32.6%, ES:34.8%, EC: 6.2%, Control: 10.4%). This study suggests that ovarian reserve may be reduced after laparoscopy regardless of whether the laparoscopic treatment is to the ovaries or only to the uterus. LOD, ES, EC appears to have little influence on ovarian reserve.