Takashi Horikawa

The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle

PurposeTo evaluate the cystectomy-induced damage on the follicular growth and ovulation of an affected ovary during natural cycles.MethodsTwenty-eight infertile patients with unilateral ovarian endometriomas who underwent laparoscopic cystectomy were retrospectively evaluated. The ovulation rate of an affected ovary during natural cycles was compared before and after cystectomy in each patient, and it was also determined if ovulation from the affected ovaries resulted in pregnancy.ResultsAfter surgery, the ovulation rate was significantly lower than that before cystectomy (16.9 ± 4.5% vs. 34.4 ± 6.6%, P = 0.013). After surgery, 14 pregnancies were achieved without IVF treatment, and only 2 of them (14.3%) were achieved from an operated-side ovary. However, the pregnancy rate per ovulatory cycle of the operated-side ovary was not different from that of the intact ovary (8.8% vs. 5.8%, P = 0.750).ConclusionsLaparoscopic cystectomy is an invasive treatment in that it reduces the frequency of ovulation; however the pregnancy rate per ovulation did not deteriorate.

Laparoscopy should be strongly considered for women with unexplained infertility

Aim:  Women with unexplained infertility frequently become pregnant after diagnostic laparoscopy. In this study the effect of laparoscopic surgery on such women was evaluated by the pregnancy rate after laparoscopic surgery.

Impact of laparoscopic cystectomy on fecundity of infertility patients with ovarian endometrioma

Aim:  To clarify the effect of laparoscopic cystectomy for ovarian endometrioma in infertility patients, the pregnancy outcome was evaluated.

Optimization of a novel nylon mesh container for human embryo ultrarapid vitrification

OBJECTIVE To evaluate the efficacy of a nylon mesh container in vitrification of human embryos and to determine the optimal osmotic pressure of the initial thawing solution. DESIGN Retrospective analysis. SETTING National Center for Child Health and Development, Tokyo, Japan. PATIENT(S) Infertile patients undergoing either in vitro fertilization or intracytoplasmic sperm injection in our hospital. INTERVENTION(S) Embryos, at the cleavage stage, were cryopreserved using the vitrification method in either a plastic straw or a nylon mesh container. The embryos were thawed using an initial osmotic pressure of either 0.5 M or 1.0 M sucrose with subsequent step-wise dilution. After thawing, the embryos were transferred to the uterus. MAIN OUTCOME MEASURE(S) Survival rate of blastomeres, embryo survival rate, implantation, and pregnancy rates, cancellation rate because of embryo damage. RESULT(S) Use of nylon mesh and the 1.0 M sucrose thawing solution significantly improved blastomere survival rate (98.0 +/- 1.0%, mean +/- SEM), pregnancy rate (41.0%) and implantation rate (32.3%). CONCLUSION(S) Vitrification using a nylon mesh container and subsequent thawing in a 1.0 M sucrose solution is an easy and inexpensive method that improves the reliability of embryo cryopreservation of embryos without adverse effects on clinical outcomes.

The ratio of late-follicular to mid-follicular phase LH concentrations efficiently predicts ART outcomes in women undergoing ART treatment with GnRH-agonist long protocol and stimulation with recombinant FSH

PurposeTo establish an index to predict ART outcomes and to identify infertile patients who need LH supplementation during ovarian stimulation.MethodsSerum LH concentrations were measured during the mid- and late-follicular phase in 86 normogonadotropic infertile patients who underwent ART treatment using GnRH-agonist long protocol with recombinant-FSH. The relationships between serum LH concentrations at both time points and ART outcomes were retrospectively analyzed, and the relationships between the ratio of late-follicular to mid-follicular LH concentrations and ART outcomes were also evaluated.ResultsThere were no significant correlations between the mid- or late-follicular LH concentrations and ART outcomes. The ratio of late-follicular to mid-follicular LH concentrations <1.0 was considered the relatively LH decreased group (RD group) and ratio ≥ 1.0 was considered the relatively LH increased group (RI group). The number of usable embryos in RD group was similar to that in RI group, but the pregnancy and implantation rates in the RD group (9.7% and 5.8%) were significantly lower than those in the RI group (31.1% and 17.2%; p < 0.05).ConclusionsRelatively decreased LH concentrations during ovarian stimulation using GnRH-agonist long protocol with rec-FSH had a negative effect on ART outcomes. Therefore, the ratio of mid- to late-follicular phase LH concentrations is suggested to be an efficient index to identify patients who might benefit from LH supplementation.

Laparoscopic proximal tubal division can preserve ovarian reserve for infertility patients with hydrosalpinges

Aim:  To investigate whether laparoscopic proximal tubal division for the treatment of hydrosalpinges could preserve ovarian function.

Recombinant-follicle stimulating hormone is more effective than urinary human menopausal gonadotropin in ovarian hyperstimulation for assisted reproductive technology treatment

AimThe aim of the present study was to establish a standard protocol for ovarian stimulation with gonadotropin-releasing hormone analog (GnRH-a) long protocol using recombinant-follicle stimulating hormone (rec-FSH) preparations for assisted reproductive technology (ART) treatment.MethodsIn 86 patients who underwent ovarian stimulation with GnRH-a long protocol for ART treatment, 53 were stimulated by rec-FSH preparations (rec-FSH group) and the others were stimulated by urinary-hMG (u-hMG group) preparations. The subjects were randomly assigned to either of these preparations. Hormonal profiles, total doses of gonadotropins, duration of stimulation and ART results were compared in both groups.ResultsThe duration of stimulation was similar in both groups (9.2 ±0.3 days and 9.2 ± 0.2 days, respectively). The total doses of gonadotropin in the rec-FSH group (1505.3 ± 29.2 IU) was significantly lower than those in the u-hMG group (2130.3 ± 54.6 HI, P < 0.0001). The FSH and LH values on the day of human chorionic gonadotropin (hCG) administration in the rec-FSH group were significantly lower than those in the u-hMG group. Pregnancy rates were 31.3% in the rec-FSH group and 33.3% in the u-hMG group, respectively.ConclusionsThe present study showed that rec-FSH preparations were more potent than conventional u-hMG preparations and the protocol of the present study with rec-FSH was a new ovarian stimulation protocol with GnRH-a long protocol.

Intraovarian arterial blood flow resistance in oligomenorrheal infertile women

Purpose: Intraovarian arterial blood flows before and after follicular rupture in ovulation induced cycles were examined by transvaginal color flow Doppler imaging. The changes observed in the intraovarian arterial resistance before and after ovulation in relation to the regularity of menstruation and several other parameters were analyzed. Methods: In a prospective study, 22 patients undergoing infertility treatment in our center were recruited. Patients were divided into two subgroups, according to their menstrual regularity (regular menstrual group and oligomenorrheal group) and 42 cycles were studied. All patients received the same FSH low-dose stimulation treatment. The relationship between the post and preovulatory arterial pulsatility indexes (PI) was analyzed. Cycles that showed a decrease in their PI after ovulation of 10% or more were considered “profoundly decreased cycles.” Cycles from the same patients without ovulatory stimulation (natural cycles) were used as control. Results: In the regular menstrual group the rate of profoundly decreased cycles during FSH stimulation was 63.2%, which was similar to the rate observed in natural cycles. In the oligomenorrheal group the rate of profoundly decreased cycles during natural cycles was 14.3%, but in FSH ovulation induction cycles this rate was significantly increased (47.6%, p < 0.05). In addition, the pregnancy rate per cycle in the oligomenorrheal group was significantly higher than that in the regular menstrual group (p = 0.03). Conclusions: Oligomenorrheal patients presented a higher rate in the decrease of their PI values after FSH stimulation, which is essential to achieve pregnancy. This elevated rate of reduction implies that oligomenorrheal patients have increased incidence of disturbance in their ovulatory process when compared to normal cycling patients. Thus, ovulation induction with FSH, in oligomenorrheal patients resulted in a higher pregnancy rate in this group.

Laparoscopically-assisted transabdominal oocyte retrieval in an infertility patient with ovarian malposition

Infertility patients with malpositioned ovaries have considerable difficulty conceiving naturally because of extended fallopian tubes and ovarian malposition; such patients turn for help to assisted reproductive technology (ART) treatment. For most of these patients, ovarian malposition prevents transvaginal oocyte retrieval, so the transabdominal approach for oocyte retrieval is required. One of our infertility patients presented with ovarian malposition, and laparoscopy-assisted transabdominal oocyte retrieval was performed. We performed a Gonadotropin-releasing hormone agonist (GnRH-a) long protocol with human menopausal gonadotropin (hMG) ovarian stimulation, and used a standard transvaginal probe through the anterior abdominal wall for ovarian imaging and monitoring of the growing follicles. The patient underwent laparoscopically-assisted transabdominal oocyte retrieval—9 oocytes were recovered, and 5 were fertilized, and 2 embryos were transferred to the patient’s uterus. The patient became pregnant and a gestational sac was detectable by transvaginal ultrasonography, but she spontaneously miscarried. The patient then received several laparoscopically-assisted transabdominal oocyte retrievals and finally became pregnant following a thawed embryo transfer during a hormone replacement cycle, and now her pregnancy is going well.

Molecular Interactions between Sperm and Oocytes in the Mouse

ABSTRACT Sperm and oocytes must undergo several steps for successful fertilization, including sperm capacitation, the acrosome reaction and completion of oocyte maturation. During these steps, it is believed that specific molecules interact with precise timing. Although an increasing body of information on the fertilization-related molecules of sperm or oocytes has been accumulated through biological and gene targeting analyses, the information on these molecular interactions remains limited. Nonetheless, the current molecular information is the basis for future advances in the understanding of the mechanisms underlying fertilization. In this review, we introduce molecules that are involved in sperm-oocyte interactions at the site of fertilization, and address the molecular events during the sperm-cumulus, sperm-zona, and sperm-oolemmal interactions. Although the information introduced in this review has been obtained primarily from mice, similar molecules are likely engaged in analogous processes in other speicies.