This article systematically reviews the relevant clinical data of rFSH for COS in ART, which were mainly obtained from the Cochrane Library, PubMed, MEDLINE, and reference lists of articles. HMG and rFSH have both been used equally successfully for COS in ART. However the another review has concluded that there is a statistically significant increase in clinical pregnancy rate with rFSH compared to uFSH, when used for COS in standard IVF cycles but not in cycles in which ICSI was used. Recombinant FSH is a new treatment option for Japanese women undergoing COS for ART with several advantages over conventional urinary gonadotropin preparations. Since SC administration of rFSH is safe, efficacious, and acceptable, the availability of rFSH as a ready-for-use solution supplied in an injector system may make its administration, in particular self-administration by the patient or her partner, more convenient the current review concludes that the use of rFSH is not associated with a higher incidence of obstetrical and neonatal problems compared to urinary gonadotropins.

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When the first successful delivery following in vitro fertilization and embryo transfer was reported in 1978, oocyte aspiration was performed laparoscopically under general anesthesia. Since 1985, almost all IVF centers have collected oocytes using transvaginal ultrasound-directed methods, since these are the easiest, most accurate and most acceptable methods to patients. Color Doppler ultrasonography is recommended to decrease blood loss during oocyte aspiration. Embryos are gently, slowly and transcervically expelled into the uterine cavity, with the patient in a lithotomy position. This basic method has remained unchanged since the first descriptions. Relatively important factors for successful embryo transfer include removal of hydrosalpinges, absence of blood or mucus on catheter, catheter type, avoidance of fundus contact, avoiding tenaculum, removal of all mucus, ultrasonography of cavity before puncture, leaving the catheter in place for 1 min, 30-min bed rest, trial transfer, ultrasonographic monitoring and antiprostaglandin administration to prevent uterine contractions.

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Anesthesia for ART procedures have been provided by a variety of anesthetic methods including sedation, regional anesthesia, and general anesthesia. Anesthetic management should be safe, and provide rapid recovery for those women undergoing procedures that are often performed on an ambulatory basis. During ART procedures, anesthetic agents are gradually transferred into follicular fluid. Laboratory studies have suggested that local anesthetic agents, nitrous oxide, volatile halogenated agents, and some intravenous agents, such as propofol, interfere with some aspects of reproductive physiology in vitro. However, there is little clinical data suggesting that brief administration of any of the currently used anesthetic agents for ART procedures adversely affect live birth rates. The concern for antiemetics and NSAIDS use around ART procedures warrants further study. Identification of agents and techniques that provide optimal analgesia or anesthesia with negligible impact on ART success remains an important task for anesthesiologists.

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In ART, once ovum is successfully yielded, embryologists have to progress the treatments as arranged regardless of the quality of semen. Sperm qualities are, therefore, the most variable factor in each case. Embryologist is certainly well informed about physiology and genetics of ovum and embryo, it is also essential to study how to evaluate and prepare the sperm according to their physiology.

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In 1972, cryopreservation of mammalian animal embryos was developed using mouse embryos. To utilize surplus embryos for in vitro fertilization programs, this technique was applied to human embryos by the slow freezing method in the first half of the 1980's, and by vitrification in the 1990's. Recently, the protocol of vitrification of human embryos has been improved by the ultra-rapid vitrification method in which the rate of cooling is highly improved. It is mainly used as an effective basic technique for cryopreservation of human embryos in current clinical IVF programs due to the extremely high embryonic survival rate after storage.

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In the present study, we assessed the effects of β-mercaptoethanol (β-ME) added to in vitro maturation (IVM) medium on the development of resultant embryos derived from in vitro fertilization (IVF) of oocytes, the number of cumulus cells, and ATP content of bovine oocytes. Furthermore, we counted the number of cells of the blastocysts derived from IVF of oocytes matured in media with or without 100 μM β-ME. When β-ME was added into the medium of IVM at concentrations of 0, 10, 50, 100 and 500 μM, the rate of embryonic development to the blastocyst stage of resultant embryos increased significantly (P<0.05) in the 100 μM group compared to the 0 μM (control) group. Although β-ME was added to media with the same concentrations (0, 10, 50, 100 and 500 μM) for the embryonic culture following in vitro fertilization of oocytes matured without β-ME, the rates of embryonic development to the blastocyst stage decreased in a concentration-dependent manner. The number of cumulus cells attached to the oocytes matured in media with 100 μM β-ME was significantly greater (P<0.05) than that in the 0 μM group. There was no difference between ATP contents of cumulus cell-enclosed oocytes (CO) matured with or without 100 μM β-ME. In contrast, the ATP content of cumulus cell-denuded oocytes after maturation in media supplemented with 100 μM β-ME was significantly lower (P<0.05) than that of the 0 μM-treated group. In addition, the average cell number of blastocysts in the 100 μM β-ME group was significantly greater (P<0.05) than that of the 0 μM group. These results suggest that β-ME may increase both the numbers of cumulus cells attached to oocytes and the cell numbers of blastocysts derived from in vitro fertilization by influencing the ATP metabolism of bovine oocytes during IVM.

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We investigated the relationship between the pregnancy rate of bovine embryo transfer and collapsed protoplasm of epithelial cells in cervical mucus samples collected from 102 cows (Japanese Black, Holstein and their crossbred). The recipient cows were divided into 3 groups according to the proportion of collapsed protoplasm: group L, 20% or less; group M, 21 to 80%; and group H, 81% or more. Rates of pregnancy in these 3 groups were compared. The observation rates of collapsed protoplasma in cervical mucus were 28.4% (29 cows) in group L, 44.1% (45 cows) in group M and 27.5% (28 cows) in group H. The pregnancy rates following embryo transfer were 66.7% (14/21 cows) in group L, 51.4% (18/35 cows) in group M, and 33.3% (8/24 cows) in group H after eighty frozen embryo transfers. The group L and group M recipients had higher pregnancy rates after frozen embryo transfer than group H (P<0.05). The rate of pregnancy increased as the proportion of collapsed protoplasm decreased. There was no significant correlation between pH of mucus, proportion of collapsed protoplasma of epithlial cells and concentration of progesterone in plasma. The present results indicate that there is a relationship between rate of pregnancy and proportion of collapsed protoplasm in the cervical mucus. The high rate of pregnancy in cows with the low proportion of collapsed protoplasma in cervical mucus suggests that the proportion of collapsed protoplasm in cervical mucus is a reliable index for selection of cows for embryo transfer.

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