To summarize the current management of in Japan, a questionnaire survey was administered. A mail-survey method was used, and surveys were sent to 126 obstetrical and/or gynecological medical facilities in Miyagi Prefecture. The respondents included 86 facilities (68.3%). The majority of participants employed routine assessments, and their records included basal body temperature (98.8%), semen analysis (88.8%), and tubal patency tests (78.8%). Laparoscopic diagnosis, however, was uncommon (15.8%). With respect to , surgical procedures, especially endoscopic procedures, were not generally carried out in addition to medicinal . Sixty-one percent of the respondents performed intrauterine insemination, however assisted reproductive technology (ART) was provided by a few participants, for example, in vitro fertilization-embryo transfer was available at 11.3% of facilities. In self-assessment, the median pregnancy rates for the group undergoing laparoscopy and that not were significant different (30% and 20%, respectively), and those of the group undergoing ART provided and that not were significant different (35% and 20%, respectively). In conclusion, there are various differentials in the methods of diagnosis and of in the medical facilities today, and the outcomes are not always satisfactory. For appropriate management of infertile couples, it will be necessary to more closely manage cooperation between primary care doctors and reproductive specialists.

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Patients with unexplained following standard screening tests usually undergo timing therapy that coordinates the time of ovulation and coitus, controlled ovarian hyperstimulation, or intrauterine insemination. If the is unsuccessful, diagnostic laparoscopy is performed. However, with recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparoscopy and proceeds directly to ART. Therefore, the value of diagnostic laparoscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy for patients with unexplained and normal hysterosalpingography (HSG) findings. Between January 1997 and December 2006, 57 infertile patients with normal HSG findings underwent diagnostic laparoscopy at Kinki University Hospital. In 46 (80.7%) of these patients, diagnostic laparoscopy revealed pathologic abnormalities. Specifically, endometriosis and peritubal and/or perifimbrial adhesions were found in 36 (63.2%) and 5 (8.8%) of the patients, respectively. In 8 patients (14.0%), the management plan was switched to ART because of severe tubal diseases. Among the 57 patients, 29 pregnancies (50.9%) were achieved, including 6 ART-mediated pregnancies. We conclude that diagnostic laparoscopy is beneficial for patients with unexplained and normal HSG findings. Indeed, by diagnostic laparoscopy, we are able to detect the cause(s) of in the pelvic cavity and to design a suitable management plan, which could lead to postoperative pregnancy. Therefore, because of the potential diagnostic and therapeutic benefits, patients with unexplained and normal HSG findings should undergo diagnostic laparoscopy prior to ART.

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In recent years, the trend of people marrying later in life has been significantly increasing. In the US, 60% of married women in their 40s reportedly have

. In half of these cases, a female factor is the cause. As a consequence, treatments are widely performed. One such is in-vitro fertilization. This technique directly removes a follicle from the ovary and ovum is fertilized it with sperm under a microscope by embryologist. Ovulation inducers can stimulate the growth of 10 to 15 follicles. However, 20% to 30% usually contain vacuoles and do not support ovary growth. In some cases, ova that are as much as 90% vacuolated do support ovary growth[1]. It thus cannot be determined whether a follicle has an ovum or is vacuolated unless the follicle is examined under a microscope. Consequently, it is useful to determine in advance whether a follicle has an ovum because follicle collection is painful for the woman. However, to date, a non-invasive method of identifying vacuolated ova does not exist. Therefore, we herein propose a method using ultrasound to determine whether a follicle has an ovum.

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In the present study, we investigated the potential of nitrite exposure to induce

in mice. Adult female C57BL/6J mice were randomly divided into control and nitrite exposure groups. Subsequently, the rate of mouse was calculated, and pathological changes in ovarian tissues were examined using hematoxylin and eosin staining. In addition, TUNEL staining, immunofluorescent labeling, and western blotting were performed to assess cell apoptosis and oxidative stress response in ovarian tissues from various groups. We observed that nitrite exposure could induce (p<0.05) in mice. High-dose nitrite exposure caused in a time-dependent manner, and two-round exposure induced higher than that one-round exposure (p<0.01). In addition, a higher number of atretic follicles were detected in the ovaries of nitrite-exposed groups than in the control group. Furthermore, TUNEL-positive cells were observed in granulosa cells of atretic follicles, and overexpression of caspase 8, c-Fos, and inducible nitric oxide synthase (iNOS) was detected in ovaries after nitrite exposure (p<0.01), suggesting that cell apoptosis and oxidative stress response were induced following nitrite exposure. Collectively, these findings suggest that nitrite exposure can induce mouse in a time-dependent manner. Oxidative stress response and cell apoptosis are involved in mediating nitrite-induced .

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A pharmacological manipulation of testicular function in rats was attempted to increase our understanding on pathogenesis of male , thereby establishing a rationale in management of male . The testicular functions in rats were evaluated after the with kallikrein (KAL) or other agents in the light of testicular blood flow (TBF) by hydrogen gas clearance method, responsiveness of Leydig cells upon gonadotropin stimulation and androgenbinding protein (ABP) by steady state polyacrylamide gel electrophoresis.
TBF in rats was significantly increased either by the with KAL (29.2±1.7) or hydralazine (HLZ)(27.2±1.7) as compared with the control (17.5±1.5ml/min/100g tissue)(p<0.01). Neither basal testosterone level nor responsiveness of Leydig cells on gonadotropin stimulation was affected by KAL.
Significantly higher binding capacity of ABP in the testicular cytosole of rats (0.26±0.01) was noted with the KAL as compared with either the control (0.21±0.01) or the HLZ (0.22±0.02pmol/mg protein)(p<0.01). These results indicated that KAL activated the Sertoli cell function independent of TBF.
Based on the results of experimental studies, the kallikrein for oligospermic patients without varicocele and for those with varicocele who failed to improve the semen quality after varicocelectomy was attempted.
Thirty-nine per cent of oligospermic patients without varicocele showed two-fold increase in sperm density after the KAL . Two-fold increase in sperm density was also noted in 45% of patients treated by varicocelectomy only, and in 55% by the with KAL in patients who failed to be improved by varicocelectomy.
Conclusion: Kallikrein activates the Sertoli cell function. Because the Sertoli cell dysfunction shares to some extent the basic pathogenesis of male , a pharmacological manipulation of Sertoli cells (i.e. KAL ) can be attempted as a for male with varicocele.

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Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and embryo transfer (ET) has been essential in the of . The world’s first IVF-ET baby was born in 1978 based on the technique developed by Dr. Robert Edwards and Dr. Patrick Steptoe. In Japan, the first IVF-ET birth was reported in 1983 by Prof. Masakuni Suzuki at Tohoku University School of Medicine.
IVF-ET is a procedure used to achieve pregnancy that consists of extracting oocytes from an infertile woman, fertilizing them in vitro, and transferring fertilized eggs into the patient’s uterine cavity (Fig. 1). Since the first report of successful IVF-ET, numerous techniques related to ART, such as cryopreservation of oocytes and embryos, gamete intrafallopian transfer (GIFT), and microinsemination, have been developed and refined (Table 1).
Herein we describe the history of basic research in IVF-ET that led to human applications, how the birth of the first IVF-ET baby was achieved in Japan, the current status of ART in Japan, issues related to ART, and future prospects for ART.

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The kininase activity in the seminal plasma was identified with kininase II (angiotensin-converting enzyme) by thin layer chromatography and its activity of infertile patients was significantly lower than in normozoospermic patients. The amount of proteinase inhibitor in the seminal plasma was 7.0 ± 0.9 trypsin inhibitor unit/ml, however no correlation was found between its activity and semen quality.
The effects of bradykinin and kallikrein on the velocity and motility of washed human spermatozoa were measured by multiple exposure photography method. The addition bradykinin at each concentration of 0.1ng/ml and 1.0ng/ml to the washed spermatozoa resulted in an increase of velocity and motility. The same effect as bradykinin on the spermatozoa was found in the presence of 0.1 KU/ml and 1.0 KU/ml of kallikrein.
In order to determine the effect of kallikrein on the concentrations of seminal fluid components, infertile men were treated orally for 6 months. Following determinations of volume, motility and sperm density, the concen-trations of kininase II, proteinase inhibitor, lactate dehydrogenase and acid phosphatase were measured. Sperm motility and density were increased dur-ing . Mean values of the parameters in the ejaculate unchanged, with the exception of kininase II, which exhibited significantly higher con-centration under .
Of a total of 131 men treated, 23 pregnancies (17.6%) is established be-tween the first and the sixth month.
Thus, present work shows that the components of kallikrein-kinin system participate in spermatogenesis and sperm motility.

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We investigated the efficacy of assisted ejaculation in combination with in vitro fertilization and embryo transfer (IVF-ET) in two couples with due to anejaculation. Case 1 was in an anejaculatory condition associated with a spinal cord-injury. We performed intrauterine insemination (IUI) three times using motile sperm obtained by intrathecal injection of neostigmine, but no pregnancy followed. The couple then entered IVF-ET. The semen volume obtained by assisted ejaculation was 4.5 ml. The sperm count was 33×10⁶/ml with 33% motility. At 35 weeks of gestation she delivered three healthy babies by cesarean section. Case 2 was in an unexplained retrograde ejaculatory condition. We performed IUI eight times before changing to IVF-ET. We then used sperm obtained from urine or sperm recovered from the bladder after administration of human tubal fluid, but no pregnancy followed. At the fifth IVF-ET attempt, using sperm obtained from urine, we succeeded. We prepared the sperm by the Percoll gradient method. The sperm count was 36×10⁶/ml with 64% motility. At 39 weeks of gestation she delivered a healthy baby. Deficient seminal quality contributes to the decreased fertility potential in patients with anejaculation. With the use of IVF-ET methods, pregnancies can be achieved in these couples.

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Purpose
The aim of the present study was to clarify the perceptions regarding and the tolerance for of midwives caring for women who had become pregnant following for .
Methods
Subjects were nurse midwives with at least one year's clinical experience who were engaged in the care of pregnant women following at medical facilities throughout Japan that provide care from through to delivery. Subjects were asked to complete a self-administered questionnaire survey. The measurement instruments were the "perceptions regarding ," "tolerance for ," and "background" sections of the questionnaire. Factor analysis was conducted and the following two factors were extracted from the section on "perceptions regarding " (18 items): "acceptance of a life without childbirth" and "encouragement to have children and undergo ." Cronbach's alpha coefficient was 0.665 for both factors. The following four factors were extracted from the section on "tolerance for " (20 items): "approval in general of involving a donor," "personal acceptance of involving a donor," "personal acceptance of between spouses," and "approval in general of between spouses." Cronbach's alpha coefficient for these factors ranged from 0.858 to 0.947. A total of 449 valid responses were included in the analysis.
Results
With regard to midwives' "perceptions regarding ", of the two factors, "acceptance of a life without childbirth" received a significantly higher score than "encouragement to have children and undergo " (p<0.01). This perception was more strongly observed in nurse midwives with no experience of nursing or of their own . There were significant differences among the four factors that were extracted from the section on "tolerance for " (p<0.05). Midwives were more tolerant of between spouses than of involving a donor and a tendency was seen towards tolerance for between spouses that more closely resembled natural reproduction. In addition, nurse midwives who offered "encouragement to have children and undergo " were tolerant of between spouses.
Conclusion
Midwives differed from members of the public and infertile couples in that they had low tolerance of involving a donor, not only with regard to whether or not they would personally use such , but also as a general opinion. Their perception of acceptance of a life without childbirth also differed depending on whether or not their background included experience of nursing or their own .

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Chronic inflammation in cesarean scar defect contributes to secondary

in women with cesarean scar syndrom; however, it remains unclear about the situation of inflammation in uterine cavity in women with cesarean scar syndrome. This ambidirectional cohort study aimed to explore the effect of inflammation in the uterine cavities of women with cesarean scar syndrome on at a single university hospital. The frequency of chronic endometritis in infertile patients was retrospectively compared between the cesarean scar syndrome group and non-cesarean scar syndrome group. The frequency of endometriosis was also investigated in patients with cesarean scar syndrome who underwent laparoscopy. The level of tumor necrosis factor-α and interleukin-1β in the uterine cavity was prospectively evaluated in the cesarean scar syndrome group and in women with a history of cesarean section (control group) using an enzyme-linked immunosorbent assay. There was a significant difference in the incidence of chronic endometritis between the cesarean scar syndrome and non-cesarean scar syndrome groups (65.8% and 46.0%, respectively, p = 0.0315). Endometriosis was detected in 51 (70%) patients with laparoscopy. Tumor necrosis factor-α and interleukin-1β levels in the cesarean scar syndrome group were significantly higher than those in the control group (p = 0.0002 and p = 0.0217, respectively). Our findings suggest that one cause of secondary in women with cesarean scar syndrome is embryo implantation failure-associated chronic endometritis, endometriosis, and chronic inflammation in the uterine cavity.

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The frequency of uterine peristalsis is closely related to the success rate of pregnancy. An ultrasonic imaging is almost always employed for the measure of the frequency. The physician subjectively evaluates the frequency from the ultrasound image by the naked eyes. This paper aims to measure the frequency of uterine peristalsis from the ultrasound image. The ultrasound image consists of relative amounts in the brightness, and the contour of the uterine is not clear. It was not possible to measure the frequency by using the inter-frame difference and optical flow, which are the representative methods of motion detection, since uterine peristaltic movement is too small to apply them. This paper proposes a measurement method of the frequency of the uterine peristalsis from the ultrasound image in the implantation phase. First, traces of uterine peristalsis are semi-automatically done from the images with location-axis and time-axis. Second, frequency analysis of the uterine peristalsis is done by Fourier transform for 3 minutes. As a result, the frequency of uterine peristalsis was known as the frequency with the dominant frequency ingredient with maximum value among the frequency spectrums. Thereby, we evaluate the number of the frequency of uterine peristalsis quantitatively from the ultrasound image. Finally, the success rate of pregnancy is calculated from the frequency based on Fuzzy logic. This enabled us to evaluate the success rate of pregnancy by measuring the uterine peristalsis from the ultrasound image.

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Objectives

This study aimed to reveal the current status and factors related to preconception care (PCC) health literacy among men visiting an

clinic in Japan.

Methods

This cross-sectional study was conducted between September and November 2022 at a clinic specializing in

in Fukuoka Prefecture, Japan. Three hundred leaflets with website addresses and QR codes linked to a web-based questionnaire were placed in the waiting rooms of the research facility. The participants were asked to complete a web-based questionnaire and participate in the study. The PCC Health Literacy Scale was used to measure PCC health literacy in men. A multiple logistic regression analysis was performed to identify factors related to PCC health literacy.

Results

Seventy-seven men completed the questionnaire. The mean PCC health literacy score was 38.8 ± 6.5 points. This mean score was used as the cut-off value according to which the participants were divided into two groups: high and low PCC health literacy. The men who visited the

outpatient clinic for the first time and who identified “kind of being tiresome” as a reason for not visiting an clinic had a significant risk of low PCC health literacy.

Conclusion

This study revealed factors related to PCC health literacy among men seeking care at an

clinic for the first time. Future research should expand the targets of the survey, such as medical facilities specializing in nationwide, and include men in the pre-perinatal period rather than solely including men who visit clinics.

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Recently in Japan, the trend towards females marrying later in life than before has increased the average age of women bearing children for the first time. The number of children being born in Japan has steadily decreased for the 26^th straight year and has become a grave socio-economical concern for the future. Artificial reproductive technology (ART) has shown advances in the past two decades, however there are no new solutions to the old problem of age. The authors have previously reported the efficacy of low reactive level laser therapy (LLLT) for the adjunctive of refractory female and will report a new method of LLLT, incorporating the Proximal Priority (PPT) with the use of novel device named the Neck Irradiator. A retrospective survey of patients receiving PPT with the Neck Irradiator showed that approximately 10% of the patients became pregnant with this . The authors compare and contrast this new with previous modalities and will discuss LLLT for the of female .

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Despite the advances in assisted reproductive technology, approximately 8–12% of the individuals worldwide who are willing to conceive are unable to do so. Fertility depends on a receptive state of the endometrium and hormonal adaptations as well as the immune system. Local and systemic immunities are greatly influenced by the microbiota. The aim of the present study was to compare the gut microbiota in female patients with that in

with fertile control subjects and to evaluate the effect of prebiotic partially hydrolyzed guar gum supplementation on gut dysbiosis and the outcome of pregnancy in patients treated with assisted reproductive technology. Dietary fiber can reconstitute the host intestinal microbiota and modify the immune function; however, clinical data regarding the effect of dietary fiber on the success of assisted reproductive technology is lacking. To investigate the gut microbiota in fertile and infertile females, we conducted 16S metagenomic analysis of fecal samples. In total 18 fertile female subjects and 18 patients with matched by age were recruited, and fecal samples were obtained to analyze the gut microbiome using 16S rRNA V3–V4 sequencing. The unweighted and weighted principal coordinate analyses showed a trend indicating microbial structural differences in β-diversity between these two groups. The abundance of the phylum Verrucomicrobia was higher in patients with . At the genus level, a decrease in the abundance of the genera Stenotrophomonas, Streptococcus, and Roseburia and an increase in the abundance of the genera Unclassified [Barnesiellaceae] and Phascolarctobacterium was observed in patients with . Twelve patients agreed to receive the combined therapy comprising embryo transfer by assisted reproductive technology and oral supplementation with partially hydrolyzed guar gum. The success of pregnancy by this combined therapy was 58.3% (7/12), and the failure was 41.7% (5/12). Predictive factors for pregnancy before were characterized by a decrease in the abundance of Paraprevotella and Blautia and an increase in the abundance of Bifidobacterium. Predictive factors for pregnancy before were characterized by a decrease in the abundance of Paraprevotella and Blautia and an increase tendency in the abundance of Bifidobacterium. In conclusion, the present study showed differences in the abundance of gut microbiota between fertile and infertile groups; moreover, partially hydrolyzed guar gum supplementation helped improve gut dysbiosis and the success of pregnancy in females with .

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The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the possibility for fertility. The evaluation of the fallopian tube is necessary to determine the management plan of . Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. In the current study, we evaluated the significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by HSG. Between 1997 and 2009, 127 patients with suspected tubal pathology as demonstrated by HSG underwent laparoscopy at Kinki University Hospital, and a retrospective analysis was performed. Of 87 patients with unilateral tubal pathology revealed by HSG, 20 patients (23.0%) were given an indication for assisted reproductive technology (ART), based on the laparoscopic findings. Of 40 patients with bilateral tubal pathology revealed by HSG, 33 patients (82.5%) with bilateral tubal pathology detected by laparoscopy were given a high indication for ART. Laparoscopy enables exact evaluation of the fallopian tube and selection of the optimal management plan in infertile patients with suspected tubal pathology revealed by HSG. Therefore, laparoscopy should be performed in infertile patients with suspected tubal pathology revealed by HSG, as it is of diagnostic importance.

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Improving the reproductive performance of livestock has wide-ranging significance that includes promotion of local industry, bioeconomy, and stabilization of food supply. Our research focused on sperm manipulation to improve the reproductive performance of cattle. Our experiments were based on previous studies on for humans by relying on the advantages of motile spermatozoa, i.e. spermatozoa that are able to swim against the flow of solutions, which is regarded as an attribute of healthy and physiologically functional spermatozoa. For the first time, we succeeded in collecting a number of spermatozoa that can be used for artificial insemination and obtained good conception results in a field trial. In addition, the field trial clarifies the advantageous relationship between sperm trajectory and conception.

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Transvaginal hydrolaparoscopy (THL) has become a first-line procedure in infertile women, and THL by flexible fiberscope (THLF) is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. We performed THLF on infertile women based on four indications; (i) tubal obstruction and⁄or peritubal adhesion as suggested by hysterosalpingography (HSG); (ii) serum antibody against Chlamydia (C) positive for trachomatis; (iii) diagnosis of early stage endometriosis; and (iv) unexplained . Seven women with a chief complaint of were the subjects of the present study. Two of the 7 cases had a history of gynecological surgery. Six of 7 cases had a history of C. trachomatis infection. Four cases had abnormal findings of fallopian tubal patency in hysterosalpingography. Parafallopean tubal atresia and tubal obstruction were observed in 4 cases by THLF. In one case the bilateral ovaries were extremely small and atrophic. None of the cases had serious complications after THLF. After the THLF, six women were able to have a baby by assisted reproductive technology (ART) within two years.
As THL was developed using a solid scope, indications for THL have been limited, and have excluded cases with retroverted uterus or peritoneal surgical history. In the present study, THL using a fiberscope was carried out in infertile women with retroverted uterus, and in women with a history of peritoneal cavity surgery to examine the feasibility of extending the indications for THL. Findings on the THLF were given precedence in deciding further strategies. We believe that THLF can be useful in helping patients with these indications to successfully achieve early pregnancy. This study is the first trial of THLF.

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