Table 5.

Evidence-based review on culture media

Culture media additives	Evidence-based review
Energy substrate	Zygotes and subsequent cleavage stages prefer pyruvate as the primary source of energy, while the post eight-cell-stage embryo uses glucose[22]
	Glucose-free media are still advertised for the early stages of embryo culture even though the inhibitory role of glucose is no longer a dogma and the content of phosphate during days 1-3 varies from zero to high concentration (Quinn, 2004)[27]
EDTA	Still a matter of debate[26]
Amino acids	Experiments in mouse embryos demonstrated that nonessential amino acids are essential during early embryo development while essential and nonessential amino acids should be included in the medium after the 8-16-cell stage[28]
Antibiotic supplementation	Most primary or normal human cells show reduced growth rates in the presence of antibiotics, which is why their role in embryo culture is debated by many who feel that keeping the cells free from microorganism contamination can be accomplished with proper knowledge of good laboratory practice[29]
Protein supplementation	Zhu et al. suggest that protein source/HSA has a significant effect on birthweights of singleton newborns[30]
Growth factors and cytokines	Study comprising of around 14 fertility units and >1300 women (Ziebe et al., 2013).[31] For supplementation of culture media with GM-CSF showed a significant increase in LBR in a subgroup of patients with at least one previous miscarriage but only in low HSA media
	GM-CSF supplementation appeared beneficial for LBR in a retrospective study for patients with previous miscarriages by Renzini et al. (2013)[32]
	A pilot study by Sfontouris et al., 2013[33] long-term follow-up of the offspring are needed to determine the benefit and safety of GM--CSF-supplemented media for the general IVF population and these patient groups (Siristatidis et al., 2013)[34]
Hyaluronan rich media	A recent update on this Cochrane review including 16 RCTs concluded that the addition of hyaluronic acid to embryo transfer medium yielded improved LBR. However, only six trials reported on LBR and the obtained evidence was of moderate quality (Bontekoe et al., 2014)
	Balaban et al. (2011) found significantly increased LBR for the hyaluronan group

HSA=Human serum albumin, Gm-CSF=Granulocyte-macrophage colony-stimulating factor, LBR=Live birth rate, IVF=In-vitro fertilization, RCT=Randomized controlled trials, EDTA=Ethylene diamine tetra-acetic