Tanaka Y, et al. - Researchers sought to provide step-by-step video demonstration of their procedures of drug-free in vitro activation (IVA) for managing patients with premature ovarian insufficiency (POI) or diminished ovarian reserve (DOR), as well as the laparoscopic ovarian incision (LOI) procedure for treating patients with resistant ovary syndrome (ROS). The following four steps were involved in the drug-free IVA: taking away a part of the cortex from one or both ovaries; cutting ovarian cortical pieces into small cubes in vitro; making pockets for ovarian tissue grafting; and grafting ovarian cortical cubes. Only one step was involved in the LOI procedure: cutting ovarian cortex in situ. Ovarian hyperstimulation for at least 1 year followed the two procedures. Per outcomes, a drug-free IVA approach represent an infertility treatment for recent POI or DOR patients. This procedure improved growth of residual ovarian follicles after ovarian tissue fragmentation in vitro, resulting in Hippo signaling disruption. Although symptoms of hypergonadotropic hypoestrogenism were reported by ROS patients similar to that of POI patients, they still had multiple secondary follicles. Follicle growth may enhance with disruption in Hippo signaling in vivo based on cutting ovarian cortex using LOI.