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Purpose: This study seeks to evaluate the association between follicular fluid (FF) coenzyme Q10 (CoQ10) levels, embryo morphokinetics, and pregnancy rate., Methods: Sixty infertile patients who underwent intracytoplasmic sperm injection (ICSI) cycles were included in the study. For each patient, CoQ10 level of the follicular fluid was measured by high-performance liquid chromatography system. After the ICSI of each oocyte, the relationship between the level of CoQ10 content of each follicular fluid, the subsequent embryo quality, and embryo morphokinetics was investigated. The relationship between the level of CoQ10 content of each follicle and optimal time-lapse parameters for the embryos of these follicles including t5, s2, and cc2 was also analyzed. The embryos were further classified into four categories, namely, grades A, B, C, and D, according to morphokinetic parameters using t5-t2 and t5-t3 (cc3). Each follicular fluid analysis was performed for a single oocyte of a single embryo which was transferred to the patients. Additionally, follicular fluid CoQ10 levels and pregnancy rates were evaluated., Results: Follicular fluid CoQ10 levels were significantly higher in grades A and B than grades C and D embryos (p < 0.05). The concentration of CoQ10 levels was significantly higher in the pregnant group (p < 0.05). There was no significant correlation between optimal t5 and s2 morphokinetic parameters and CoQ10 levels. However, CoQ10 levels were significantly higher in follicular fluid of embryos which had optimal cc2 (p < 0.05)., Conclusion: High follicular fluid CoQ10 level is associated with optimal embryo morphokinetic parameters and higher pregnancy rates.

Purpose: Our purpose was to evaluate the progression of embryos derived from round spermatid injection to the blastocyst stage and compare the results with those obtained by the use of testicular or epididymal spermatozoa., Methods: Thirty-eight patients with azoospermia enrolled in this study. In 29 patients with obstructive or nonobstructive azoospermia, spermatozoa were recovered from epididymis or testis. In the remaining nine cases with nonobstructive azoospermia, only round spermatids were found in seven, whereas in two of the patients, there were no elongated or round spermatids. Six of these cases underwent round spermatid injection., Results: Twenty-one of 29 patients with injection of spermatozoa underwent embryo transfer on day 3, and 10 pregnancies (47.6%) were obtained. In eight cycles, embryos were further cultured for delayed transfer. In six cases undergoing round spermatid injection, no transfer was performed on day 3 and extended culture with delayed embryo transfer was applied. The mean number of fertilized oocytes and mean number of embryos on day 3 and also the fertilization rate and mean number of good-quality embryos on day 3, mainly grade 1 or 2, were statistically significantly higher in the spermatozoa group than the round spermatid injection group. Compared to the spermatozoa group, the number of arrested embryos was significantly higher and the number of blastocyst-stage embryos and number of good-quality blastocysts were significantly lower in the spermatid injection group. No blastocysts developed in two spermatid cycles and embryo transfer was not possible, and in the remaining four cycles, after at least one blastocyst transfer, no pregnancies were achieved. However, in eight cycles with extended culture in the spermatozoa group, embryo transfers were achieved in all and three pregnancies, for a pregnancy rate of 37.5%, were obtained after blastocyst transfer., Conclusions: Our preliminary results showed that round spermatid injection was associated with a significantly lower fertilization and embryo development rate and a significantly higher developmental arrest rate compared with the injection of spermatozoa. Extended culture and delayed embryo transfer did not improve the clinical outcome after round spermatid injection, and these results suggested a developmental failure in embryos preventing successful implantation after round spermatid injection.

Purpose: In this prospective randomized study the effects of enzymatic treatment of zona pellucida of blastocysts on implantation and pregnancy rates were evaluated in a group of patients who had more than five embryos on day 3., Methods: Forty-six patients with a mean age of 29.8 +/- 4.5 years and mean duration of infertility of 6.72 +/- 0.63 years had blastocyst stage transfers, with a mean number of 2.9 +/- 0.1 embryos replaced per patient. Patients were randomly divided into two groups. The first group consisted of patients (n = 22) who had zona intact blastocyst stage transfers and the second group consisted of patients (n = 24) who had zona manipulated (enzymatic treatment) blastocyst stage transfers. Patient and cycle characteristics were similar in both groups. A commercial cell and serum-free sequential culture system was used for all embryos., Results: Overall blastocyst formation rate was 50.3%. Transfer could be done in all patients. The positive beta-human chorionic gonadotropin rate in the zona intact group was 50% (11/22) and in the zona-manipulated group was 70.8% (17/24). Clinical pregnancy, ongoing pregnancy, and implantation rates in zona intact and manipulated groups were 45.5%, 27.3%, and 19%, and 62.5%, 45.8%, and 24% respectively. Although implantation and pregnancy rates in the zona-manipulated group were higher, there were no statistically significant differences in terms of these variables between two groups. No triplet pregnancy was obtained in either group, and the twin pregnancy rate was 20% (2/10) in the zona intact group and 13.3% (2/15) in the zona-manipulated group., Conclusions: With further improvements in the embryo culture systems it will become possible in the near future to achieve high implantation rates even with single blastocyst transfers. Enzymatic treatment of the zona pellucida seems that it does not alter the pregnancy and implantation rates, but further studies with larger group of patients are needed to clarify the real effect of this zona manipulation on pregnancy outcome.