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Objective To assess whether the embryo cultivation at different oxygen tensions had any effect on intracytoplasmic sperm injection (ICSI) outcome. Design Prospective randomized trial. Setting University clinical center. Patient(s) Women undergoing ICSI (n = 647). Intervention(s) Culturing of embryos, either at 6% CO 2 , 5% O 2 , 89% N 2 , or at 6% CO 2 in air. Main Outcome Measure(s) The primary outcome was ongoing pregnancy rates (PR). Secondary outcomes: cumulative PRs, implantation, and embryo quality, for both treatment groups and clinical outcomes for subgroups (optimal cycles, poor responders, older women). Result(s) Although low oxygen resulted in a higher proportion of good day 2 embryos (0.547 ± 0.021 vs. 0.39 ± 0.019) and optimal blastocysts (0.162 ± 0.199 vs. 0.083 ± 0.128), the ongoing PRs (31.6% vs. 27.1%) and implantation rates (28.8% vs. 25.2%) were similar in both oxygen groups. Low oxygen caused a higher cumulative PR (38% vs. 28.3%) in the main group and a higher PR in the poor responder subgroup (23% vs. 9.8%) with embryo transfers performed mostly on day 3. Conclusion(s) The use of reduced oxygen in IVF is reasonable, irrespective of the duration of embryo culture. It improves embryo development and cumulative PR and is also recommended in poor responding cycles.

Objective: To determine whether extended culture of embryos to blastocysts has any benefit in cycles with only one or two created embryos. Design: Retrospective analysis of cycles comparing outcomes of day 2 and day 5 transfers. Our day 2 group was from the year 1999 and our day 5 group, from the year 2000. Setting: Assisted reproductive technology program of a teaching hospital. Patient(s): All patients, irrespective of age, who had developed one or two embryos. Intervention(s): Stimulated IVF, intracytoplasmic sperm injection, or testicular sperm extraction and intracytoplasmic sperm injection cycles with 2-day culture in universal IVF medium (n = 133) or 5-day culture in BlastAssist media (MediCult, Jyllinge, Denmark; n=132). Main Outcome Measure(s): Pregnancy, implantation, and take-home baby rates. Result(s): In the groups of 2-day and 5-day culture, embryo transfer was performed in 98% and in 57% of cycles, respectively. However, the total implantation rate per created embryo (18% vs. 18%), the pregnancy rate per cycle (23% vs. 21%), and the take-home baby rate (69.4% vs. 71.4%) did not differ between the day 2 and day 5 groups. Conclusion(s): Extended culture of embryos does not improve or decrease their capacity for implantation but only allows for better selection and is therefore not necessary in cycles with fewer than three embryos.

Objective To determine the diagnostic value of the following sperm function tests in predicting the fertilizing ability of spermatozoa in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI): hyaluronan-binding assay (HBA), DNA fragmentation (Halosperm), and hyperactivity. Design Prospective study. Setting University medical center. Patient(s) 133 couples undergoing infertility treatment with IVF/ICSI. Intervention(s) Analysis of sperm DNA fragmentation, hyaluronan-binding ability, and hyperactivation on washed semen samples used for the insemination of oocytes. Main Outcome Measure(s) Correlation between the results of sperm function tests and the fertilization rate (FR) or embryo quality (EQ) after IVF and ICSI. Comparison of the sperm DNA fragmentation, hyperactivation, and hyaluronan binding ability between cycles with less than 50% (group 1) and more than 50% (group 2) of oocytes fertilized after IVF. Result(s) Both FR and EQ in IVF cycles negatively correlated with sperm DNA fragmentation. Furthermore, a positive correlation was observed between FR and hyaluronan-binding ability or induced hyperactivity. The semen samples from the IVF cycles with low FR (group 1) were characterized by statistically significantly higher sperm DNA fragmentation and lower hyaluronan-binding ability in comparison with semen samples from the group with high levels of fertilization (group 2). In ICSI cycles, no relationship was found between sperm function tests and FR or EQ. Conclusion(s) The Halosperm test, the HBA test, and induced hyperactivity are useful in predicting the ability of spermatozoa to fertilize oocytes in IVF and are helpful in distinguishing semen samples suitable for IVF or ICSI.

Objective: To predict the risk of premature ovulation and possibility of pregnancy in natural IVF/ICSI cycles on the basis of the estradiol (E2) level on the day of hCG injection and on the day after. Design: A prospective study. Setting: Hospital research program. Patient(s): One hundred sixty-four women undergoing 305 IVF/ICSI natural cycles. Intervention(s): Serum E2 levels were measured ∼12 h before (day 0) and 12–17 h after hCG administration (day 1). Main Outcome Measure(s): E2 levels on day 0 and day 1, the ratio of the day 1 to day 0 levels, and cycle outcome. Result(s): In cycles with premature ovulation and in conception cycles, the average E2 level on day 0 was statistically significantly higher than in other cycles, whereas the E2 ratio was statistically significantly lower. Multiple logistic regression was used to determine the connection of the E2 level on day 0 (B0 = −0.742, B = 2.147, P = .01) and the E2 ratio (B0 = −0.742, B = −3.135, P

Objective To determine the influence of delayed compaction and fragmentation on the developmental capacity of morulas. Design Prospective study. Setting University IVF center. Patient(s) Intracytoplasmic sperm injection (ICSI) cycles with compact embryos on day 4 or day 5. Intervention(s) The embryos were divided into day 4 (n = 329) and day 5 (n = 256) morulas and graded I, II, or III, according to the percentage of fragmentation ( 20%). The embryos were measured using Cronus3 software. Main Outcome Measurement(s) Blastocyst development rate, blastocoel expansion rate, and optimal blastocyst rate. In an optimal blastocyst: surface area, trophectoderm cell number, inner cell mass (ICM) surface area, ICM volume and ICM shape. Result(s) Day 4 morulas in classes I–III developed into optimal blastocysts in 57.4%, 50%, and 35.6% of the total, respectively, and day 5 morulas in classes I–III in 43.3%, 29.1%, and 13.6% of the total, respectively. A negative association was identified between the amount of morula fragmentation, the blastocyst ICM size, and the number of trophectoderm cells. A delay of 1 day in compaction was associated with a reduced ICM volume. Conclusion(s) The measurement of compaction timing and cytoplasmic loss in morulas assists in predicting their ability to develop into optimal blastocysts.