# Robotic Manipulation of Cumulus-Oocyte Complexes for Cumulus Cell Removal
## 6 Conclusions  
This article reported on a physical robotic system integrated with AI-powered technologies to automate and standardize the removal of cumulus cells from COCs in IVF. An EPSANet50 network was developed to accurately assess the oocyte's maturity before removing cumulus cells, alleviating the influence on the maturation of the immature oocytes and further reducing the discard rate of oocytes. An adaptive controller was designed to accurately position the COC at the target position inside the micropipette, which took the varying mass of the COC into account and reduced the oocyte loss inside the micropipette. Additionally, an improved Yolov5s network was integrated into the system for quantitatively assessing the cumulus cell number and size, and the completeness of cumulus cell removal, which ensured that the embryonic DNA was not contaminated by the DNA from the cumulus cells in the subsequent PGT procedure. Experiments on mouse COCs revealed a success rate of 98.0 \(\pm\) 1.8% and a discard rate of 4.1 \(\pm\) 2.7% by the robotic system. Compared with manual operation, the robotic system achieved a higher amplification rate of 97.9 \(\pm\) 4.2% and a lower non-specific rate of 6.3 \(\pm\) 6.1%, indicating the higher performance of the PGT test and its potential to further improve clinical practices in modern IVF. In future research, we still need to explore new ideas to further automate and standardize our robotic system for cumulus cell removal in IVF. (1) The first idea is creating 3D digital twins for robotic planning prior to the physical control of COCs. This approach involves the 3D modeling of COCs, simulation of cumulus cell removal, and AI-driven path planning and optimization. It allows for the validation of the cumulus cell removal process in a risk-free virtual space, identifying potential risks before any physical manipulation of human COCs prior to clinical trials. (2) The second idea involves developing a cyber-physical approach for the robotic manipulation of COCs. This approach integrates physical robotic manipulators with computational models and vision feedback to remotely and automatically remove cumulus cells. This technology will mitigate the dilemma due to the shortage of experienced embryologists and enable advanced IVF treatments for patients in various locations, including underdeveloped regions. Conceptualization, R.Z. ; Data curation, R.Z. ; Formal analysis, R.Z. ; Funding acquisition, J.Z. ; Investigation, Y.W. ; Project administration, J.Z. ; Resources, C.R. ; Supervision, J.Z. and C.R. ; Visualization, M.H. ; Writing--original draft, R.Z. ; Writing--review and editing, J.Z. All authors have read and agreed to the published version of the manuscript. **Funding:** This research was funded by the National Key Research and Development Program Intelligent Robot Special Project of China (Grant No. 2023 YFB4706700), the National Natural Science Foundation of China (No. 62273247, No. 61933008), and the National Key Research and Development Program Basic Research Conditions and Major Scientific Instrument and Equipment Research and Development Special Project of China (Grant No. 2023 YFF0721400). **Institutional Review Board Statement:** Not applicable. **Informed Consent Statement:** Not applicable. **Data Availability Statement:** The data presented in this study are available on request from the corresponding author due to (privacy). **Acknowledgments:** Thanks to reviewers for their constructive comments and suggestions that improved this research. **Conflicts of Interest:** The authors declare no conflicts of interest.