Physiological Intra-Cytoplasmic Sperm Injection (PICSI) outcomes after oral pretreatment and semen incubation with myo-inositol in oligoasthenoteratozoospermic men: results from a prospective, randomized controlled trial.

OBJECTIVE: The aim of the current study was to evaluate the effect of an oral pretreatment with a mix of myo-inositol (Myo-Ins), folic acid, vitamin E, L-carnitine, L-arginine and selenium (Folandrol, Exeltis, Hungary) and subsequent direct Myo-Ins incubation of spermatozoa before Physiological Intra-Cytoplasmic Sperm Injection (PICSI) procedures in infertile couples due to oligoasthenoteratozoospermia with previous failed PICSI procedures. PATIENTS AND METHODS: We performed a prospective, randomized controlled trial at the Assisted Reproduction Unit of the Kaáli Institute (Gyor, Hungary). The male partners were randomly assigned to two groups: the first one treated with a myo-Inositol-based supplement (Folandrol®, Exeltis, Hungary) for two months; the second one did not undergo any treatment in the same time range (controls). The semen of the treated group was incubated for 2 h with 2 mg/ml of MI (Andrositol Lab, Lo.Li. Pharma, Rome, Italy) for the PICSI protocol. RESULTS: There was no significant difference for mean female partner age (p = 0.17) and mean previous failed PICSI procedures (p = 0.65) between the two groups. Although there was no significant difference (p = 0.85) regarding the rate of mature oocytes and the fertilization index was significantly higher (p < 0.001) in the treatment group than control group. Also, despite the comparable average number of transferred embryos between the two groups (p = 0.55), in the treatment group there was a significantly higher rate of good quality embryos at day 3 after fertilization (p = 0.001). Finally, 11 pregnancies were obtained only in the treatment group (p = 0.001). CONCLUSIONS: The combination of oral supplementation and semen incubation with MI in oligoasthenoteratozoospermic men could improve PICSI outcomes.

Infertility Specific Quality of Life and Gender Role Attitudes in German and Hungarian Involuntary Childless Couples.

Introduction: As gender role attitudes and the evaluation of parenthood and childlessness have subtle variations in each society, cross-country studies focusing on infertility are needed to draw a complex picture in the psychosocial context of infertility. This study investigates similarities and differences between German and Hungarian infertile couples regarding infertility specific quality of life and personal gender role attitudes. Methods: A cross-sectional study was conducted with data of 540 participants (270 couples) attending the first fertility consultation in one fertility clinic in Germany and in five fertility clinics in Hungary. Data were collected between February 2012 and March 2013. Two psychological questionnaires were applied: The FertiQoL to measure infertility specific quality of life and the PAQ to measure gender role attitudes like "instrumental" acting (as a traditional "masculine" attitude) and "expressive" communicating (as a traditional "femine" attitude) and their combinations "combined" attitude (as both "instrumental" and "expressive") and "neutral" attitude (neither "instrumental" nor "expressive"). Results: German couples seeking assisted reproduction treatment are older aged and have longer lasting relationships than Hungarian couples. Hungarian couples scored higher on all quality of life scales than did German couples. In the Hungarian group, "combined" attitudes (use of both "expressive" and "instrumental" attitudes) is associated with higher levels of quality of life compared with other gender role attitudes. In the German group, individuals with "combined" attitudes seem to show better quality of life than those in "expressive" and "neutral" clusters. Conclusions: The strategy of using combined "expressive" and "instrumental" attitudes proved to act as a buffer against infertility-related stress for both members of the couple in two European countries and can therefore be recommended as helpful in counselling the infertile couple.

[The healing process following gynecologic laparoscopy: data on the significance of psychological factors]. / A gyógyulás folyamata nögyógyászati laparoscopiát követóen: adatok a pszichés tényezök jelentóségéhez.

It is known that patients undergoing laparoscopic surgery can be discharged from hospital sooner and their reconvalescence is achieved faster than after laparotomy. Beside the medical judgement of the healing process it is also important to assess the length of time needed for the patients to feel themselves completely cured and be free of complaints. The data on the subjective judgement of the healing process provided by 335 patients who underwent laparoscopic surgery are analyzed retrospectively here. The aim of the study was to assess how anxiety as a personality trait might influence the healing process and also if there is any connection between anxiety, clinical diagnosis and laparoscopic findings. Anxiety was measured by Spielberger's State-Trait Anxiety Inventory (STAI). The estimated average healing time is 29.8 days (appr. 4 weeks), but patients with diagnostic and/or operative laparoscopy felt themselves free of complaints after 18.9 days (appr. 3 weeks) on the average. The duration of the healing process is independent of the laparoscopic findings and the type of procedure. There is a strong correlation between the anxiety level and the healing process. The average level of anxiety trait was 47.99 +/- 9.50. Anxiety level was the highest in the group of patients operated on for pelvic pain (mean = 51.21). There was no serious organic alteration in the small pelvis in 37% of the cases. One year after the operation 11.3% of the patients did not feel themselves cured and 17.6% had complaints. These data emphasize the role of anxiety and that of psychological factors in the etiopathogenesis and treatment of gynecologic diseases, especially in chronic pelvic pain and infertility or sterility.

[Empty follicle syndrome as cause of unsuccessful in vitro fertilization]. / "Ures" tüszö szindróma, mint a sikertelen in vitro fertilizáció egyik oka.

The authors report a case, where ultrasound guided transvaginal follicle aspiration was carried out for oocyte retrieval during the source of in vitro fertilization. Despite the favourable situation described by ultrasound and prognosed by serum hormone levels aspiration of oocytes proved unsuccessful even after lavage of follicules. The authors give an overview of the literature of "empty" follicle syndrome, its possible aetiology and methods of treatment.

[Functioning conditions of laboratories dealing with cryopreservation of human pre-embryos]. / A humán préembriók fagyasztásával foglalkozó laboratóriumok müködési feltételei.

The authors discuss about the functional conditions of the Human Reproductive Laboratories dealing with the cryopreservation of the human preembryos. They determine the safety specifications and recommend documentation of the cryopreservation based on their own practice. Finally they suggest the licensing-controlling system of the Human Reproductive Laboratories concerning cryopreservation of the human preembryos.

[Programmed pre-embryonic freezing in the pronuclear stage]. / Programozott préembrió fagyasztás pronukleusz állapotban.

The authors discuss about freezing procedure of surplus pronuclear stage praeembryos in six cases. The total amount of praeembryos were 36. From these nine were thawing and were cultured further. The surviving rate was 88.8%, the development to blastocysts rate was 77.7%. The freezing procedure in pronuclear stage needs some extra methodological force. The success, increasing influence on pregnancy rate and the benefit that reduces the IVF-ET patient's intolerance procedure is also an important factor. Beneath the cost saving effect of this intervention, the cryopreservation technique for the institutes performing this way of assisted reproduction is highly suggested.

Molecular forms of acetylcholinesterase in subcortical areas of normal and Alzheimer disease brain.

We have previously reported that the 10s molecular form (G4) of acetylcholinesterase (AChE) is selectively lost from several cortical areas of Alzheimer's disease (AD) brain. In the current follow-up study, we microdissected several areas of nondemented and AD brain, including the hippocampus, amygdala, and cingulate gyrus. Tissue homogenates were separated on sucrose density gradients and the resulting fractions were analyzed for AChE activity in order to define the ratios of the predominant AChE molecular forms (G4/G1). Both the hippocampus and amygdala exhibited distinct patterns of alterations in the G4/G1 ratio which correlate with the known distribution of histopathological changes in AD brain. In order to further define the major pool of AChE that is depleted in AD, we separated fractionated tissue homogenates into salt-soluble and detergent-soluble fractions. The G4/G1 ratios were only altered in the detergent-soluble fractions, indicating that the loss of the G4 AChE molecular form involves a selective depletion of the membrane pool. Available evidence would suggest that this form is the AChE molecular form physiologically relevant at the cholinergic synapse.

Importance of the DHEA-sulphate-test in pregnancy.

The DHEA-sulphate was applied in the 34th-41st weeks of pregnancy for the estimation of placental function (foetoplacental unit) in normal and pathological pregnancies. It has been established that: the peak of oestrogen excretion is in the dawn hours; the diurnal rhythm of E1 + E2 + E3 excretion is identical; the DHEA-SO4----oestrogen conversion takes place immediately, and within the subsequent 8-10 hours the urinary oestrogen values return to the original level; in physiological pregnancies between the 34th-36th weeks the DHEA-sulphate test indicated normal function in 91% of the cases; in the 37th-41st weeks of apparently normal pregnancies the test showed pathological placental function in 50% of the cases; in pathological pregnancies between the 37th-41st weeks the test in 77% of the cases predicted placental dysfunction.