Kaali Institute

Budapest, Hungary

Kaali Institute

Budapest, Hungary

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Cserepes R.E.,Debrecen University | Bugan A.,Debrecen University | Korosi T.,Kaali Institute | Toth B.,University of Heidelberg | And 3 more authors.
Geburtshilfe und Frauenheilkunde | Year: 2014

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. © Georg Thieme Verlag KG Stuttgart.


Kovacs P.,Kaali Institute | Kovats T.,Kaali Institute | Sajgo A.,Kaali Institute | Szollosi J.,Szegedi Tudomanyegyetem | And 2 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2011

Purpose: Patients with unexplained infertility may have fertilization problems. Split fertilization (ICSI and conventional IVF on sibling oocytes) is often used to avoid poor fertilization. Our aim was to assess the ability of hyaluronic acid binding (HA-binding) assay to predict spontaneous fertilization during IVF. Methods: Prospective, blinded, controlled trial. Patients undergoing their first IVF cycle for unexplained infertility were eligible. Split fertilization was used. IVF and ICSI fertilization rates and embryo development based on 3 HA-binding cut-offs (< 60%; 60-80%; >80%) were compared. Results: ICSI fertilization was higher than IVF, but none of the HA-binding cut-off levels predicted those cases where IVF was less effective, therefore ICSI only would have lead to improved outcome. Embryo development and morphology were similar in all cut-off groups. Conclusions: HA-binding did not predict spontaneous fertilization in patients with unexplained infertility undergoing IVF treatment. When it was used for "screening" it did not help to select the method of fertilization. © 2010 Springer Science+Business Media, LLC.


Vrontikis A.,Center for Reproductive Health | Chang P.L.,Beth Israel Center for Infertility and Reproductive Health | Kovacs P.,Kaali Institute | Lindheim S.R.,Center for Reproductive Health
Journal of Assisted Reproduction and Genetics | Year: 2010

Purpose: Antral follicle count (AFC) is used as a marker of ovarian response. We assessed its value in predicting pregnancy outcomes in ovum donation cycles by retrospective review. Methods: Oocyte donors (n=94) underwent ovarian hyperstimulation using rFSH and GnRH-antagonists. Recipients were synchronized using GnRH-agonist down-regulation followed by fixed dose of estrogen and progesterone following hCG. Outcomes measured included correlation of AFC to pregnancy outcomes and cycle characteristics in those with and without clinical and ongoing-delivered cycles. Results: AFC significantly correlated with clinical [Exp β 1.12; 95% CI: 1.02-1.23, p<0.05] and ongoing-delivered pregnancy [Exp β 1.10; 95% CI: 1.01-1.20, p<0.05]. Significantly greater AFC, total and M-2 oocytes, and cycles resulting in cryopreserved embryos were seen in clinical and ongoing-delivered cycles. Conclusions: AFC predicts cycle stimulation responses and clinical outcomes and may serve as a guide for dosing protocols and in choosing to proceed with the most optimal cycle. © 2010 Springer Science+Business Media, LLC.


Kovacs P.,Kaali Institute | Kovats T.,Kaali Institute | Kaali S.G.,Kaali Institute
Fertility and Sterility | Year: 2010

Objective: To study the effect of early follicular phase recombinant LH supplementation on stimulation outcome among women undergoing IVF using the GnRHa long protocol and recombinant FSH. Design: Randomized, controlled trial. Setting: Private IVF unit. Patient(s): Women under the age of 40 with normal ovarian function undergoing their first or second IVF cycle. Intervention(s): All stimulations followed the standard luteal long GnRHa down-regulation protocol. At suppression, patients in the experimental group received 75 IU of rLH daily for 4 days, and recombinant FSH at a fixed starting dose of 150 IU for the first 5 days was started a day later, on day 2 of rLH. In the control group, patients started rFSH at a fixed dose of 150 IU for the first 5 days at suppression. Main Outcome Measure(s): Baseline, stimulation, embryology parameters, and treatment outcome were compared. Of primary interest, recombinant FSH need during stimulation was assessed. Result(s): Stimulation, embryology parameters, and treatment outcome were comparable. The amount of gonadotropins used and medication expense were similar in the two groups. Conclusion(s): Early follicular phase recombinant LH supplementation at a daily dose of 75 IU does not improve response to stimulation among normal responder women undergoing IVF. © 2010 American Society for Reproductive Medicine.


Porat N.,Tel Aviv University | Porat N.,University of Wisconsin - Madison | Boehnlein L.M.,University of Wisconsin - Madison | Barker M.A.,Good Samaritan Hospital | And 2 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2010

Aim: Using oocyte donation cycles as an ideal model, we sought to compare pregnancy and implantation rates in cleavage stage (day 3) versus blastocyst stage (day 6) embryo transfers (ET); assess the predictive value of blastocyst formation rates based on cleavage cell stage and morphology grade; and evaluate the ability to predict formation of high quality (HQ) blastocysts. Methods: Ninety three consecutive oocyte donation cycles from July 2003 to August 2005 were retrospectively evaluated and analyzed to determine if either resulted in a cleavage stage (n = 30) or blastocyst (n = 45) ET. The primary outcomes measured pregnancy rates, the percent development of HQ blastocysts based on day 3 embryo status, and the ability to select day 3 embryos suitable for transfer among four blinded evaluators by assessing their day 6 embryo outcome. Results: Cleavage stage ET resulted in significantly lower pregnancy rates, clinical pregnancy rates, and implantation rates (47% [n = 14/30]; 40% [n = 12/30] and 27 ± 7%) compared to blastocyst stage (82% [n = 37/45]; 73% [n = 33/45] and 64 ± 6% [±SE], P < 0.01). In total, HQ blastocysts resulted from high and good quality day 3 embryos 35% (191/546) and 17% (93/546), respectively. Blinded evaluation revealed at least one, two or all three day 3 embryos were correctly selected for ET on day 6, 97%, 67% and 19%, respectively. Conclusion: Day 6 ET resulted in significantly better clinical outcomes compared to day 3 ET. While day 3 status is not predictive of blastocyst quality, the selection of at least one day 3 embryo ultimately suitable for blastocyst ET underscores the significance of optimal endometrial receptivity. © 2010 Japan Society of Obstetrics and Gynecology.


Kovacs P.,Kaali Institute
Journal of Obstetrics and Gynecology of India | Year: 2014

Cancer may be detected at any age and could affect children, and reproductive age women as well. In recent years, cancer treatment has become less destructive and more specific. As a result, survival rates and quality of life following successful treatment have continuously improved. Cancer treatment typically involves surgery, chemo- or radiation therapy, or the combinations of these. These interventions often adversely affect the function of the reproductive organs. Chemo- and radiation therapy are known to be gonadotoxic. Survivors of oncologic therapy are typically rendered infertile primarily due to the loss of ovarian function. There are, however, several medical, surgical, and assisted reproductive technology options that could be and should be offered to those diagnosed with cancer and wish to maintain their fertility. Embryo cryopreservation has been available for decades and has been successfully applied for fertility preservation in women diagnosed with cancer. Recent advances in cryobiology have increased the efficacy of not just embryo but even oocyte and ovarian tissue freezing–thawing. Oocyte vitrification just like embryo cryopreservation requires the use of stimulation but does not require the patient to be in a stable relationship or accept the use of donor sperm. Ovarian tissue cryopreservation does not require stimulation and, following successful transplantation, provides the patient with the most eggs but is currently still considered experimental. This paper summarizes the various fertility-sparing medical, surgical and assisted reproductive technology options. It reviews the current status of embryo, oocyte, and ovarian tissue cryopreservation and discusses their risks and benefits. © 2014, Federation of Obstetric & Gynecological Societies of India.


PubMed | Kaali Institute
Type: Journal Article | Journal: Fertility and sterility | Year: 2010

To study the effect of early follicular phase recombinant LH supplementation on stimulation outcome among women undergoing IVF using the GnRHa long protocol and recombinant FSH.Randomized, controlled trial.Private IVF unit.Women under the age of 40 with normal ovarian function undergoing their first or second IVF cycle.All stimulations followed the standard luteal long GnRHa down-regulation protocol. At suppression, patients in the experimental group received 75 IU of rLH daily for 4 days, and recombinant FSH at a fixed starting dose of 150 IU for the first 5 days was started a day later, on day 2 of rLH. In the control group, patients started rFSH at a fixed dose of 150 IU for the first 5 days at suppression.Baseline, stimulation, embryology parameters, and treatment outcome were compared. Of primary interest, recombinant FSH need during stimulation was assessed.Stimulation, embryology parameters, and treatment outcome were comparable. The amount of gonadotropins used and medication expense were similar in the two groups.Early follicular phase recombinant LH supplementation at a daily dose of 75 IU does not improve response to stimulation among normal responder women undergoing IVF.


PubMed | Biotalentum Ltd., Kaali Institute and Szent Istvan University
Type: Journal Article | Journal: Reproduction, fertility, and development | Year: 2016

The efficiency of various assisted reproductive techniques can be improved by preconditioning the gametes and embryos with sublethal hydrostatic pressure treatment. However, the underlying molecular mechanism responsible for this protective effect remains unknown and requires further investigation. Here, we studied the effect of optimised hydrostatic pressure treatment on the global gene expression of mouse oocytes after embryonic genome activation. Based on a gene expression microarray analysis, a significant effect of treatment was observed in 4-cell embryos derived from treated oocytes, revealing a transcriptional footprint of hydrostatic pressure-affected genes. Functional analysis identified numerous genes involved in protein synthesis that were downregulated in 4-cell embryos in response to hydrostatic pressure treatment, suggesting that regulation of translation has a major role in optimised hydrostatic pressure-induced stress tolerance. We present a comprehensive microarray analysis and further delineate a potential mechanism responsible for the protective effect of hydrostatic pressure treatment.


PubMed | Kaali Institute
Type: Journal Article | Journal: Journal of obstetrics and gynaecology of India | Year: 2014

Cancer may be detected at any age and could affect children, and reproductive age women as well. In recent years, cancer treatment has become less destructive and more specific. As a result, survival rates and quality of life following successful treatment have continuously improved. Cancer treatment typically involves surgery, chemo- or radiation therapy, or the combinations of these. These interventions often adversely affect the function of the reproductive organs. Chemo- and radiation therapy are known to be gonadotoxic. Survivors of oncologic therapy are typically rendered infertile primarily due to the loss of ovarian function. There are, however, several medical, surgical, and assisted reproductive technology options that could be and should be offered to those diagnosed with cancer and wish to maintain their fertility. Embryo cryopreservation has been available for decades and has been successfully applied for fertility preservation in women diagnosed with cancer. Recent advances in cryobiology have increased the efficacy of not just embryo but even oocyte and ovarian tissue freezing-thawing. Oocyte vitrification just like embryo cryopreservation requires the use of stimulation but does not require the patient to be in a stable relationship or accept the use of donor sperm. Ovarian tissue cryopreservation does not require stimulation and, following successful transplantation, provides the patient with the most eggs but is currently still considered experimental. This paper summarizes the various fertility-sparing medical, surgical and assisted reproductive technology options. It reviews the current status of embryo, oocyte, and ovarian tissue cryopreservation and discusses their risks and benefits.


Pribenszky C.,Szent Istvan University | Losonczi E.,ARTechnic Co. Research and Development | Molnar M.,ARTechnic Co. Research and Development | Lang Z.,Szent Istvan University | And 6 more authors.
Reproductive BioMedicine Online | Year: 2010

Single blastocyst transfer is regarded as an efficient way to achieve high pregnancy rates and to avoid multiple pregnancies. Risk of cancellation of transfer due to a lack of available embryos may be reduced by early prediction of blastocyst development. Time-lapse investigation of mouse embryos shows that the time of the first and second cleavage (to the 2- and 3-cell stages, respectively) has a strong predictive value for further development in vitro, while cleavage from the 3-cell to the 4-cell stage has no predictive value. In humans, embryo fragmentation during preimplantation development has been associated with lower pregnancy rates and a higher incidence of developmental abnormalities. Analysis of time-lapse records shows that most fragmentation is reversible in the mouse and is resorbed in an average of 9 h. Daily or bi-daily microscopic checks of embryo development, applied routinely in human IVF laboratories, would fail to detect 36 or 72% of these fragmentations, respectively. Fragmentation occurring in a defined time frame has a strong predictive value for in-vitro embryo development. The practical compact system used in the present trial, based on the 'one camera per patient' principle, has eliminated the usual disadvantages of time-lapse investigations and is applicable for the routine follow-up of in-vitro embryo development. © 2009, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

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