IVF Fertility Center in Manila, Philippines - KRBC


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Management of the Follicular phase

ivf

IVF begins with management of the follicular phase. To collect a good egg, it is essential to focus on the process of egg maturation in the ovary. This period is very long (more than 5 months), and the last 2 months are particularly important. During this period, we apply our unique method of treatment, which stimulates ovulation in a setting akin to the natural one, while minimizing the use of drugs to avoid disturbance in egg maturation.

Minimal Stimulation (mini-IVF)

From the third day of the menstrual period, follicular development is stimulated and spontaneous ovulation is suppressed using clomiphene citrate. Midway during the clomiphene treatment period, an FSH (follicle-stimulating hormone) preparation is additionally used at a low dose level to facilitate the growth of the dominant follicles. Upon sufficient follicular growth, trigger is administered to induce final oocyte maturation.

In women with advanced age and women who are low responders, another treatment method was developed in our clinic. Starting with clomiphene citrate on the third day of menstruation, this is followed by the addition of a very low dose of human menopausal gonadotropin (HMG) to stimulate follicular development.

Carefully selected types of drugs are used at low doses, to achieve IVF that is body-friendly, while maximizing the natural principles of oocyte development.

Natural Cycle

No injection or any medication is given during the period from the 3rd day of menstruation to immediately before ovulation. Close ultrasound monitoring of follicular development and hormonal levels are utilized to time the administration of a trigger to start final oocyte maturation and ovulation. This is the simplest yet the most delicate treatment method which has the least interference with the oocyte’s natural development. This adheres to nature’s process of natural selection.

Kaufmann Therapy

We occasionally encounter females in whom collection of a good oocyte is difficult because excessive use of ovulation inducing agents from previous treatments have disturbed the subsequent menstrual cycles. The disturbed cycles are repaired and restored to normal ones by our unique technique employing the Kaufmann therapy for a period of 50 days. With this method, we attempt to collect a good oocyte for IVF.

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Oocyte and sperm collection

After having reached a point immediately before ovulation, an egg is taken out with a needle from the mature follicle. At our clinic, a fine egg collection needle is used to enable unanesthetized egg collection, causing little physical stress to the patient and allowing her to return home 15 minutes later.

Semen is collected in the semen collection room or brought from home. Our clinic treats male factor infertility as well. If sperm is not found in the semen collected, surgery is conducted to take out sperm directly from the epididymis or testis. With an operative technique based on our long experience, the patient can return home several hours after surgery.

Our unique egg collection needle

We began our efforts to develop our unique needle for egg collection in 1999. At present, an egg collection needle (21 or 22 gauge), about half the global standard thickness (17 gauge), is used at our clinic. The blade at the needle tip has been processed with a special technique to minimize tissue damage. At present, over 20,000 eggs are collected annually at the Kato Ladies’ Clinic. As a result of modifications and improvement we have made, no accident involving bleeding has occurred during egg collection (Usually, massive bleeding with blood loss over 500 ml has been reported to occur at an incidence of about 3%. In 1998, before such efforts, literatures showed that bleeding requiring hospitalization occurred in about one out of 500 cases. The same was experienced at our clinic).

This very fine needle causes minimal pain and bleeding, thus not requiring general anesthesia usually applied at facilities providing treatment of infertility. With this needle, egg collection can usually be completed in several minutes, without causing physical stress, thus allowing the patient to return home after a short period of rest (about 15 minutes).


Sperm collection from epididymis or testis

This is done for males whose semen does not contain sperm. A needle is used to aspirate semen from the epididymis. If no sperm is acquired from the epididymis, testicular sperm extraction (TESE) is performed. In vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) under a microscope is possible as long as at least one sperm is available.

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Fertilization and Embryo culture

When an egg and sperm are available, fertilization is performed. Usually, a large number of sperm is applied to the egg to induce fertilization. In case fertilization is unlikely to occur with this method, ICSI is performed under a microscope. The fertilized egg is returned into the uterus usually after 2 days of culture in vitro. Depending on the case, culture is performed for a longer period until the blastocyst has formed.

Intracytoplasmic sperm injection (ICSI)

This method is applied to cases where the fertilization rate is unacceptably low because of problems in the number, shape, etc. of the sperm. A sperm is directly injected into the egg to induce fertilization. Presently, an ICSI technique enabling a more gentle and smooth injection of sperm into the egg has been developed.


Blastocyst culture

The fertilized egg is incubated in vitro for 5 or 6 days, longer than usual, until the egg grows to the blastocyst. Although the egg sometimes fails to grow to the blastocyst, the implantation rate is more than twice higher with the blastocyst than with the ordinary 4-cell stage embryo. This method is very effective in cases having oviduct abnormalities or having undergone unsuccessful embryo transfers many times before. >>more read

Assisted hatching

This pertains to the removal of the clear zone (zona pelucida) around the blastocyst at the time of its transfer. This manipulation can improve the implantation success rate in cases where oviduct-associated abnormalities are anticipated (e.g., cases with a history of extrauterine pregnancy), cases where embryonic growth is slow, and cases where embryo transfer is done under hormonal adjustment.

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Embryo transfer and cryopreservation

The fertilized egg cultured in vitro is returned into the uterus. Usually, a small tube called “a catheter” is used to transfer the fertilized egg under ultrasonic guidance. If the endometrium cannot readily accept the fertilized egg, the egg is cryopreserved and transferred into the endometrium at a later and more appropriate point of time.


Catheter used for transfer

A fine soft catheter of size 2 French made of silicone is used to transfer the embryo into the endometrial cavity.

Single Embryo transfer

Kato Ladies Clinic (KLC) has been attempting to reduce multiple pregnancies for many years now. At present, only one embryo (fertilized egg) is returned into the uterus at a time in 100% of the cases. In Kato Repro Biotech Center, we will adopt the KLC way. >>more read

Treatment of endometrial abnormalities

Abnormalities in the endometrium can disturb implantation of the embryo into the wall of the uterus. If any endometrial abnormality is found, we treat it before embryo transfer using a simple and effective method, to make sure that the uterus is in the optimum condition to facilitate implantation.

Embryo transfer during the luteal phase

It is desirable to transfer the cryopreserved embryo into the uterus at a time when the uterine environment is most favorable. We make it a rule to conduct embryo transfer after taking measures not only to improve the endometrial condition but to properly control hormone levels that are favorable for the establishment of pregnancy.

Vitrification

Eggs and embryos that cannot be readily utilized are cryopreserved. With the cryopreservation technique adopted at our clinic, eggs and embryos at any growth stage can be cryopreserved with a high survival rate. The cryopreserved fertilized egg is thawed and transferred soon after the uterus becomes ready to accept it.

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Fertility preservation of patients with malignant tumors

Patients with breast cancer who desire preservation of their eggs

It has been reported that females who receive anti-cancer treatment are likely to undergo arrest of their ovarian function (a condition akin to menopause) due to the adverse effects of anti-cancer drugs or radiation. Whether the female recovers from this menopause-like condition or enters permanent menopause is determined by multiple factors such as the type of treatment received, age at the start of treatment and so on, and we cannot say anything uniformly applicable to all cases.
However, if menopause occurs, ovulation does not occur, and the female is unable to become pregnant with her own egg, that is, she becomes infertile. Also for patients with breast cancer, it has been reported that treatment with some combinations of anti-cancer drugs involves the risk for induction of menopause. Meanwhile, following the recent increase in the survival rate of patients with breast cancer, thanks to advances in treatment methods, there has been an increase in the number of patients interested in preservation of their fertility after treatment of their breast cancer.

For preservation of fertility, studies have been conducted on two methods: (1) direct protection of the gonads, and (2) cryopreservation of the gametes (sperm and egg) or the fertilized egg (hereinafter called “embryo”). Among others, the technology for the latter, i.e., cryopreservation of egg/embryo, has been advancing rapidly under the recent progressive trends in assisted reproductive therapy, and has been applied for many patients.
Under the current guidelines prepared by the Japan Society of Obstetrics and Gynecology and the Japan Society for Reproductive Medicine, cryopreservation of embryos of married couples is acceptable as a means of preservation of fertility within the framework of infertility treatment. It is also acceptable to cryopreserve the sperm of unmarried males. No formal guidelines have been published from any of these two societies concerning cryopreservation of eggs of unmarried females.
Thus, unmarried females are not covered by infertility treatment, as a rule. However, considering that the technology for egg preservation has already been established, our clinic applies cryopreservation of eggs also from unmarried females with breast cancer on the basis of the Clinic president’s policy of meeting the desires of patients about fertility preservation.

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New ART (Assisted Reproductive Technologies)

(Instead of Human genomic research projects) Stem cell therapy Adipose tissue derived stem cells obtained from patient’s tissues will be utilized for the purpose of treatment of infertility and other acute degenerative diseases as well as for rejuvenation and reconstructive surgery. Under strict aseptic technique, minimal amount of the patient’s own adipose tissue are collected by lipoaspiration. Mesenchymal cells found in the stromal vascular fraction are harvested and cultured and may be used to treat various conditions and illnesses which may respond to stem cell infusion. This is an emerging form of treatment and numerous studies have shown its benefit. Clinical uses of mesenchymal stem cells are in autoimmune hearing loss, multiple sclerosis, polymyositis, atopic dermatitis, rheumatoid arthritis, muscular dystrophy, diabetes mellitus, critical limb ischemia, acute myocardial infarction, and cardiomyopathy. Further studies will be conducted to maximize the potential of this treatment method.

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