ICSI with own oocytes and sperm Philippines

Management of the Follicular phase

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.