Pioneer of infertility treatment. Covering the needs of infertility from various tests 
to IVF/ICSI’s Advanced Reproductive Technologies.

How We Think about Ovulation Induction at Our Clinic

First of all in principle, we think that it should be something tailor-made and suited to each individual’s situation.  However, there is a great value on the points of safety and success rate of going though the long years of protocol.  But, we believe that the success rates will be heightened additionally by responding to and arranging various situations on top of that.

 

 

Stimulation Method, Natural Method or Low Stimulation Method

 

In regards to the ovulation induction of in vitro fertilization, the data that we can trust is the data coming from western countries and centering out of America.  In western countries, they prospectively consider and analyze the many cases at large-scale IVF centers.  Therefore, when it comes to the patients coming in, “You will have the long method” and “You will have the short method” are at random, and the one equal method that is chosen by everyone will be the way to take IVF.  Additionally, we generally don’t use Low stimulation method.  First, that is a situation based on protocol.

 

Japanese IVF is becoming quite a thing of considerable features.  There are many cases of low stimulation and moderate degree stimulation when compared to western countries, and we have the style of doing it like that, while checking on the follicle development we moderate.  In addition to the inside, it is also seen as an extreme way that we only use the ways devised by our own clinic.

 

At our clinic, from long years of experience, the basics of ovulation induction are tailor-made, and therefore, we feel that it is something that ought to be considered accordingly to each individual case.  That’s why before the oocyte retrieval period we build a plan geared to the patients.

 

However, the first selection is the Short Method or HMG-MPA Method, or in other words, the Stimulation Method.
The reasons are as follows:

  1. In the case of a Low Stimulation or Natural Method oocyte retrieval, there are many cases where the potential of oocyte retrieval cancellation from ovulation and vacuolation, and fertilization and splitting not occurring in the cases where a transplant can not take place when compared to the Stimulation Method.
  2. In the case of Low Stimulation or Natural Method, because the number of retrieved oocytes is few there is no surplus freezing and it will be necessary for continuous cycle oocyte retrieval.  The burden to the body, and in terms of the results, the financial burden is more of an increasing thing.
  3. In the case where one is thinking about a second child, if one is in the upper 30’s, it would be advantageous to have surplus embryos frozen.

 

 

Short Method or Long Method?
~When compared with other methods (Short Method, etc.), is the Long Method truly better~

 

Actually, it is the Long Method of Agonist Method that is the worldwide standard. Whether either Long Method is good or Short Method is good has been discussed from long ago, but the success rate is the result that the Long Method is slightly better than RCT (random controlled study) and there are a lot of reports (though there are reports that it does not change very much in terms of fertility rate of live births).

 

However, we dare to adopt the Short Method or HMG-MPA Method as a first choice.

 

As a reason, 

  1. Long Method requires contraception use from the previous cycle. To use an agonist from the middle stage in the high temperature phase of the previous cycle means that contraception is necessary in the previous cycle. It is unnatural to have contraception by those who are infertile because they are infertile, and they take away opportunity of pregnancy once. Moreover, in order to confirm the high temperature phase, it is necessary to measure the basal body temperature in detail. Furthermore, if contraception does not work and pregnancy is achieved, you will use unnecessary drugs in the early pregnancy.
  2. Compared with the Short Method, the Long Method has no flare up effect and strong pituitary suppression, requiring a large amount of HMG injection.
  3. It is said that it is easier to adjust the oocyte pick-up (OPU) date or adjustment of the injection volume makes it easier to avoid OHSS (especially PCO) because the long method is not flare up and strong pituitary suppression, but even with the short method in the case of the first OPU, sufficient control can be done by confirming the number and size of the follicles as early as the 6th day of the menstrual cycle.
  4. However, this does not mean that, "Short Method is absolutely better" or that, "Long Method is not good", but that rather they are as a result of thinking about methods suitable for each patient, the Short method is increasing as a result of that reality.  As a reality, those who receive IVF are more likely to be in an age range from late thirties until around the forties and being in a starting condition that the ovarian reserve capacity and the percentage of good oocytes are slightly lowered, due to circumstances of the couple's work, etc., that it's better to be able to adjust the OPU to 1 or 2 days, and for couples wanting to secure as many frozen oocytes as possible.

... And the list continues.

 

 

Agonist or Antagonist (Cetrotide®) or MPA?
~Methods of Ovulation Suppression~

 

Although the use of Agonist (Mainly nasal medicine, used for Short Method and Long Method) was a conventional method to retrieve oocytes by inhibiting ovulation, the story of the use of Antagonist, which can inhibit ovulation for a brief time, came around about 10 years ago.  Until the development of the formulations we have today, the side effects were very strong and were hardly used.

 

From the 6th day of menstruation in the stimulation Method, it will start being used.  At the time when early on formulations came out, there were reports that the quality of the oocytes were better with the use of Antagonist more so than with Agonist, but nowadays, it is said in regards to the quality of the oocytes that there is no change.  We, at Oak Clinic, are feeling the same way.

 

The good points of Antagonist are that the pituitary suppression is weak; it is temporary and will not prolong. 
On the other hand, because there is a risk of ovulation, for example, such as when there are various follicle sizes and are numerous follicles with slow development, because there is a suffice pituitary suppression with the Agonist Method, even if there is a good enough size of follicles, we can still wait for the development of the small follicles.  However, with the Antagonist Method, it will be trouble if large follicles are ovulated, so we can’t really wait.  Consequently although the suppression is strong, we can get more oocytes by means of the Agonist Method.

 

At our clinic, first we'll try the Short Method and in cases where 3 or fewer oocytes are collected, we'll weaken the suppression and in order to increase the number of oocytes collected we'll change to the HMG Cetro Method that is one way of the Antagonist Method. 

 

MPA (oral medicine) is also being used recently for the ovulation suppression method.  The advantage point of this method is that one can start (Random Start Method) taking this method at any point in the menstruation cycle.  Because of this, in the beginning it was used before treatment of breast cancer, etc., and for patients doing oocyte cryopreservation that didn't know how much time they would have before ovulation, but now is being used for the first choice.  There is also the advantage point that it is easy to avoid the risk of OHSS, even more so that the Short Method. 

 

 

Summary of Ovulation Induction

 

Method Development Control Ovulation Risk ET Cancel Cryopreservation Cancel OHSS Preliminary functional decline example Cost❈1 Cost until pregnancy ospital Visit❈2
Satisfactory
Satisfactory
Non
Non
Non
Non
Effectiv
Satisfactory
Satisfactory
Few
Short Method
HMG-MPA Method ×
Long Method
HMG Cetro Method
Clomifene®
Method
Femara®
Method
(Breast cancer ex. Is ○)
Complete Natural Cycle

❈1) The cost is only for that oocyte retrieval cycle.  In the case of low stimulation, because it may take several cycles until pregnancy, the total cost tends to be slightly lower with the stimulation cycle

❈2) As for the number of visits, that can be adjusted by means of self-injections.

 

 

 

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Oak Medical Group has been from the time we opened, supporting the many issues of women's health, building performance and trust, and not only here in Osaka, but centering in Kansai we are receiving patients from across Japan.
Especially with our infertility treatment, we are widely covering the various tests to IVF/ICSI's Advanced Reproductive Technologies.  Depending on the cause of the infertility, we are handling the treatment of each patient one by one.  If you have some concerns, please don't hesitate to consult with us.