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If you have not been able to achieve a pregnancy through IVF and/or ICSI at the other clinic, we will put into place a customized program depending onthe resultsof the first consultation called gthe strategy meeting with your doctorh. This is our unique relief program that is adopted after we have analyzed all the available data. The exact choices will be chosenon a case by case basis. Using this unique relief program, pregnancy often is achievable quickly, even after recurrent failures at other clinics.
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¡Acquisition of ovum program |
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This approach is taken for patients whose eggs do not develop normally, or fail to ovulate. If you are using suprecure, we will consider changing from the long protocol to the shortor ultrashort protocol. Furthermore we will adjust the amount of suprecure you use and regulate your pre-treatment hormone levels using low-dose oral contraceptive pills or prepare for your stimulation cycle following the Kaufmann method. Taking supplements like DHEA*1 or carnitine*2 may improve your ability to make normal eggs.. We may also suggest changing to an antagonist protocol or to try natural cycle IVF. We may try to improve blood flow to your ovaries by nutritional counseling,try to improveyour whole mind and blood flow by acupuncture and qigong or employ the gfertile stretchh methodology to help the important pituitary hormones easily reach your ovaries.
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*1 DHEA (Dehydroepiandrosterone)
DHEA is a hormone that is produced by the adrenal gland and can form a substrate for conversion into eitherr male or female hormones. It has been produced in your adrenal gland or gonad since you were born, ultimately being converted into testosterone (male hormone) or estrogen(female hormone). Circulating levels of DHEA are normally maximal between the ages of twenty and thirty and decrease gradually thereafter to a nadir of ~20% of adult peak levels when you reach your seventies. DHEA is an indicator of the balance of hormone loss as you age and is a commonly used supplement for anti-aging. Itfs use is banned by most sporting organizations and its use (and abuse) has recently been in the spotlight. There are several reports about its effects on fertility treatment. In one report DHEA wass administered at 75mg a day to a 43 years-old patient with reduced ovarian function.The authors reported much improved responsivity of the ovaries (Barad, DH & Gleicher N. Increased oocyte production after treatment with dehydroepiandrosterone. Fertil Steril 2005;84: 756.e1-3.)A second study involved administering DHEA at 75mg a day for an average of 17 weeks (7 to 42 weeks) to nine women with reduced ovarian responsivity (42 years old in average). The number of oocytes retrieved at pickup increased from 4.4 to 8.6 on average, and two of the eight women who receivedtransfer achieved a pregnancy (European Society for Human Reproduction & Embryology, 2005).
*2 L-carnitine
L-carnitine is aquaternary ammonium compound synthesized from the amino acids lysine and methionine. L-carnine helps the body burn fat. To achieve this thefat has to get into the mitochondria which is the gfat incineratorh in the cell. L-carnitine halps transport the fatty acids into the mitochondria (the bodyfsgincineratorh). This is a unique and essential operation that no other nutrients can do. Mitochondrial activety is thought to be indicative of a high-quality ovum or sperm, as it is needed to support cell division of fertilized egg, and protect the cell from attack by active oxygen free radicals. The amount of L-carnitine in the body peaks in your twenties, then decreases and become in short supply as you age. Taking L-carnitine properly will help you burn more fat improve energy levels,and as a result possibly increase your chances for pregnancy.
Click here to see detail AA Project (http://www.aaproject.co.jp/)
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¡Advancement of the embryo quality program |
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This is the program we use for patients with slow embryo division, where most embryos to not progress to become blastocysts, or are of low quality because of increased numbers of fragments in the embryo. As a first step, we change the culture media, then try to improve the quality of sperm, both of which willinfluence the quality of the embryo. If that does not work we consider induction of ovulation combined with the use of a GnRh antagonist protocol or even suprecure. As a further step we would try high purity medicines like recombinant FSH for ovarian stimulation. If that still does not work we might try the mitochondrial activation method*3 to see whether that may have an effect on delayed embryo division or poor quality embryos with excessivefragmentation. Finally, we might try to reduce the effects of oxygen free radicals by a number of approaches. One involves psychological counseling. A second approach involves changing the way the way you get your nutrition and increase the intake of foods that arase active oxygen radicals such as Vitamin-E.
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*3 Medicines for mitochondria active
Laennec(capsule, injection)
This was originally developed for improvement of liver function. But it also can have the effect of accelerating tissue respiration, improve blood flow, or activate metabolism. We use this expectantly to try to improve ovum quality A supplementaleffect on the endometrium, and possible improvements of implantation rates are additional possibilities.
ATP (adenosine triphosphate)
There are proteins, sugars and fats in the energy provided from outside cells in the body. ATP works as a component of the metabolism in the cell. In a similar fashion as Laennec, ATP canaccelerate tissue respiration, improve blood flow, or activate metabolism. We use ATP to improve oocyte quality, support cell division of the fertilized egg and, improvement of ovaian function.
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¡Program to improve implantation |
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This is for the patient who produces good or reasonably good embryos but still fails to achieve implantation. First of all, we carry out various tests to determine the cause of implantation failure. These exams determine whether 1)nutrition or oxygen doesnft reach the endometrium because of poor blood circulation to the ovary, 2)disturbed implantation of the embryo due to some immune factor, 3)the couplefs body constitution are trying to remove embryo by mistake as foreign matter (Ifm sorry but I do not understand this one?). All of the evaluations involve blood tests. If the results show any abnormality, we try to make it right before undertaking IVF. This approach alsoincludes treatments for lymphocyte immunity and antibody inhibition. We also can try blastocyst transfers or a two-step embryo transfer that has the potential toimprove the chance of implantation for the patient. Similarly, we can, add hormones or use Levitra suppository (we prepare specially), or low doses of aspirin to try to improve thin endometrium. We also carry out certain treatments for uterine atony and for uterine contractions . It is also possible to freeze all the embryos and replace them in a cycle where exogenous hormones are used to optimize the endometrial receptivity. . Additionally, we use psychological counseling and practice AT lessons to helpcontrol uterine contractions.
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| ¡IVF with oocytes matured in vitro |
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We were the first IVF center in Japan to successfully perform IVF with oocytes matured in. Using this technique there is no risk of of ovarian hyperstimulation syndrome (OHSS) because this procedure does not require any ovary stimulation by any fertility drug. This is the good choice for the patient with polycystic ovary syndrome who has heightened risks of ovarian hyperstimulation syndrome.
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In cases where the spouse presents with azoospermia, but having the ability to make sperm, it is feasible to extract sperm from epididvmis or testicle directly for an ICSI procedure. We have used this approach very successfully to help our patients achieve pregnancy.
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| ¡TMET ? Tibialis streak embryo transfer |
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This is another embryo transfer method that introduces the embryo directly to the uterus through the uterine muscle. Many patients will have a chance to get pregnant even though they werenot able to get pregnant by the conventional method.
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| ¡AHA ? Assisted Hatching |
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This method is use for disorders of implantation, especially disorders of the zona pellucid. This technique allows us to make it easier for the developing embryo to hatch (jump out of the zona). It involves creating a small hole or tear in the zona. It is an innovative technique for patients who fail to achieve implantationdespite having what appear to be good quality embryos.
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| ¡Blastocyst culture method |
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If you have a problem with implantation, we can carry out a method that involves cultivation of the embryo in specialized culture media for an extended period of time(5 to 7 days), followed by transfer of the blastocyst.
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| ¡Two-step embryo transfer |
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This involves leaving an embryo with the strongest possibility to reach blastocyst from all after two days of fertilization, and transfer of the second and third rate embryos. The theory behind this method is that the embryos transferred on day 2 work on the endometrim to make it more receptive to the blastocyst when it is introduced after 5 days. We carry out this procedure for couples where the cause of their previous failures appears to be due mainly to embryo inability to implant in theendometrium even though they have received fine blastocyst transfer.
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| ¡Mitochondrial activation method |
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In cases of low quality because of age, we can attempt to activate the mitochondria. In addition, we have found that this approach increasing the numbers of oocytes retrieved, even forpatients with impaired reaction to the stimulatory effects of the fertility drugs.
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Metoformin is a medicine used to treat insulin resistance in patients with diabetic hyperglycemia. PCOS (polycystic ovaries syndrome) is associated with elevated concentrations of androgen in the ovaries and often brings about ovulation disorders, OHSS, and degradation of quality of ovum. The useof Metformin for patients with PCOS has received a lot of attention overseasrecently since it does not appear to bring any benefits over use of clomiphene alone. However, we and others also have some patients that seem to have improvement as aresult of itfs usage.
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| ¡Endometrium improvement method by sildenafil encoplism |
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This is the method noticing intrauterine ischemia by contraction and use intrauterine ischemia inhibitor at embryo transfer to improve intrauterine circulation and possibly raise rates of implantation. Using this encoplism 2 to 4 times a day, it is said that it is absorbed directly and improves blood circulation and thickens the endometrium.
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| ¡r-FSH (recombinant FSH: trade name gFollistimh) |
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Injected medicines for ovarian follicle stimulation in general use (called FSH or hMG) were until recently all refined from the urine of postmenopausal women. The r-FSH is of higher purity (more than 99%) than urinary gonadotropins, and may also be more consistent.
This rFSH is superior in terms of purity and quality. You get more effect with less total dose, and it is now possible to recommend subcutaneous administration. Using rFSH increases the number of oocytes per retrieval and produces a higher quality of ovum and transferable embryos. However, it costs more per unit than urinary productsleading some to suggest that urine-derived products still represent a more cost effective.
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