How We Think about Ovulation Induction at Our Clinic

Here at Oak Clinic, we offer two courses for proceeding with ovulation induction.
“Natural”/“Body-friendly” IVF and “Active” IVF. From our many years treating patients, our approach is one of tailoring the treatment to each individual patient.
Therefore, before the oocyte pick-up cycle begins, we will devise a plan that suits each patient, based on one of these styles or the other.
Both courses offer painless IVF procedures.

Even for patients who can grow multiple oocytes, not all oocytes can be fertilized.
For example, some oocytes may be immature or have other obstacles.
Additionally, some patients do not respond well to stimulation and many follicles may not grow despite daily injections.
In cases like this, it is less burdensome to collect oocytes with a relaxed, natural cycle.

In order to do so, equipment and expertise like what we have at Oak Clinic is required to quickly perform hormone tests and collect the oocyte(s) upon release.
If this is not done smoothly and the oocyte is missed, it may be necessary to wait another month.

In "Active" IVF, the ovaries are actively stimulated by injected medication, in order to produce as many oocytes as safely possible.
This is a popular method, because many oocytes can be collected at one time, rendering overall treatment more efficient.
This is especially useful for those who are older, who have a decrease in ovarian reserve, and those who wish to adjust their oocyte pick-up date (by 1-2 days) due to their busy lifestyle.

Further reasons for popularity are as follows:

Recently, the HMG-MPA method (which uses oral medication for ovulation suppression) and the "short" method are very popular.
One of the advantages is that you can start at any point in your menstrual cycle, using our "random start" style.
For this reason, it is particularly enjoyed by patients who want to freeze their oocytes urgently, such as before cancer treatment.
The HMG-MPA method is also good for reducing the risk of OHSS.

An overview of IVF can be found here.

We are prepared to relieve the pain during oocyte pick-up as much as possible.

①Oocyte pick-up needle

At our hospital, the thickness of the oocyte pick-up needle is adjusted according to the number of follicles.
Some people believe that the thinner the needle, the less pain there is, but the pain of needle insertion is very brief.
On the other hand, a thinner needle takes a longer time to collect the oocytes, which may also cause discomfort.
Therefore, balance is necessary.
Generally speaking, the needle used maybe 21 gauge to 19 gauge.

② Anesthesia

In the case of a natural cycle, some facilities may collect oocytes without anesthesia due to the small number of developing follicles.
However, there is no getting around the fact that oocyte pick-up without anesthesia is a painful process, no matter the number of follicles.
The ovaries are located in the abdomen, so the needle must pass through the vaginal wall to reach and pierce the ovaries.
The vaginal wall in particular is very sensitive to pain, so local anesthesia is used to eliminate this pain in a similar way as a dentist might use anesthesia on a patient’s gums.
As the ovary itself is an organ and is impacted by systemic medication, pain associated with the ovary can be greatly relieved by inserting a suppository in advance.
It also works well when there is pain after the oocyte pick-up, not only during.
In addition, short-acting intravenous anesthesia is used to reduce or eliminate the tension from pain during oocyte pick-up, which would otherwise increase discomfort.
It also prevents the patient moving the body too much, which would make it harder to collect oocytes.

The time required for oocyte pick-up is about five minutes, so only a small amount of intravenous anesthesia is necessary. Most patients sleep through the procedure.

③ Reassuring environment

There are individual differences from person to person on how pain is experienced, but whether you have peace of mind has a great effect on the pain you feel.
We strive to reduce patient anxiety as much as possible, and you can always ask us any questions you may have.
In addition, on the day of the event, the nurse, doctor, and embryologist will each introduce themselves and confirm their identity before oocytes are collected.

The long agonist method of ovulation induction has become the world standard.
There has been a long debate about whether the long method or the short method is better, but as for the success rate, randomized controlled studies have indicated that the long method has some advantage overall, but only very slightly.
However, this is not always our first choice.

Reasons for this:

Historically, the conventional method was to suppress ovulation with an agonist (mainly nasal drops for the short method/long method) and collect oocytes, but antagonists that can temporarily suppress ovulation have since entered use, around ten years ago.
Until the current formulation was developed, however, strong side effects rendered it unpopular.
(New formulations are gentler.)

In the stimulation cycle, use starts on the sixth day.
At the beginning of formulation, it was reported that the quality of oocytes collected by antagonist use was better than that of agonists, but developments since then have rendered the quality of oocytes the same by either method.
It is the same at our hospital.

With antagonists, there is weak pituitary suppression and the effect is more temporary.
On the other hand, there is more risk of spontaneous ovulation.
So, for example, when there are several follicles with different sizes (some of which are growing slowly) the agonist method firmly suppresses ovulation until all follicles are sufficient size.
Then you can wait for the development of small follicles.

However, with the antagonist method, it becomes difficult for large follicles to ovulate, so you cannot wait for too long.
As a result, there are cases where the agonist method may be able to recover more oocytes.