Rohto Pharmaceutical, which has been supporting couples who want to conceive for many years, has been researching and developing Do-Test® hCG pregnancy tests andDo-Test® LH ovulation prediction tests, and they often feel that "correct knowledge about pregnancy is still not widespread" in society. Therefore, they held an "in-house fertility seminar" to deepen the knowledge of their employees. The lecturer was Dr. Sakae Goto, director of Goto Ladies Clinic (Osaka, Takatsuki). He explained the "mystery of pregnancy" from the perspective of an expert in infertility treatment and research.
Sakae Goto
Graduated from Shiga University of Medical Science in 1988 (completed clinical training in the Department of Obstetrics and Gynecology at Shiga University of Medical Science Hospital).
While striving to achieve pregnancy as naturally as possible, we also conduct advanced reproductive medicine treatments and research.
In 1999, he devised and developed the two-stage embryo transfer method, and in 2006, the SEET method. He has been involved in infertility treatment and research for approximately 25 years.
Why is pregnancy considered "mysterious"?
I meet many patients during my consultations. Among them, I feel that there are still many who have misconceptions about pregnancy, such as "intercourse on ovulation day is most likely to result in pregnancy" or "medical advances make it possible to get pregnant even at an older age." First of all, I want to convey the old saying, "A baby is a gift" and "Pregnancy is a mystical experience." With that in mind, I will now introduce the truth about pregnancy in detail.
According to the Japan Society of Obstetrics and Gynecology, "infertility" is defined as "the inability of healthy men and women who desire to conceive to become pregnant after one year of unprotected sexual intercourse." Many people might think, "Infertility after only one year?" In reality, it's not uncommon for couples to not conceive after about a year of marriage.
The reason lies in the mechanism of pregnancy. For natural conception to occur, the ovulated egg must be fertilized by just one of approximately 100 million sperm as it travels through the fallopian tube, and then implant in the uterus. (See diagram) While ovulation and implantation take about five days, the period when pregnancy is possible is from six days before ovulation to one day after. Incidentally, the probability of pregnancy from intercourse during this period is "30-50% for women under 29 years old." It peaks at age 26 and then gradually declines, with the pregnancy rate for infertile couples being said to be "about 2%" per cycle. From this data, you can really appreciate how miraculous pregnancy is.
In recent years, late marriages have become more common, and so have the number of older mothers. With celebrities giving birth after the age of 40 and "age-gap marriages" becoming popular topics, many people seem to think that "you can get pregnant and give birth even at an older age." However, in reality, the probability of getting pregnant decreases significantly after the age of 35, and drops even further after the age of 40. On the other hand, the miscarriage rate increases, and it is an undeniable fact that the probability of chromosomal abnormalities in eggs and genetic abnormalities in sperm also increases.
Commonly misunderstood "most fertile times"
Many couples who want to conceive as soon as possible try to "find their ovulation day and have intercourse at that time." However, this is not always efficient. According to one study, the time when intercourse has the highest chance of conception is "two days before ovulation," followed by "the day before ovulation." Also, since sperm live for about 36 to 48 hours, having intercourse every 36 to 48 hours starting 6 days before ovulation will further increase the chances of conception. Ideally, intercourse should occur about three times a week. That being said, for couples who both work or have long working hours and don't have much time together, it would be good if they could at least make time for each other around the time of ovulation.
If you're still not getting pregnant after trying these timing methods, please visit a clinic with your partner. Infertility can stem from a variety of factors, and it's said that the causes are roughly equal in men and women. Also, the chances of getting pregnant decrease after the age of 35, so if you got married after 35, it's a good idea to get tested early, such as through a clinic's "bridal checkup." After all, "you'll never be younger than you are today!"
What is actually done in "infertility treatment"
What is a test?
At the clinic, you will first undergo basic examinations over about a month, with 5-6 visits. These examinations will check for any problems with ovulation, fallopian tubes, or uterus according to your menstrual cycle, and will include tests such as the "post-coital test" (Huhner test) to check the number of healthy sperm in the cervical mucus after intercourse, and sperm collection tests for the male. Based on the results, a treatment plan will be developed that is as short and minimal as possible for the couple.
After basic examinations, traditional infertility treatment mainly followed a "step-up approach," sequentially trying "timed intercourse," "artificial insemination," and "in vitro fertilization/intracytoplasmic sperm injection." However, with the increasing age of women giving birth (the average age of first-time patients at our clinic is 37), it is not uncommon to try in vitro fertilization from the start. In some cases, we may return to artificial insemination after in vitro fertilization/intracytoplasmic sperm injection. We also take breaks and try timed intercourse, and we proceed with treatment flexibly, using ovulation induction drugs and hormone therapy as needed.
Now, let's go into detail about each treatment method.
First, "timing therapy" is a treatment that involves timing sexual intercourse to coincide with the day of ovulation. When ovulation induction drugs are used, the pregnancy rate per cycle is said to increase from the original approximately 2% to about 4-8%. However, this is data for younger women, and the effect is less likely to be seen in women over 40. Of course, there are exceptions, so it is not entirely meaningless.
Next, "artificial insemination" is a method in which a man's sperm is collected in a container, and only the healthy sperm are injected directly into the uterus. After that, the process from fertilization to pregnancy is the same as natural conception, and the pregnancy rate is said to be around 8-10%.
These two are what are called "general infertility treatments." Many people may feel that "the pregnancy rate doesn't increase as much as I thought..." Indeed, the older the age of the first consultation, the more likely it is that there are some underlying infertility factors. In such cases, treatment proceeds based on "in vitro fertilization/intracytoplasmic sperm injection," which will be introduced later.
In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are treatments in which eggs and sperm are collected from both the man and woman and fertilized outside the body. If there are no problems with the sperm, sperm are added to a container holding the eggs to achieve a certain concentration for fertilization (IVF). If the sperm quality is poor, sperm are injected into the eggs using a needle (glass needle) under a microscope for fertilization (ICSI). The embryo (fertilized egg) is then cultured to the blastocyst stage and transferred back into the uterus. If the embryo successfully implants, pregnancy occurs.
Don't hesitate, feel free to visit the clinic.
Let's go.
At our clinic, 484 patients achieved pregnancy through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in 2015 alone. Some people may feel ashamed of infertility treatment, but it is said that one in 27 babies born each year is conceived through IVF, so it is no longer an uncommon occurrence.
Furthermore, some people still seem to have the impression that "in vitro fertilization (IVF) is expensive and doesn't lead to pregnancy." At our clinic, the pregnancy rates for first-time IVF are "under 29 years old: 75%", "30-34 years old: 65.5%", "35-39 years old: 46.5%", and "40 years and older: 14.3%". As this data shows, the probability is not so low if you seek treatment earlier.
Another option is to freeze-preserve eggs. Younger eggs have a higher pregnancy rate, so if multiple eggs can be retrieved during egg retrieval, multiple embryos can be cultured and frozen. For example, it may be possible to "use fertilized eggs retrieved at age 34 and become pregnant again at age 37." Thanks to advances in cryopreservation technology, there is also data suggesting that frozen-thawed embryo transfer has a higher pregnancy rate.
In this way, we provide treatment every day with the hope that "as many couples struggling with infertility as possible will be able to conceive." If you are thinking, "I want to have children someday," even if you are not currently struggling with infertility, please visit our clinic as soon as possible.
—What did you think of the seminar given by Professor Goto? As a company that handles pregnancy tests and ovulation prediction tests, Rohto Pharmaceutical is working to disseminate accurate knowledge about pregnancy and fertility treatment, and to spread the idea that "fertility treatment" is not something "special" but something "normal."