Center for Reproductive Medicine
Our Medical Services
In Japan, the birth rate has been declining at a speed without parallel in the world. In this environment, it has been reported that more than 10% of all couples have not been successful in achieving pregnancy or have had multiple miscarriages despite their wish to have children. Taking comprehensive measures for such couples is considered to be not only a medical concern, but also an important issue in terms of countermeasures against the declining birth rate.
Based on this concept, we have established the Center for Reproductive Medicine at the initiative of the Departments of Urology and Obstetrics & Gynecology, taking into account the recent growth in social needs for the treatment of infertility and the inability to carry a pregnancy to full term. We are working with the help of the Department of Pediatrics, the Comprehensive Perinatal Care Center, the Department of Pediatric Surgery, and staff of the Department of Genetic Counseling for perinatal management after pregnancy and genetic counseling. Additionally, particularly in order to treat infertility and the inability to carry a pregnancy to full term for patients with underlying diseases, we have developed a system in which we can collaborate with all medical departments in an organic and integrated way.
Our Special Features
In the Center for Reproductive Medicine, a reproductive medicine team centering on specialists in reproductive medicine and including embryologists and nurses provides medical services. Furthermore, since we work closely with other departments while taking advantage of being a university hospital, patients can receive a wide range of specialized care.
For women with various diseases who wish to become pregnant (infertility with concomitant diseases)While providing multidisciplinary treatment in collaboration with other departments, we are searching for ways to increase the possibility of pregnancy for patients with a wide range of diseases (complications), including medical conditions, urological diseases, gynecological diseases, genetic disorders, post-organ transplantation, etc. In order to ensure safe pregnancy and delivery as much as possible, it is important that the patient's complication is stable prior to becoming pregnant. Patients can continue to visit our department for the physical examination of pregnant women after they become pregnant. We will provide constant support and care for the treatment of infertility, pregnancy, and delivery through a strong collaboration with other departments.
For men with diseases or conditions associated with infertility who wish to have children (male infertility)Causes of male infertility, including oligozoospermia, azoospermia, and asthenozoospermia, often require specialized care by urologists. Of the patients who need advanced reproductive medicine such as in vitro fertilization and microinsemination, patients with oligozoospermia or azoospermia will have to have their sperm collected by urological surgery. In such cases, the Departments of Urology and Obstetrics & Gynecology work together in a timely manner to provide treatment after obtaining sufficient informed consent.
For patients who will need surgical procedures for the treatment of infertility (reproductive surgery)With regard to diseases and conditions associated with infertility (e.g., congenital anomalies of the uterus, benign tumors such as uterine fibroids and endometriosis, cervical stenosis, Caesarean scar syndrome, etc.) that may require a surgical procedure, we review whether or not we should really proceed with surgical therapy, and if it is determined that we need to, we will actively carry it out. As surgical procedures are performed in the same facility, the preoperative instructions, tests, and resumption of infertility treatment after surgery will be carried out smoothly.
For patients who wish to have children pre- or post-treatment of cancer, etc. (treatment to preserve fertility)In cases where anticancer or radiation therapies are performed to treat cancer, connective tissue diseases, and so on, the function of the testes or ovaries may be negatively affected, and it becomes less likely to successfully achieve pregnancy after such therapies. We are trying to provide treatment to preserve fertility (the ability to become pregnant) for such patients with medical justification. We actively administer fertility preservation treatment for not only adults, but also for pediatric or young patients with cancer, together with the Departments of Pediatrics, Pediatric Surgery, and so on. Providing fertility preservation treatment is possible only in cases where the attending physician working on the primary disease determines that preservation treatment can be considered. Thus, we will provide it in close collaboration with the attending physician.
Our hospital performs the following procedures based on the patient's request: sperm freezing for men; and fertilized egg freezing, egg freezing (unfertilized egg freezing), and ovary freezing for women. The hospital also operates as a registered treatment facility by working in partnership with oncofertility networks.
For women diagnosed with impaired ovarian function (ovarian dysfunction)The main functions of the ovaries are to maintain health and to be in charge of pregnancy and delivery. Patients with ovarian dysfunction may experience irregular menstrual cycles or develop amenorrhea because the ovaries themselves become smaller and cannot secrete ovarian hormone. Although ovarian hormone replacement therapy can result in having menstrual periods and complement the function of maintaining health, it may be difficult to get pregnant in some cases, because such therapy can cause egg depletion. The function of the ovary can be impaired even in young people (juvenile ovarian failure), so patients should start active infertility treatment as early as possible for pregnancy and delivery.
For patients who are concerned about complications or oral medications for the treatment of infertility (counseling)We think that it is necessary for patients to fully understand their medical condition and the medications they will take in advance so they can undergo fertility treatment to become pregnant with peace of mind. It is also important to initiate a pregnancy when the patient's medical condition is stable. We will provide counseling to patients about the mutual effects of pregnancy and complications, in conjunction with testing and treatment for infertility. Our hospital has been designated as one of the hub hospitals for the Japan Drug Information Institute in Pregnancy since April 2019. Based on the information provided, patients can consult with us about medications and effects on pregnancy, etc. (by appointment only; patient's co-payment will be separately required).
Although it is a feature of our hospital that we can provide multidisciplinary treatment for patients with complications, etc. as described above, we also provide treatment for people who do not have any complications. We provide comprehensive and careful support, so please feel free to consult us if you are considering fertility treatment to become pregnant.
Our Main Treatment Policy
Regarding treatment for infertility and the inability to carry a pregnancy to full term, both spouses (partners) need to receive care rather than involving only the woman. Because it is thought that male factors contribute to almost half of infertility cases, it is necessary for a couple to undergo treatment together. If the cause preventing pregnancy is found from test results, etc., we will treat it based on the results. At the same time, fertility treatment will be provided. We ensure that all patients are informed about and understand the reasons for and adverse effects of testing and treatment before we proceed with treatment.
General reproductive treatmentBased on age, ovarian function, findings of seminal fluid, patient preferences regarding pregnancy, etc., we perform procedures such as timing treatment, artificial insemination, in vitro fertilization and embryo transfer (VF-ET), and intracytoplasmic sperm injection (ICSI).
Male infertilityMicrosurgical testicular sperm extraction is performed for nonobstructive azoospermia, which is a severe infertility factor. In addition, microsurgical subinguinal varicocele ligation, in which a microscope is used for varicocele surgery, has been producing good outcomes without many adverse effects. Our hospital also performs this procedure, as an increasing number of couples are interested in it. We also actively perform percutaneous coil embolization of varicocele treatment for patients who had recurrence after undergoing varicocele surgery in another medical facility. Furthermore, our hospital works on male infertility associated with cancer treatment. At any time, we provide consultation services on ejaculatory nerve-sparing retroperitoneal lymph node dissection against progressive testicular tumors, sperm preservation prior to chemotherapy, and so on.
In vitro fertilization and embryo transferIn this fertility treatment method, eggs are directly taken out from ovaries (egg collection) and fertilized by sperm in a lab. After the fertilized eggs have developed into embryos, they are transferred to the uterus (embryo transfer). The process or condition of the eggs and insemination cannot be observed with general tests for infertility, timing treatment, or artificial insemination. They can be evaluated only by direct observation outside the body through in vitro fertilization and embryo transfer. Thus, this treatment method will come with examinations or tests. Methods to stimulate the ovaries to produce eggs include short protocols, long protocols, antagonist protocols, random start protocols, etc., and we will recommend optimal approaches tailored to the individual patient.
- Ovulation factors: We induce ovulation with oral medication and injections. Follicles are measured by ultrasound as appropriate.
- Fallopian tube factors: Other than surgical therapy, in vitro fertilization and embryo transfer may be performed as needed.
- Uterus factors: We perform hysteroscopy, transvaginal ultrasound, or MRI studies, and provide therapy.
- Male factors: Urologists in our hospital examine patients, conduct tests, and administer treatment (endocrine testing, chromosome analysis, and surgical therapy).
- Other factors: Treatment options including surgical procedures are reviewed, depending on the medical condition, such as uterine fibroids and endometriosis.
- Unknown causes: Treatment is administered in a stepwise manner, which may include advanced reproductive medicine involving in vitro fertilization while taking into account age, ovarian function, etc.
Inability to carry a pregnancy to full termTreatment is provided based on the results of appropriate investigation into causes and current studies by the Departments of Urology and Obstetrics & Gynecology. In addition, patients are asked to receive genetic counseling at the Department of Genetic Counseling as needed. We also work together with clinical psychologists. For patients who visit our hospital to receive care, we will provide treatment while talking with them about their feelings, thoughts, life, and so on at their request.
Outcomes of treatment (pregnancy)2020
Preimplantation genetic testing for aneuploidy (clinical study of PGT-A)Preimplantation genetic testing for aneuploidy (PGT-A) is performed on embryos (fertilized eggs) obtained through assisted reproductive technologies. A few cells from the part of the embryo that will become the placenta are biopsied to detect chromosomal aneuploidy before transferring the embryo to the uterus. Osaka University Hospital has been approved and registered as a cooperating institution participating in PGT-A clinical research. For more details, please visit the website of the Department of Obstetrics & Gynecology of Osaka University Hospital (Center for Reproductive Medicine): http://www.med.osaka-u.ac.jp/pub/gyne/www/html/info04.html.
Points to Note for ReferralReferrals are accepted at the Urology and Obstetrics & Gynecology outpatient clinic. Please try to make an appointment via the Patient Support Center. However, if you need to visit us for an urgent case, such as fertility preservation treatment, you can contact us directly. We will respond as soon as possible.
Information for Outpatients
|First visit||8:30 am to 11:00 am|
|Revisit||8:30 am to 11:30 am|
|Revisit with appointment||8:30 am to 3:00 pm|
※First-time visitors to Osaka University Hospital must have a referral from a physician.
Outpatient consultation days
Monday to Friday
Saturdays, Sundays, Holidays New Year’s Holidays: Dec. 29 to Jan. 3