IVF at Kato Repro Biotechnology Centre

Our first IVF attempt was at Kato in the Philippines. The clinic is located within an office building, Enterprise Towers, in Makati. There are two well known IVF centers in Manila: Kato and Carmi which is at St Luke’s Hospital in BGC. We chose Kato as its the cheaper option of the two. It also has the added advantage of being a specialised fertility clinic located in an office tower so we won’t get exposed to diseases as we would inadvertently be in a hospital setting.

Kato’s principle is to use as little medicines as possible. They work with the woman’s natural body rhythm to ensure a gentler approach. They also discourage multiples (twins, triplets etc) as they only implant one embryo at a time and counsel couples to use up all the embryos they produce.

Kato has two IVF protocols: the natural cycle IVF where no follicle stimulating hormones are used and therefore the cheaper option (costs about P160,000) and the minimal stimulation IVF where follicle stimulating hormones are used and therefore more expensive (P300,000++). The natural cycle IVF is an option for younger women who still produce good quality follicles during their monthly menstrual cycles. We underwent the minimal stimulation IVF as I am older and need some help to produce follicles.

The most distinctive feature of Kato’s IVF procedure is that they retrieve follicles and transfer embryos in two separate cycles. They said that this allows the chemicals from the follicle stimulating hormones to wash out first out of the woman’s system before the embryo transfer. For example, the egg was taken during the January cycle. The follicle(s) are fertilised and are then frozen once the embryos reached the 5th day. The earliest the embryos will be transferred will be during the February cycle.

Kato has a team of three lady ob-gyn doctors who do the consultations with patients during the initial visit and during follicle monitoring. These ob-gyns also personally do the ultrasounds to monitor the growing follicles so you may ask them questions on how fast your follicles are growing. Notwithstanding that there are several doctors in the team, the medical director, Dr Mendiola, is the only one who does the egg retrieval and embryo transfer procedures.

If you are going to Kato, be on time for your appointment. The waiting time can be very bad, the longest I waited was 2 hours to have an ultrasound. However they are trying to be more efficient now by having patients come in hourly appointments. As soon as you exit the elevator, the security guard will check your name and appointment and give you a card to give to the front desk.

Kato has an in house laboratory for all the blood tests. During the follicle monitoring stage, you have to undergo ultrasounds and blood tests. Your doctor will wait for the results of the blood tests before she will see you. It takes about 1-2 hours for the results to come out. Each appointment usually takes 4 hours to complete. You pay as you go, that is you pay only for the medicines and tests that you undergo each visit. I noticed that compared to private laboratories like Premier, their laboratory charges were less expensive. Doctors consultation was also cheap at P560 only. Where you pay big time are for the medicines and for the cost of procedures.

The nurses and staff at Kato were all very sweet. They will tell you patiently how to use your medicines. Consultation time with the ob gyns tend to be quick but they will gladly answer any questions you may have. Their ultrasound rooms have curtains hanging from the ceilings for your privacy. They also have nice insulated bags for the medicines, these are in purple which were so feminine looking. If you are a bit shy, be prepared for a male doctor during follicle retrieval and embryo transfer, and that there would be male embryologists inside the operating room.

After our initial consultation at the clinic, we were told to contact them again once my next menstrual cycle started. We informed the clinic on my day 1 by text message. We visited the clinic on day 2 for blood tests and ultrasounds. After ultrasounds confirmed that there were growing follicles, one of the ob-gyn doctors prescribed me follicle stimulating hormones: oral medicines for 5 days (days 2-6 of my cycle) and GonalF injections for 3 days (days 4-6). I was told to come back to the clinic on day 7 for ultrasounds to check how well the follicles were growing.

I injected myself on the tummy with the GonalF injections every morning of days 4-6 of my cycle. GonalF was changed to Menogon on days 7-8, also tummy injections. GonalF injections were easier to use because they came in pre-filled “pens” and the needles were very fine so they didn’t hurt so much. Menogon was more complicated as I needed to mix two vials of powder with one vial of water using disposable syringes. GonalF however was also more expensive than Menogon.

I had to go to the clinic for ultrasounds on days 2, 7 and 9. Finally I had the trigger shot Ovidrel (also self injected) on the evening of day 9. I had 5 dominant follicles based on my ultrasound, the largest measured 21mm. The amount of medication was much lesser than what was used at Lee Hospital in Taiwan. I only had to use 1 GonalF pen of 300iu, 2 Menogon shots and the final trigger shot Ovidrel at Kato.

My follicles were retrieved on day 11. Kato refers to the procedure as OPU (Oocyte Pick Up). My husband and I were asked to arrive at the clinic 7am. Kato’s recovery room is partitioned into cubicles separated by curtains. I changed into the operating gown and cap, and laid down in a bed to wait for my turn. There were about 6 women scheduled for retrieval that morning. As I only had 5 follicles, I did not need to be sedated. Women who had substantial number of eggs had to be put under general anaesthesia. While I was in the recovery room, my husband went to the andrology lab to give his sperm.

The recovery room had pink wooly blankets but lights were overhead so I just laid there with my eyes closed. When my turn came, I was lead to the operating room by a nurse. Inside the operating room, I had to lie down with my legs up in stirrups. I was given a stress ball to hold and a nurse stayed by my side to tell me what was happening during the procedure. There were a couple of big TV monitors on the walls and I was able to see the ultrasound images of when the catheter was inserted and then the needles sucking in the follicles.

I felt a slight discomfort during the procedure as I felt the catheter piercing my ovaries. Two pieces of gauzes were put in and I went back to the recovery room to rest. After about 30 minutes of rest I was told to go to the restroom and pull out the gauzes. The nurse inspected them and as there were no excessive bleeding, I could go home. I was told that some spotting was to be expected after egg retrieval but to come back immediately in case of bleeding.

We found out later on that the clinic managed to retrieve only 2 mature follicles. These follicles were fertilised with my husband’s sperm via ICSI (Intracytoplasmic Sperm Injection). We had two embryos initially from the two follicles, but only 1 made it to day 5. The embryo was frozen and stored. The embryo transfer will only happen the next month.

Upon the start of my next cycle, we informed the clinic of our intention to transfer that month. I visited the clinic on day 2 for baseline blood hormones and ultrasound. As we were not retrieving follicles this month, I did not have to take follicle stimulating hormones. I did have to undergo ultrasounds on days 2, 10 and 13 to check how my uterine lining was growing. The doctors decided that my transfer should be on day 17 of my cycle. I was given a nasal spray to use on day 10.

On day 17, we were asked to come to the clinic by 8am. Before the transfer was confirmed I had to have one last ultrasound to check that my lining was thick enough and a blood test to make sure hormone levels were correct for embryo transfer. Thereafter, the embryo was thawed and underwent laser assisted hatching to prepare it for implantation.

Embryo transfers were done at the clinic after lunch. Similar to follicle retrieval, the embryo transfer was done in the operating room. The ladies change and wait in the recovery room and when it was my turn for transfer, a nurse came and lead me to the OR. They had strict procedures for identification and you will hear your name and birthday said several times in the operating room. I guess this is to make sure that there will be no switching of embryos. I was able to see the ultrasound images on the screen when they placed the embryo in my womb. Afterwards they also showed the microscope image of the catheter when they check that it was now empty. Sometimes the embryo might get stuck in the catheter and they have to put the catheter back into the womb. It was very heartwarming to see the embryo being implanted in my womb and I whispered a prayer and a “welcome baby” to my embryo. I was given an ultrasound picture and a sheet of paper summarising how many follicles I had, how many embryos were transferred and how thick was the uterine lining.

After the transfer, I had to get up and walk back to my bed in the recovery room. I rested for about 30 minutes and then a nurse came and told me it’s ok to go. I was prescribed progesterone pills and suppository, and estadiol pills. Pregnancy test was scheduled one week later.

One thing I appreciate at Kato was that they are able to tell you if there is a pregnancy or not after just 7 days through a blood test. They check if hcg levels are high. If hcg levels were elevated then its considered a positive pregnancy test.

What happens during IVF?

IVF at Lee Womens Hospital, Taichung, Taiwan