General Infertility Treatments Now Available

Social and insurance-related considerations

Before discussing medical issues, we would like to touch on some social and insurance-related points.
Infertility treatment can currently be provided under the national health insurance system. Under health insurance, “infertility treatment” refers to medical care that supports having a child with your partner. For married couples, there is generally no issue. However, in the case of unmarried couples who wish to receive medical intervention, it is a prerequisite that, if pregnancy occurs, the male partner—who will be the child’s father—intends to raise the child. In addition, before starting treatment, we must confirm that neither partner is legally married to someone else (for example, by checking the family registry).
Within the framework of health insurance, tests and treatments are covered only when they are provided on the premise of pursuing pregnancy.
On the other hand, if you “do not necessarily want a child right now, but would like to check your fertility potential,” testing cannot be performed under health insurance, regardless of whether you are married or unmarried. However, such testing can be offered as self‑funded (out‑of‑pocket) care.
At our clinic, we provide a wide range of examinations as part of preconception care—that is, health care in preparation for a future pregnancy—on a self‑funded basis. Many people have already undergone these tests and consulted with us, so please feel at ease in visiting the clinic.

When aiming for pregnancy

The World Health Organization (WHO) has reported that the probability of pregnancy in couples who have regular sexual intercourse without contraception is about 80% within one year and 95% within two years. In other words, if regular intercourse is taking place, aggressive infertility treatment is often not necessary.
However, it is not always clear what level of intervention is needed and what is unnecessary. Our clinic does not focus on aggressive infertility treatments. Instead, we recommend treatments that are as close to natural conception as possible. We provide detailed guidance on timing and frequency of intercourse, and for couples who still cannot achieve pregnancy through intercourse alone, we offer intrauterine insemination (IUI).
This approach is based on WHO data indicating that most couples should be able to conceive without extensive testing or highly invasive treatments.
We understand that some people wish to undergo more aggressive infertility treatment or advanced testing. There are more than 600 infertility clinics throughout Japan, and although many advertise themselves as “cutting edge,” it is difficult for the general public to judge which facilities are truly reliable.
For patients who wish to proceed with more active infertility treatment and advanced testing, we refer them to our partner facility, Denentoshi Ladies Clinic, located a 3‑minute walk from Azamino Station in Yokohama.

Causes of infertility

According to data from the Japan Association of Obstetricians and Gynecologists, among couples who have difficulty conceiving, approximately 33% of causes are male factors, 21% ovarian factors, and 20% tubal factors. (These figures are based only on couples who are unable to conceive.)
1) Male factors
Typical male factors include:
• Oligozoospermia – low sperm concentration below the reference range
• Asthenozoospermia – poor sperm motility (low percentage of moving sperm)
Some men show large day‑to‑day variation in semen parameters, while others show relatively stable values. If a semen analysis does not meet reference values, the test should always be repeated 2–3 times.
There is also a self‑funded test called the sperm DNA fragmentation index (DFI), which cannot be done under health insurance. It has been reported that when sperm are exposed to strong oxidative stress, their DNA becomes fragmented, and this can be quantified. Generally, the higher the DFI, the more difficult natural conception is thought to be.
At our clinic, before starting infertility treatment, we recommend that the male partner undergo infection screening, semen analysis, and DFI testing as part of preconception care. If semen parameters are poor, we will discuss possible oral medications, supplements, and lifestyle modifications with the male partner.
2) Ovarian factors
“Ovarian factors” may be an unfamiliar term. The most common issue is ovulatory dysfunction.
If ovulation is impaired, regular monitoring is required to see whether you are able to ovulate properly on your own. Because hormone balance plays a major role, detailed hormone testing is essential. In women, hormone levels differ between the follicular (low‑temperature) and luteal (high‑temperature) phases of the cycle, so a single blood test is not sufficient. We perform blood tests at several time points to check whether there are any abnormalities in your hormone levels.
a) Hormonal imbalance (including PCOS: polycystic ovary syndrome)
Even if a hormonal imbalance is found, there is no need to be overly anxious. Depending on the situation, we may use Chinese herbal medicines alone or in combination, clomiphene citrate, or low‑dose gonadotropin therapy (FSH injection) to promote appropriate follicular development, then induce ovulation with hCG injections, and supplement progesterone after ovulation if your luteal function is insufficient.
b) Ovarian insufficiency / diminished ovarian reserve
Ovarian insufficiency means that the stock of eggs in the ovaries is reduced. If there are not enough eggs remaining, questions naturally arise such as “When might menopause occur?” Premature menopause does occur in some women, so if you are concerned about your fertility, we recommend hormone testing at an early stage.
Testing is done in a natural cycle (without medication), usually on days 2–4 of the menstrual period, with both transvaginal ultrasound and blood tests. Among the blood tests, the values of FSH (follicle‑stimulating hormone), LH (luteinizing hormone) and E2 (estradiol) are particularly important.
Under health insurance, in the context of infertility treatment, AMH (anti‑Müllerian hormone) testing is also covered. AMH is a marker of ovarian reserve and indicates roughly how many eggs remain compared with the average for your age. However, as noted earlier, if you are not starting “infertility treatment” immediately but simply wish to know your fertility potential, AMH testing is considered self‑funded.
If FSH levels are high during menstruation or if AMH levels are low, it may not be appropriate to spend time solely on intercourse guidance or IUI. Imminent menopause may be a concern, and it could be necessary to aim for pregnancy promptly. In such cases, even if natural conception is desired, in vitro fertilization (IVF) may need to be considered without delay. When that is the case, we will refer you to Denentoshi Ladies Clinic, our partner facility.
3) Conditions affecting both ovarian and tubal factors
Here we discuss uterine fibroids and endometriosis (adenomyosis, ovarian endometrioma or “chocolate cysts”).
a) Uterine fibroids
Uterine fibroids are usually evaluated by transvaginal ultrasound to assess their size. When fibroids are large, we recommend MRI to confirm that they are truly benign fibroids and not malignant uterine sarcomas.
If MRI suggests a benign tumor but it is large, the fibroid itself may decrease the chance of pregnancy. In such cases, when you are aiming for pregnancy we may refer you to an affiliated hospital for surgery (myomectomy: removal of the fibroid only). If malignancy is suspected, we will promptly refer you to our partner or university hospital for further evaluation and treatment.
b) Endometriosis (adenomyosis, chocolate cysts)
i) Adenomyosis
Adenomyosis is a type of endometriosis that develops within the muscular wall of the uterus. When adenomyosis is still small, priority is usually given to trying for pregnancy. We monitor tumor markers related to endometriosis with blood tests as needed.
As adenomyosis grows, menstrual bleeding may become very heavy (menorrhagia). In such situations, MRI is indicated, so we will arrange MRI imaging. If heavy bleeding continues and causes anemia, treating adenomyosis becomes a higher priority than attempting pregnancy. Depending on the case, treatment may consist of medication or injections, and in some cases surgery. We will discuss the options with you and decide on an appropriate treatment plan together.
ii) Ovarian endometrioma (“chocolate cyst”)
A chocolate cyst is an endometriotic cyst that forms within ovarian tissue. When it is small, trying for pregnancy is usually prioritized. As with adenomyosis, we use blood tests for tumor markers associated with endometriosis.
If a chocolate cyst becomes larger, the risks of abdominal pain, cyst rupture, adhesions, and malignant transformation increase. In these situations, MRI is necessary, and we will arrange MRI imaging. When symptoms such as abdominal pain appear or the cyst grows, treatment of the chocolate cyst becomes more important than attempting pregnancy. Depending on the case, we may use medications or injections, or surgery (cystectomy) may be recommended. Management is case‑by‑case, and we will decide on treatment together with you.
4) Tubal factors
Tubal factors refer to situations where the fallopian tubes are blocked, preventing sperm and egg from meeting and thus resulting in infertility.
The most common causes of tubal obstruction are past infections such as chlamydia or gonorrhea. Advanced endometriosis with large chocolate cysts can also lead to inflammation and adhesions that block the fallopian tubes.
If you have such a history and are concerned about tubal patency, a hysterosalpingography (HSG) test is required. Our clinic does not perform HSG. Because patients with the above history have a risk of peritonitis during HSG, we refer them to Denentoshi Ladies Clinic, an infertility specialty clinic and our partner facility, for both the test and subsequent treatment.

Infertility care at our clinic – our concept

Rather than “infertility treatment” in the narrow sense, our clinic focuses on supporting pregnancy.
We aim to help people who do not necessarily need highly aggressive infertility treatment—those who are likely to conceive naturally but who may require only minor support, such as fine‑tuning hormone balance or improving slightly reduced sperm quality. Our goal is to provide the support needed to connect such individuals and couples to successful pregnancies.
Of course, there are also patients who, medically speaking, do require more intensive infertility treatment. However, based on WHO pregnancy rates, about 20% of couples do not conceive within one year and have an identifiable reason; this implies that many others should be able to conceive without aggressive interventions.
Through general evaluations, we will identify:
• those for whom active infertility treatment would be beneficial, and
• those who, based on preconception care, would be better served by receiving more intensive treatment in the near future.
For such patients, we will explain the reasons clearly.
As noted, Japan has more than 600 infertility facilities advertising advanced care, and it is very difficult for the general public to judge which ones are truly reliable. Therefore, for patients who wish to undergo active infertility treatment or advanced infertility‑related testing, we refer them to Denentoshi Ladies Clinic, our partner facility located a 3‑minute walk from Azamino Station in Yokohama.

Infertility care and pregnancy support at our clinic

1) Timing therapy
“Timing therapy” refers to detailed guidance on sexual intercourse.
In each menstrual cycle, your eggs grow, ovulate, and your basal body temperature shifts from the low phase to the high phase. Timing therapy is more than simply advising that intercourse should take place around ovulation in every cycle. There are specific techniques and strategies involved, and we offer guidance to support natural conception as much as possible.
2) Intrauterine insemination (IUI)
In IUI, the male partner provides a semen sample in the morning, usually before work. Either the woman herself or the male partner brings the sample to the clinic. The semen is then processed (washed) and the prepared sperm are returned into the woman’s uterus at the time of ovulation.
Here as well, there are important techniques we use to make the procedure as close to natural conception as possible.
One major advantage of IUI is that it allows us to monitor the male partner’s reproductive health—specifically, sperm condition—on a cycle‑by‑cycle basis. We will discuss with you and your partner whether or not to proceed with IUI and how often.

一般不妊治療の開始について

2025年5月より、聖マリアンナ医大産婦人科准教授の杉下陽堂医師の監修、指導のもと、

一般不妊治療を開始する事となりました。

女性のみならず、パートナーの男性の方のプレコンセプションケアについても行います。

ご希望の方は受付までご連絡ください。

杉下陽堂医師の特別診療、外来診療時間は以下の通りです。

7月19日(土)9-15

8月23日(土)9-14

杉下陽堂医師の外来診療以外でも、竹島医師が基本的な指導を行います。

気軽にご相談ください。

Finally

We understand that it may be difficult to fully grasp everything explained above.
At our clinic, we aim to proceed with treatment using the body’s natural abilities as much as possible. If you are interested, please feel free to visit us for a consultation.
Please note that we do not accept male patients coming alone. Our basic policy is that women are the primary patients, and we provide examinations and treatment for their partners within that context. We appreciate your understanding.