Sugiyama Clinic

Setagaya, Japan

Sugiyama Clinic

Setagaya, Japan
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Nakagawa K.,Sugiyama Clinic | Kuroda K.,Juntendo University | Sugiyama R.,Sugiyama Clinic | Yamaguchi K.,National Center for Child Health and Development
Reproductive Medicine and Biology | Year: 2017

Aim: An immune etiology for idiopathic recurrent miscarriage is an important issue because a fetus is allogenetically different from the mother. Type 1 T helper (Th1) and Type 2 (Th2) cells have important functions in immune responses and there is a general agreement that pregnancy is associated with Th2 cell dominance. The purpose of this case report is to establish the effectiveness of an immunosuppressive treatment for a patient who had 11 consecutive miscarriages despite several treatments, such as anticoagulation, that showed elevated Th1/Th2 cell ratios. Methods: This patient visited our clinic following 11 consecutive miscarriages between 2009 and 2014 that occurred between 5 and 8 weeks’ gestation. The Th1/Th2 cell ratio was evaluated after the 12th conception and she received an immunosuppressive treatment (tacrolimus; 1 mg/d). Results: The Th1/Th2 cell ratio was elevated after the 12th conception, but the patient miscarried, with a normal karyotype of chorionic villi despite the immunosuppressive treatment. After the 13th conception, she began receiving treatment with 2 mg/d of tacrolimus at 4 weeks’ gestation, which was continued until delivery. Conclusion: For recurrent miscarriage cases that show an elevated Th1/Th2 cell ratio after achieving pregnancy, immunosuppressive treatment with tacrolimus could be effective. © 2017 The Authors. Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.

Matsumoto Y.,Shizuoka City Hospital | Mori Y.,Shibukawa Clinic | Kageyama S.,Kageyama Urological Clinic | Arihara K.,Ohtemachi Clinic | And 7 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives This study sought to assess whether spironolactone treatment reduces the high incidence of cardiovascular and cerebrovascular (CCV) morbidity and mortality in hemodialysis (HD) patients. Background Aldosterone receptor blockers reduce cardiac-related events, but the efficacy of the agents in HD patients is unclear. Methods A 3-year randomized trial involving 5 clinics was performed. Of the 309 oligoanuric HD patients enrolled in the study, 157 patients were randomly assigned to receive 25 mg/day of spironolactone without any restriction on dietary potassium intake (treatment group), and 152 patients were assigned to a control group. The primary outcome was a composite of death from CCV events or hospitalization for CCV events, and the secondary outcome was death from all causes. Results During the 3-year follow-up, the primary outcome occurred in 5.7% of patients in the treatment group and in 12.5% of patients in the control group. Hazard ratios (HRs) for the primary outcome for treatment were 0.404 (95% confidence interval [CI]: 0.202 to 0.809; p = 0.017) and 0.379 (95% CI: 0.173 to 0.832; p = 0.016) before and after adjustment, respectively. The secondary outcome was significantly reduced in the treatment group compared with the control group (6.4% vs. 19.7%; HRs: 0.355 [95% CI: 0.191 to 0.662; p = 0.002] and 0.335 [95% CI: 0.162 to 0.693; p = 0.003] before and after adjustment, respectively). Gynecomastia or breast pain was reported in 16 patients (10.2%) in the treatment group. Serious hyperkalemia led to treatment discontinuation in 3 patients (1.9%). Conclusions Aldosterone receptor blockade using spironolactone may substantially reduce the risk of both CCV morbidity and death among HD patients; however, larger-scale studies are recommended to further confirm its efficacy. (Effects of Spironolactone on Cardio- and Cerebrovascular Morbidity and Mortality in Hemodialysis Patients; NCT01687699) © 2014 by the American College of Cardiology Foundation.

PubMed | National Center for Child Health and Development and Sugiyama Clinic
Type: Journal Article | Journal: Archives of gynecology and obstetrics | Year: 2016

Follicular fluid (FF) might reflect the environment during follicle and oocyte growth, and an evaluation of oxidative stress in the FF might be useful in predicting oocyte quality. In order to measure the oxidative stress (OS) in the FF from a single follicle of patients with endometrioma (EM), we evaluated whether an EM might affect the environment of follicular growth.Between December 2011 and July 2013, 26 patients with a unilateral EM (EM group) and 29 without EM (control group) were enrolled in this study. The FF was obtained during the first puncture of follicular aspiration, and was stored at -30 C until it was assayed. A Free Radical Elective Evaluator (WISMERLL, USA) was used to perform d-ROM and BAP tests to measure oxidative stress (U.CARR) and antioxidant power (mol/L).The d-ROM values in the EMC and control groups were 328.7 97.8 and 414.9 84.2, respectively, and the BAP values for the two groups were 2474.3 432.0 and 2552.8 435.58, respectively. These values were similar between the two groups (mean SD). The number of patients with a modified BAP/d-ROM ratio of <1.0 in the EM group was similar to that for the control group at 16 and 15, respectively (61.5 and 51.7 %).The oxidative stress and antioxidant potential in the FF of the patients with unilateral EM showed values similar to those without an EM. Therefore, we concluded that EMs do not affect the environment for follicle growth during ART treatment.

Nakagawa K.,Sugiyama Clinic | Ojiro Y.,Sugiyama Clinic | Jyuen H.,Sugiyama Clinic | Nishi Y.,Sugiyama Clinic | And 3 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2014

Aim: To determine the efficacy of prostaglandin administration during the proliferative phase in order to improve pregnancy rates following frozen embryo transfer during a hormone replacement cycle (HRC). Methods: From September 2010 through March 2012, patients (n = 135) were recruited who had undergone oocyte retrieval during a stimulation cycle with clomiphene and had deferred fresh embryo transfer (ET) due to a thin uterine endometrium. All patients were less than 40 years of age and underwent thawed ET following all embryo cryopreservation, and were randomly divided into two groups for thawed ET using a conventional hormone replacement cycle with or without prostaglandin derivatives (prostaglandin or conventional group). Prostaglandin derivatives were administrated during the proliferative phase. Pregnancy and implantation rates following frozen ET were compared between the two groups. Results: Although the endometrial thickness on the day of ET was similar for the prostaglandin and conventional groups, the pregnancy and implantation rates for the prostaglandin group were 40.0% and 22.0%, respectively, which was significantly higher than the rates for the conventional group (P < 0.01). Conclusion: Among patients who avoided fresh ET due to a thin endometrium, the pregnancy rate following a thawed cycle was low. However, it was improved when prostaglandin derivatives were used during the proliferative phase. © 2014 Japan Society of Obstetrics and Gynecology.

PubMed | Sugiyama Clinic and Center for Reproductive Medicine and Endoscopy
Type: Journal Article | Journal: Journal of reproduction & infertility | Year: 2016

The purpose of this study was to evaluate the effect of needle type on pain and bleeding during oocyte pick-up (OPU).From May through November 2013, patients undergoing OPU from a single follicle without any analgesic treatment were including this study. Eligible patients (n=75) were randomized 1:1 to undergo the procedure with either a reduced needle (17 gauge body, 20 gauge tip; RN group) or a standard needle (19 gauge; SN group). Overall pain was assessed by patients using a visual analogue scale (VAS), and vaginal bleeding after the procedure was recorded. Fisher exact, t-test or Wilcoxon test were used, and p<0.05 was considered to be statistically significant.The percentage of mature oocytes was 86.5% in the RN group and 91.7% in the SN group. Pain during OPU was significantly lower in the RN group than in the SN group (mean VAS scoreSD: 3.22.0 cm vs. 4.92.2 cm, p<0.01; meanSD). The frequency of vaginal bleeding was also significantly lower in the SN group (26.3% vs. 48.6%; p<0.05). The frequency of bleeding in the RN group was also significantly lower than that in the SN group (26.3% vs. 48.6%; p<0.05). No significant differences were found between the two groups with regard to fertilization and pregnancy rates.The newly designed needle significantly reduced pain and vaginal bleeding associated with single-follicle OPU in patients receiving no analgesic treatment, in comparison with a standard needle. The RN had no adverse effect on the quality of retrieved oocytes.

Nakagawa K.,Sugiyama Clinic | Takahashi C.,Sugiyama Clinic | Nishi Y.,Sugiyama Clinic | Jyuen H.,Sugiyama Clinic | And 2 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose To ascertain whether the use of hyaluronanenriched transfer medium (HETM) improves pregnancy and implantation rates among embryo transfer patients with a history of multiple implantation failures. Methods Patients (n0314) under the age of 40 and with a history of multiple unsuccessful embryo transfers were enrolled. There were three groups of patients: those undergoing fresh embryo transfer (fresh ET [n0111]), those undergoing vitrified-warmed ET in the natural cycle (WET-N [n0101]) and those undergoing WET in a hormone replacement cycle (WET-H [n0102]). On the day of ET, patients were randomized to HETM (0.5 mg/ml hyaluronan) or control medium containing no hyaluronan. Only patients with good quality embryos on day 3 were included. Results For all three patients groups (fresh ET, WET-N and WET-H) pregnancy rates (37.5 %, 31.4 % and 41.2 %, respectively) were significantly higher when using HETM compared with control medium (10.9 %, 10.0 % and 15.7 %, respectively; p<0.05), and implantation rates when using HETM were also significantly higher compared with control medium (p<0.05). Miscarriage rates were similar in both groups. Conclusion HETM significantly increased pregnancy and implantation rates among embryo transfer patients with a history of multiple unsuccessful implantations- regardless of method used to prepare the endometrium. © 2012 Springer Science+Business Media, LLC.

Nakagawa K.,Sugiyama Clinic | Nishi Y.,Sugiyama Clinic | Sugiyama R.,Sugiyama Clinic | Jyuen H.,Sugiyama Clinic | And 3 more authors.
Reproductive Medicine and Biology | Year: 2012

Purpose: The purpose was to establish a mild ovarian stimulation protocol that would help assisted reproductive technology (ART) units to avoid scheduling on weekends. Methods: This protocol directed patients to take 50 mg/day of clomiphene citrate between days 3 and 7 of the menstrual cycle: 225 IU of recombinant follicle-stimulating hormone (rec-FSH) were administered on days 3, 5 and 7; human chorionic gonadotropin (hCG) was administered on day 9; and, oocyte pick-up (OPU) was planned for day 11. From October 2008 through October 2009, 514 women underwent ARTtreatment with mild stimulation at the Sugiyama Clinic, and we evaluated whether OPU was accomplished on the planned day. Results: Of all the treatment cycles, 419 (81.5%) underwent OPU on day 11 (scheduled group). Additional rec-FSH administration was needed in 83 cycles, in which case OPU was performed on day 12 or later. In 12 cycles, OPU was canceled. The unscheduled group (n = 95) consisted of delayed OPU cycles and canceled cycles. Of all treatment cycles, 332 cycles in the scheduled group and 68 cycles in the unscheduled group underwent embryo transfer, with 81 and 16, respectively, resulting in pregnancies. Conclusions: Using this protocol, OPU was performed on the scheduled day in about 80% of the cycles. Most weekend scheduling of OPU can be avoided using this mild stimulation. © Japan Society for Reproductive Medicine 2011.

Nakagawa K.,Sugiyama Clinic | Nishi Y.,Sugiyama Clinic | Sugiyama R.,Sugiyama Clinic | Kuribayashi Y.,Sugiyama Clinic | Inoue M.,Sugiyama Clinic
Journal of Obstetrics and Gynaecology Research | Year: 2010

Aim: To confirm whether women who choose to have one fresh embryo transferred and one frozen-and-thawed embryo when needed can dramatically reduce the possibility of a multifetal pregnancy while giving themselves a better chance of achieving pregnancy. Methods: We enrolled 685 patients who were undergoing assisted reproductive technology (ART) treatment at our clinic between January 2005 and December 2008. None of the patients had a history of ART treatment, and they received either a double-embryo transfer (DET) or single-embryo transfer (SET) during this period. The outcomes of the ART and the pregnancy rates per patient were evaluated for both groups and comparisons were made. Results: The mean age was 35.7 ± 0.2 years (mean ± standard error of the mean) for all patients (n = 583) who received a fresh embryo cycle of DET. In contrast, the mean age (34.3 ± 0.4) of all patients (n = 102) who received a fresh- or thawed-embryo transfer cycle of SET was significantly younger than the average age in the DET group (P < 0.05). The per-patient overall pregnancy rate in the SET group was an estimated 35.3%, which was significantly higher than that in the DET group (P = 0.02). However, the multifetal pregnancy rate for the DET group was significantly higher than that for the SET group (P < 0.01). Conclusion: We demonstrated that women who choose to have one fresh embryo transferred and one frozen-and-thawed embryo when needed, can dramatically reduce their possibility of a multifetal pregnancy while giving themselves a better chance of achieving pregnancy. © 2010 Japan Society of Obstetrics and Gynecology.

Sugiyama R.,Sugiyama Clinic | Nakagawa K.,Sugiyama Clinic | Shirai A.,Sugiyama Clinic | Nishi Y.,Sugiyama Clinic | And 2 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2010

Purpose: We attempted clinical application of a plastic blade, which is a novel cryopreservation device, for vitrification of human embryos and blastocysts. Methods: Between February 2003 and December 2007, a total of 4,430 Day 3 embryos from 898 patients (Day 3 group) and 55 blastocysts from 29 patients (blastocyst group) were vitrified and cryopreserved with a plastic device, and subsequently thawed for embryo transfer. Clinical outcomes after thawing and transfer of vitrified embryos and blastocysts were evaluated. Results: In the Day 3 group, all embryos resulting from 1,441 oocyte retrieval cycles were recovered, and the thawed embryo survival rate was 98.4%. In the blastocyst group, the survival rate after thawing was 100%. A total of 3,026 day 3 embryos and 46 blastocysts were transferred. The pregnancy and implantation rates in the Day 3 group were 25.0% and 15.5%, respectively, and in the blastocyst group the rates were 24.2% and 26.1%, respectively. The miscarriage rates in the Day 3 and blastocyst groups were 18.3% and 50.0%, respectively. Conclusions: A plastic blade is a useful novel device in cryopreservation of vitrified human embryos. © 2010 Springer Science+Business Media, LLC.

PubMed | Sugiyama Clinic
Type: Journal Article | Journal: American journal of reproductive immunology (New York, N.Y. : 1989) | Year: 2015

We evaluated the clinical efficacy of immunosuppressive treatment with tacrolimus for repeated implantation failure (RIF) patients who have elevated in T helper (Th1)/Th2 cytokine producing cell ratios.This was a prospective cohort study of treatment for RIF patients (n=42) with elevated peripheral blood Th1 (CD4(+) /IFN-(+) )/Th2 (CD4(+) /IL-4(+) ) cell ratios at the Sugiyama clinic between November 2011 and October 2013. Twenty-five patients were treated with tacrolimus (treatment group) and 17 received no treatment (control group). Treatment group received tacrolimus 2days before embryo transfer and continued until the day of the pregnancy test, for a total of 16days. The daily dose of tacrolimus (1-3mg) was determined based on the degree of the Th1/Th2 cell ratio.The clinical pregnancy rate of the treatment group was 64.0%, which was significantly higher than that of the control group (0%) (P<0.0001). In the treatment group, the miscarriage rate was 6.3%, the live birthrate was 60.0% (P<0.0001). There was no significant side-effect from tacrolimus in treatment group. No one developed obstetrical complications during pregnancy.An immunosuppressive treatment using tacrolimus improved pregnancy outcome of repeated implantation failure patients with elevated Th1/Th2 ratios.

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