If you haven’t read Part 1 where I shared about choosing Kato Repro Biotech Center and our initial consultation, I suggest you go ahead and read it first. You can also read the story behind our unexplained infertility.

Now, let’s dive into what happened during our mini-IVF at the clinic, including the results and how much it cost us. This IVF cycle happened last July 2024.

Starting out with renewed hope

Remember how I mentioned my AMH (anti-müllerian hormone, which measures ovarian reserve) had improved to 0.9 ng/ml from 0.5 ng/ml in June 2024? Well, that number, while not ideal, gave us hope.

When we arrived at Kato for Day 2 of my cycle, we started with baseline tests to see what we were working with. We’d just traveled from Cebu to Manila for this mini-IVF adventure.

I was both nervous and excited when I went in for my first transvaginal ultrasound (TVS). The result? 14 follicles! For someone with my AMH level and age, this was actually pretty good news.

They also did some hormone testing and the usual STD tests (we already did this in Cebu, but they wanted to do it again). Our results came back okay so we’re ready for egg retrieval!

A pleasant surprise with the husband’s sperm analysis

Another good news is that husband’s SA (sperm analysis) results were outstanding! His count and motility were above normal as always. Plus, his sperm morphology improved from 1 percent to 10 percent!

I’m not sure if this jump has to do with the supplements and lifestyle changes we’ve done or if Kato has less strict morphology standards than that clinic in Cebu where my husband’s sperm was initially tested.

Our mini-IVF protocol at Kato Philippines

One thing I really appreciated about Kato was how organized they were with the IVF medication schedule. A nurse will orient you on the dosages and timing. 

Here’s what my mini-IVF protocol looked like at Kato:

Days 3 to 7

• Morning: Letrozole 2.5 mg and Gonal-F 150IU injection
• Evening: Clomid 25 mg after meals

Days 8 to 9

• Morning: Humog 150IU injection
• Evening: Clomid 25 mg (until Day 8 only)

The waiting and watching phase

On Day 7, we had our first follicle check after starting medications. The ultrasound showed:

• Right ovary: 6 follicles (largest ones measuring 16.3mm and 15.2mm)
• Left ovary: 2 follicles (around 10mm)
• Endometrium: 0.49 cm

By Day 9, things were looking promising:

• Right ovary: 11 follicles with the three lead follicles measuring 23.2mm, 22.6mm, and 21.5mm
• Left ovary: 3 follicles (largest at 13.3mm)

That evening of Day 9, we did the trigger shot (Ovidrel 250 mcg) at exactly 7:30 pm. The 36-hour countdown to egg retrieval had begun.

The big day: Egg retrieval or ovum pickup (OPU)

We arrived at the clinic on Day 11 of my cycle for my OPU (ovum pickup). Here’s what we got:

• 9 eggs retrieved (2 mature, 7 immature)
• The good news? Kato’s laboratory does IVM (in-vitro maturation: a process that helps immature eggs become mature in the lab), and the 7 immature eggs definitely matured overnight. 

Hunger games: Egg to blastocyst edition

Of the 9 eggs, Doc F suggested that we fertilize 5 while storing the rest for future use. Here’s how it played out for my eggs:

• 5 fertilized
• 3 stored for future use
• 1 disintegrated

For fertilization, we opted for some “add-ons” (these are optional):

• MACS (Magnetic-Activated Cell Sorting – a technique that helps select the healthiest sperm)
• Embryoscope (a special incubator with time-lapse cameras that continuously monitor embryo development)

Of the fertilized eggs, one made it to a Grade A blastocyst on day 5, while the others arrested on days 5, 6, and 7. I was really hopeful because of our lone blastocyst’s grade.

Hunger games what? This FriedEggs podcast episode talks about the egg retrieval “hunger games” and attrition rates.

The PGT-A results

We opted for Preimplantation Genetic Testing for Aneuploidy (PGT-A testing) for our Grade A blastocyst. It’s a test that checks if a blastocyst has the correct number of chromosomes.

While it was optional at the clinic, it was recommended for us because of our age. I’m in my late 30s, and the husband is in his early 40s.

Unfortunately, the test came back full aneuploid, a monosomy 22. This means it wasn’t viable for transfer. We were devastated. I remember getting that email and opening the PGT report. I was crying at random times for almost a week.

The PGT-A at Kato came with free genetic counseling. The genetic counselor we got was based abroad. My assumption was she was an independent counselor hired by the PGT company to talk to couples who wanted counseling support after seeing the results.

Our IVF egg retrieval costs at Kato in July 2024

Let’s talk money – because I know this is one of the first things people want to know! Our OPU with mini-IVF protocol totaled roughly 380,000 PHP. This amount included:

• Consultations
• Diagnostic procedures
• Lab tests
• MACS 
• Embryoscope 
• Culture
• ICSI
• PGT- A of one blastocyst
• Egg/embryo freezing for 3 years

Keep in mind that this cost doesn’t include FET (frozen embryo transfer). This doesn’t also include our flights to Manila and back, accommodation, groceries, and supplements.

It’s also worth noting that Kato accepts bank transfers, credit cards (not for everything though!) and cash.

Closing thoughts and lessons learned 

Looking back, there are a few things I would have done differently:

1. We could have insisted on fertilizing all nine eggs instead of just five. This would have given us more chances of getting a viable blastocyst. I assume that they suggested fertilizing just five to avoid having too many blastocysts if they all made it to day 5.
   
2. After reading about IVF protocols post-OPU, I learned about single versus double triggers. Most of my eggs were immature; from what I’ve read, this might have been related to using a single trigger. If I had to do it again, I would discuss the possibility of using double triggers with my doctor.
   
3. I’m still not sure why most of my eggs were immature. So many questions ran through my mind: Was it a protocol issue? Was it related to my endometriosis or adenomyosis? Did I need one or two more days of stimulation? Should I have done a dual trigger instead of a single trigger? What if I doubled my CoQ10 dosage?
   
4. What if we skipped PGT-A and just gave the blastocyst a chance? For example, this peer-reviewed article concluded that PGT-A might not be beneficial for all IVF patients. The review explains that while the testing itself has become more accurate, new challenges have emerged, such as dealing with partial abnormalities and mixed (mosaic) results.

Despite the poor outcome of our egg retrieval at Kato, I appreciate how organized and transparent Kato was throughout the process. Their laboratory’s IVM capabilities was what wowed me as I heard that some clinics don’t do IVMs.

I hope sharing these details will help you consider IVF at Kato Repro Biotech Center. If you’ll ask me, Kato’s mini-IVF is ideal if your AMH is still within normal range. However, I’ve also read of success stories in Facebook groups and forums where mini-IVF yielded good results for patients with DOR (diminished ovarian reserve, which means lower egg count and AMH). So do your own research before jumping into mini-IVF.

Finding the right IVF protocol could also be a process of trial and error (which, in this case, can be difficult for us living in the Philippines because IVF is not covered by insurance or subsidized by the government here).

As for our next steps, I’ll write about it soon. See you then!