Work in Progress

Oral Pills for 21 Days

I just finished taking the birth control pills (Gynera) today.  How time flies... it's been 21 days already... in a few more days, off we go to Taiwan...

IVF - Protocol 4

It's been more than a year since I went to Taiwan for the consultation for IVF.  We did not push through with it at that time for some reasons and also of course, we were hoping that it would come naturally.  Unfortunately, it didn't.  

It was just a few months back when I finally started to do something again.  See my post regarding it here.  

So fast forwarding it, we've finally gotten the courage to go through the IVF process and this is it!

I contacted Vanessa Lin of Mackay Memorial Hospital and asked if I still need to go to Taiwan for consultation and or re-examination.  She responded to me through email that there is no need for me to go to Taiwan for reconsultation and I can just proceed with protocol 4.   

Protocol 4

Before, there were only Protocol 1, 2 and 3 and the usage of this depends on the result of your AMH.  However, since Buserelin is now out of stock in the Philippines and Taiwan, Dr. Lee has changed it to Protocol 4.  So, this is what I am following right now.

I started to take the birth control pills on the 5th day of my menstrual cycle, which was August 28 and will continue to take it for 21 days.  Good thing, the birth control pills (Gynera) prescribed to me by Dr. Lee, which i bought in Taiwan last year is not expired yet. So far, I've been taking it for 10 days now.

Preferably, you should take the pills more or less at the same time each day.  I take mine every 1pm.  I set the alarm on my cellphone so as not to forget it.

That's it for now.  I will post again soon the preparations I've been doing for this one big fight.

Update on Taiwan Visa Application

I started to process our Taipei visa just recently for our IVF in Taiwan this coming September and found out that effective March 1, 2012, it is required to fill up the visa application forms online, print them out and bring them along with other documents required in applying for a visa.

So before going to the Taipei Economic and Cultural Office (TECO) located at 41F, Tower 1, RCBC Plaza, 6819 Ayala Avenue, Makati City, Philippines or before you apply through a travel agency, please make sure that you fill up the online visa application form, which you can access from the website https://visawebapp.boca.gov.tw and print them out.

Other requirements needed are the following:

1. Two (2) passport size photos 1.5”x2” with white background taken within the last three (3) months

2. Passport valid for at least six months and old passport showing previous visa stamps, if any

3. Birth Certificate issued by NSO

4. Marriage Contract issued by NSO (if applicable)

5. Bank Book or Bank Statements

6. Optional: Other supporting documents such as Certificate of Business Name Registration and SEC Registration (if owner of the company), Income Tax Return, confirmed round trip air ticket, etc.

All documents submitted to the office should be original with 1 photocopy.

Visa Fee: Same as before

Single entry – P2,400, +1,200 if with expedite fee for one day processing

Multiple entry – P4,800 +2,400 if with expedite fee for one day processing  

** Fees could be higher if visa application is coursed through a travel agency  

Visa Processing time is 3 working days, but better to allot 4-5 days for it.

Filing Time: Monday to Friday 8:45am to 11:45am

Releasing Time: Monday to Friday 1:45pm to 4:45pm

If you are a Filipino and have a valid, existing US Visa, you don’t need to apply for a Taiwan Visa anymore.  But you need to register your documents and personal data with the "Advance Online Registration System for the Visitors of Nationals from Five Southeast Asian Countries to Taiwan" in this link and print out the confirmation sheet for online boarding and immigration check.  

Results of LAT and NK Cells Post LIT

Here are the results of my LAT and NK Cells after 2 LIT sessions using 2 donors each.

LAT after 2 LIT sessions using 2 donors

My LAT has improved! Thank God! :) From 10% and 5%, it has gone up to 76% and 41% with reaction code of 6 (strong positive) and 4 (positive reaction).    

NK Cells test results after 2 LIT sessions using 2 donors

As for my NK Cells, it is now within normal range.  Cut-off is 12.  From 14.39, it is down to 10.61.  Finally!

Though results are quite good, my immunologist still suggested that we go for another set of LIT using 2 donors to further increase my LAT score and also to lower my NK cells.  This we have done last September 4, 2012.  Hopefully, with this LIT session, my LAT will go as high as 100% and my NK cells will also decrease.  All of these we are doing in preparation for the IVF.  

Hope it works...

No Pain, No Gain

Here's a nice poem I chanced upon the net that says it all...

THE RAINBOW AFTER THE RAIN

Submitted by: maple

Author: Maple

God never promise us a good life on earth;
but He gave the assurance that there will always
be a rainbow after the rain.

Life on earth is not always what we expected
and wanted it to be. But if we can put our
trust in God, He can sail us through definitely.

God never let us bear what is impossible;
and He makes sure what we bear is the
limit that we can take without much difficulty.

After the rain, things will be changed;
everything on earth seems to be new
and clean. With these renew scenario,
we should be:

- a more positive and courageous person
as indicated by the RED of the rainbow;

- a creative, thoughtful and joyful person
as indicated by the ORANGE of the rainbow;

- an intelligent, confident and logical person as
indicated by the YELLOW of the rainbow;

- a renewed, generous and practical person as
indicated by the GREEN of the rainbow;

- a peaceful, sincere and responsible person as
indicated by the BLUE of the rainbow;

- a relaxed, devoted and wise person as
indicated by the INDIGO of the rainbow;

and last but not least, a spiritual and idealistic
person as indicated by the VIOLET of the rainbow.

Let's keep going... like a rainbow after the rain, there's always a good thing after the pain.

Think Positive

Lymphocyte Immuno Therapy (LIT) Session

A typical LIT session starts with the extraction of blood from husband or donor.  As early as 8am, you can go to Manila Endocrine Lab (MEL) to have your husband’s or donor’s blood extracted. 

Before I forget, you must make sure that the donors have their blood screened first to make sure that they don’t have any diseases that could be transferred to you.  The blood screening should be done a few days before the actual blood extraction.  The test should include the following: CBC, malarial smear, RPR, HIV, Hepa B, and Anti-HCV.  You must present the results of the blood test to the med tech at MEL.

12 vials of blood will be extracted from your donor.

  

After this, the laboratory will then process the blood wherein only the lymphocytes or white blood cells will be extracted.  You will be surprised that out of the 12 vials of blood, only a small vial of white blood cell will be extracted and that will be the one to be injected to us.   

Kuya Reggie of MEL will bring the white blood cells to the clinic of Dra. Aleta at Don Santiago Building.  He usually arrives around 12:00noon, so I usually go there around that time also.

Dra. Aleta will then inject the white blood cells under the skin (sort of like allergy test). My husband took a video of the procedure and here it is.  Warning: Not for the faint-hearted.  

I am not allowed to remove the bandage for 48 hours... not allowed to wet the area and exposed it to sunlight also.  Rashes, pain and itchiness in the injection spots are expected.  

Here's a picture of my arms after removing the bandage.  After this, the injection spots will bruise, like insect bites.

LIT can be done weekly, every two weeks or every three weeks depending on your preference or depending on your need.  You can either use one donor or two donors. The donor can be your husband or other people not related to you.  

Before, I used my husband's blood, but after 4 LIT sessions, my LAT still did not go up, so right now we are using donors' blood for my LIT.  For my recent LIT sessions, we used the available donors from MEL.  You just have to pay an additional of Php1000 per donor.  They say that these donors have been tried and tested already. Their blood were already screened as well.  Ate Aw of Mel sent me their blood screening results through email.  You can always request for that if you want.

I'll be having another LIT session this coming Tuesday.  I just hope that all that we are doing will really be worth it... Hoping that my LAT will increase ASAP.

Consultation With My Immunologist

I went to Dr. Lara Theresa Alentajan-Aleta, my immunologist at the Don Santiago Bldg. across PGH in Taft Avenue last July 10, 2012.  I presented to her the results of all the blood tests I’ve done and here was her interpretation.

My LAT was back to negative. 

My KCT was high.

My NK Cells was also high.  (Though it was within normal range, according to Dr. Aleta, the cut-off should be 12.  Mine was 14.39.)

So, my options are the following:

1. LIT – Lymphocyte Immunotherapy Treatment (solution for Category 1 and 5 problem)

2. IVIG – Intravenous Immunoglobulin (solution for Category 1 and 5 problem)

3. Intralipids infusion (solution for Category 5 problem)

4. Take aspirin 80mg once a day (solution for Category 2 problem)

I told Dra. Aleta that we are planning to have IVF in Taiwan by September 2012.  So, we are doing this in preparation for the IVF.  

According to her, we can either have IVIG before going to Taiwan or have LIT. 

IVIG is more expensive and it will only stay in my body for a month.  LIT, on the other hand is cheaper (but will need at least 4 sessions or more depending on my body) but once my LAT is up, it could stay in my body for 6 months.  If within 6 months, I don’t get pregnant, I have to have booster shots to maintain the LAT. This, I wasn’t able to do before, that is why my LAT returned to 10% and 5%, which is considered a negative reaction.  So, it is very important to remember this: Booster shots within 6 months if you don’t get pregnant to maintain positive LAT.  If not, you’ll have to do it all over again, just like me.

So, Dra. Aleta and I agreed that we will have LIT since I still have time to do it before going to Taiwan.  So our schedule is this:

July 17 – LIT using 2 donors

July 31 – LIT using 2 donors

August 14 – blood test

Then we will decide from there if I need additional LIT and if I still need to have intralipids infusion.

Another thing I asked Dr. Aleta is how can I increase my LAT naturally.  Her answer: Avoid xenoestrogens.  Avoid processed and canned foods.  Avoid using styro and plastics.  Do not use fabric softeners.  Stop using make-up and lotions that contain paraben.  Avoid eating meat.  It is ok to eat fish, vegetables, fruits, seafood, organic eggs and free range chicken.

She asked me if I am taking any vitamins and I said I was taking Usana Essentials, Calcium, Biomega and Proflavanol.  She asked me to continue taking the vitamins and on top of this, she prescribed Glutathione 500mg, 1 capsule daily.  The brand she prescribed was Cosmo Skin which can be bought at Watson’s for Php45 per capsule or Php1350 per bottle of 30 capsules. 

That's it for my consultation with Dra. Aleta.  

I'll be posting my LIT session soon.

Have a great day ahead!

NK Cells Test Result

Here's the result of my NK Cells Test.

This is not the same as the one I had 3 years ago wherein the blood sample was sent to a laboratory in Chicago (Rosalind Franklin University).  This NK Cells test was done here in the Philippines (St. Luke's Medical Center).

Natural killer cells (NK cells) are important.  They make up 50% of all white blood cells and are needed to control rapidly dividing cells like cancer.  The theory is that some women produce too many natural killer cells which will aggressively attack any cells that grow and divide, offering protection against cancer but making pregnancy impossible.

Treatment possibilities for elevated NK cells include LIT, intravenous immunoglobulins (IVIG), steroids, rheumatoid arthritis drugs and or the latest one is the intralipid infusions.  The natural solution for this is to take fish oil, specifically EPA, to decrease NK killer cell activities.

Here in my recent test, my NK cells are within the normal range.  However, I still have to show this to my immunologist for proper interpretation as I do not know what those other items meant.... some are below the normal range, yet some are over.  

I'll update you after the consultation with my immunologist.  

LAT Result

Here’s my recent LAT result from Manila Endocrine Laboratory (MEL).

I should have gotten the result already last Friday.  However, Ate Aw of MEL called me up and told me that my result was very low and since she knew that I had my LIT sessions done before, she was surprised with my very low result.  So just to be sure that there was no error whatsoever on their part, she wants my blood to be retested again by a different laboratory to verify and confirm the result.  Just so that both of us can have a peace of mind, she had it retested without me paying anything in addition to what I have paid for.

  

The result came out already and here it is…

Both results showed that my LAT is back to negative again.  It’s been more than a year already since I had my LAT checked… If I remember it right, it was last April 2011 when my LAT has increased to 100% but with only a reaction code of 4 (positive reaction).  That was after 9 LIT sessions.  Since then, I haven’t checked my LAT and did not undergo any LIT session.

For those of you who are not familiar with LAT and LIT...

LAT - Leukocyte Antibody Test

- This test is done to measure if you produce blocking antibodies to stop the immune system from attacking and rejecting the fetus.  The problem is when the woman shares the same antibodies with her partner; in other words the couple’s DNA is too similar.  Normally the father’s DNA in the embryo tells the mother’s body to set up a protective reaction around the baby.  But when this blocking effect does not happen, the baby is rejected. 

LIT – Lymphocyte Immunization Therapy

- This is the treatment for those who have negative or low leukocyte antibodies, in which the male partner or donor’s white blood cells are injected into the woman to help her body increase the level of leukocyte antibodies in her blood.

Low levels of leukocyte antibodies have been linked with fertility problems.  Women with lower than normal levels of the antibodies are more likely to experience miscarriage, have stillbirth and have repeated spontaneous abortions.  Those struggling with infertility especially those with unexplained infertility, multiple miscarriages and continued IVF failure can benefit from this test.

Normal result should indicate that you have tested positive for leukocyte antibodies in your bloodstream.  A normal LAT level is above 50%.

Borderline normal results mean that you do have leukocytes antibodies in your blood, but in less than typical quantities. A measurement between 30% and 50% is considered borderline.

Abnormal results indicate very low levels of leukocyte antibodies in the bloodstream. Levels of less than 30% are considered abnormal. (Source:www.sharedjourney.com)

This I think is one of the factors contributing to my infertility.  Though my LAT has increased to 100% already, the reaction was only 4 which meant that it was only a positive reaction and not a strong or very strong positive reaction.  Most likely, my LAT level at that time was just borderline.  I should have continued my LIT sessions then...  Oh well, now I’m back to zero and I have to start all over again...

They say that the leukocytes antibodies from the LIT can stay in your body for 6 months.  That is why once your LAT has increased to 100% and has a very strong positive reaction of 8, you should get pregnant within 6 months.  If not, you have to have booster shots to maintain your LAT.

I have yet to consult my immunologist with regards to the result.  I will update you again after my appointment on Tuesday.

Have a happy weekend!

Which Step Have You Reached Today?

Something to ponder on... 

As for me, I'm almost there... I'LL TRY TO DO IT... I CAN DO IT... I WILL DO IT... and hopefully, really soon... I can proudly say that YES, I DID IT! :)

How about you?  Which step have your reached today? :)

A Prayer for Conception

Dear Lord,

Hear this prayer and answer the wishes of my heart.  

You know my deep desire for a child,

A little one to love and to hold,  

To care for, to cherish.

Grant that my body may conceive and give birth 

To a beautiful, healthy baby in Your holy image.

Guide me in all my choices 

So that this conception, my pregnancy,

And my baby's birth are all in line with Your will.

Heavenly Father,

Hear this prayer of my heart, mind and spirit.

Amen.

Fertility Food: Avocado

Borrowed from this site.

Avocados are considered fertility food.  Why?  What is it about this fruit that makes it so?

Avocados provide a great source of Vitamin E, which is a powerful antioxidant and an important fertility nutrient for both men and women.  It improves sperm function and helps to regulate ovulation and improve cervical mucus.

Avocados are high in folic acid and vitamin B6 which help to regulate sexual hormone function that help to optimize sexual health.  Folic acid or folate, also known as vitamin B9 contributes to spermatogenesis in men and oocyte maturation, implantation and placentation in women.  Moreover, adequate folate intake during pregnancy is essential for normal tissue growth and helps protect against a number of congenital malformation including neural tube defects.

They are high in monounsaturated fat, the good and healthy kid of fat that helps lower cholesterol.  Fat plays a very important role in our endocrine system, which regulates the hormones involved in reproduction.  Estrogen, for example, is manufactured and stored in fat, so you want to get your fat in, just make it the healthy kind, which is the mono- and poly-unsaturated varieties.

Avocados also contain good enzymes which aid in digestion.

They are also high in fiber, which helps regulate blood sugar levels, and are filled with other great nutrients, such as potassium and vitamin C.

Avocados are in season now… Grab the opportunity to eat more…

Enjoy eating your avocados!!! :)

APAS Test Results

I got my APAS test results yesterday and here's the report:

Well, of the 5 items tested, only 1 was a little over the normal range, my KCT.

I made a chart to compare the results of my APAS tests from 2009-2012.  So far, I have done the test 3x already...  Looks like there were some improvements in my results over the years... Yipee! :)  But the fact remains, I'm still positive for APAS... huhuhu!  Hope the next time I test for this, it would be within normal range already... :)

MY APAS TEST RESULTS
	1st Test*		2nd Test*		3rd Test**
	7/7/2009		5/26/2010		6/26/2012
	RESULT	CONTROL	RESULT	CONTROL	RESULT	NORMAL RANGE
Lupus Anti-coagulants
KCT	105	70	90	75	79	52-78 sec
APTT	30	25	27	25	35	25-39 sec
DRVVT	30	30	35	30	39	37-47 sec
Anti-Cardiolipin Antibodies
ACA IgG	7.52	15 U GPL U/mL	4.07	15 U GPL U/mL	3.9	0-12 GPL U/ml
ACA IgM	8.58	15 MPL U/ml	8.13	15 MPL U/ml	1.2	0-10 MPL U/ml
*Tested at Reproductive Immunology Center Asia
**Tested at Manila Endocrine Laboratory

Read on to learn more about APAS test.

Antiphospholipid Antibody Test (APA)

Antibodies are special cells that are supposed to help our bodies attack foreign invaders, like bacteria from colds and infections. Sometimes though, the body mistakes its own cells for invaders and attacks them, causing a host of problems. This is the case with antiphospholipid antibodies - they attack our own cells.

Antiphospholipid antibodies are proteins that circulate around in the bloodstream. These proteins bind to cell membranes, making them sticky. This prevents our blood from flowing properly, resulting in blood clots. These antibodies can endanger the health of both you or your baby. High levels of antiphospholipid antibody are often associated with unexplained infertility including: recurrent miscarriage, stillbirth, placental insufficiency, implantation failure and increased rates of IVF failure.

It is thought that antiphospholipid antibodies compromise the placenta which nourishes your baby. Because the antibodies cause clotting, the embryo is cut off from oxygen and nutrient support. As a result, spontaneous miscarriage or fetal death can occur. Clotting can also cause distress to the placenta, making it difficult to have a successful implantation. (Source: sharedjourney.com)

There are several kinds of antiphospholipid antibodies. The two most commonly measured kinds are 1). lupus anticoagulant and 2). anticardiolipin antibody.  These two are closely related, but are not the same antibody.  This means that a person can have one and not the other.

1.Lupus Anticoagulant

Lupus anticoagulant is a specific type of antiphospholipid antibody that exists in your bloodstream.  It is actually a protein, which causes your blood to clot differently in your arteries and veins than it normally should.  

A specialized blood tests called coagulation tests measure blood clotting and are used to find the lupus anticoagulant.  Here are the tests done: 

a). Kaolin Clotting time (KCT)

b). Activated Partial Thromboplastin time (APPT)

c). Dilute Russel Viper Venom Time (DRVVT)

Each of these tests works to detect lupus anticoagulant by measuring the time it takes for a sample of your blood to clot in a test tube.  If it takes longer than normal for your blood to clot inside the test tube, it is more likely that you have lupus anticoagulant in your blood.

2. Anti-Cardiolipin Antibody (ACA)

Cardiolipin antibodies are proteins found in your body that work against cardiolipin. Cardiolipin is a molecule found in your blood platelets and various cell membranes. It is one of a group of molecules called phospholipids. You need cardiolipin in order to help regulate blood clotting throughout your body. Sometimes though, your body can mistake cardiolipin for an attacking substance. As a result, your body creates soldier-like molecules to fight against the cardiolipin. (Source: www.sharedjourney.com)

Women with cardiolipin antibodies have a harder time getting pregnant and carrying their pregnancies to term. This may be because anti-cardiolipin antibodies can cause tiny blood clots, preventing blood from flowing to the reproductive organs or placenta.

Treatment for high antiphospholipid or anticardiolipin antibodies

If you do test high for antiphospholipid or anticardiolipin antibodies, you may be recommended to take low-dose aspirin and the anticoagulant Heparin as treatment. Treatment is aimed at reducing the number of clots in your blood, and restoring blood flow to the placenta.

If you are suffering from unexplained infertility or recurrent miscarriages, it might be a good idea to undergo APAS testing as this might be the cause of your inability to get pregnant or maintain a pregnancy.   Ask your reproductive endocrinologist or your OB about it.

This might just help you... Knowledge is power!