Super Late Post: She's Finally Here!!!

In our life, there comes a time when wishes do come true.

This comes to let you know that our precious little one has finally arrived last June 13, 2013. (Yes, it has been a year already since I last posted here... so sorry about that!)

Presenting to you... Briella Bliss Dior Sy Yu!

After 8 years of waiting and countless fertility treatments, God has finally answered our prayers with a healthy baby girl.  She is a living proof that miracles do happen.  

We would like to thank Dr. Robert Lee Kuo-Kuang of Mackay Memorial Hospital for the successful IVF.  

Out of 7 eggs retrieved, only 4 were fertilized.  Of the 4 embryos, there were 2 grade 5, 1 grade 4 and 1 grade 3 embryos.  Not the best odds.  

The day of the transfer, I was crying already.  I can clearly recall Dr. Lee telling me, "You only need 1 good embryo and you have one, so don't worry."  

I held on to these words all throughout the waiting period. It served as my strength and hope.  

True enough, I only need one and she is here with me now, my bundle of joy.

Thank you Dr. Lee, and to all the nurses and staff of Mackay Memorial Hospital for being an instrument in the conception of this little miracle.  This wouldn't be possible without you.  Thank you very very very much. 

For all of those who were with us all throughout this journey, thank you for all your prayers, love and support. They meant so much.  From the bottom of our hearts, we would like to say THANK YOU VERY MUCH!

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.

IVF Consultation Part 3: Infertility Treatment Consent Form

http://www.flickr.com/photos/qwrrty/

Ms. Tsai showed me into another room where she asked me to fill up a patient information sheet.  She also asked us to sign an Infertility Treatment Consent Form.  This form is in Chinese, but she provided us an English copy of the consent form so that we'll understand the content.  I typed the English version of the consent form, word for word.  Read it through so that you'll get to better understand IVF.

We are both of legal age and with healthy mind and body.  In our own free will, we have consulted this institution for infertility treatment.  Dr. Robert Lee Kuo-Kuang had explained the following points to us and we fully understand:

1. We understand when both the husband and wife have a normal reproductive abilities, the spontaneous pregnancy rate for each menstrual cycle is 10-15%.  When using assisted reproductive technique (ART), depending on the type of treatment used, the pregnancy rate will be variable, but will not be lower than that of a normal cycle.

2. We understand that in a normal pregnancy, 4% of the newborns may have mental or physical defects and 20% can result in miscarriages.  Infertility treatments can only help a woman to get pregnant but does not increase the chance of having a newborn with congenital defects.  Washed sperm used during infertility treatment do not increase the rate of congenital malformation in the newborn.

3. We understand that during ART procedures, drugs are use for ovarian stimulation.  They can result in ovarian hyperstimulation syndrome and can increase the rate of multiple pregnancy and preterm labor.  After a successful pregnancy from ART, we agree to a prenatal care and genetic diagnostic procedures, if deemed necessary.  After delivery, the baby will undergo newborn screening for congenital metabolic disease.

4. We understand that after a successful pregnancy from ART, such pregnancies have a higher chance of miscarriage and ectopic pregnancy than a normal pregnancy.

5. ART will entail some surgical procedures, thus, bleeding, infection, or any other complications may occur as consequence of such procedures.

6. We understand that ART institution respects the patient's right of privacy.  Thus, only patient him/herself can request for information regarding on his/her medical records.

7. We understand this ART institution will keep the patient's well being as its highest priority, thus, all disposable instruments used during any of the ART and sperm washing procedures will be discarded.

8. We agree to undergo IVF type of pf artificial reproductive technique and any anesthetics procedures associated with it.  The medical staff in this ART institution will do their best to fulfill their responsibilities to promote patient's utmost well being.  If any unforeseen emergency occur during any of these procedures, we will allow any interventions they considered deemed necessary.

9. We understand all the procedures necessary for ART, as well as, all the statements above.

Ms. Tsai also explained to us the difference of Protocol 1, 2, 3.  Once we get the result of the AMH, we'll know as to what protocol we will use for the IVF procedure.  The difference lies in the dosage of Buserelin (Suprefact). 

By the way, you can buy Buserelin (Suprefact) 5.5ml per vial at Center for Reproductive Medicine Inc. (CRM) located at 11/F Raffles Corporate Center, F. Ortigas Jr. Rd., Ortigas Center, Pasig City, Philippines.  Telephone Nos. 470-5092, 915-1048, or 915-1049.  It costs Php6,000 per vial.

After this, she repeated the orders of Dr. Lee and off we went for the blood test, scheduling of semen analysis, picking up of medicine and payment of everything we have done that day.

To be continued... IVF Consultation Part 4: Blood Test

IVF Consultation Part 2: Consultation with Dr. Robert Lee Kuo-Kuang

Borrowed from this site.

Consultation with Dr. Robert Lee Kuo-Kuang

The clinic of Dr. Lee started around 2pm.  Since we were new patients, Ms. Vanessa was the one who got the number for us.  We waited for our turn in the waiting area.  Your name will be called.

Obstetrics-Gynecology Department, Mackay Memorial Hospital

The clinic of the doctors are on both sides, while the center is the waiting area.  This is located on the 2nd floor of Mackay Memorial Hospital.

Dr. Robert Lee Kuo-Kuang's Clinic

Dr. Lee holds clinic in Room No. 2 every Monday morning, Wednesday afternoon, Friday morning and Saturday morning.

After around 30 minutes, I was called in.  But I have to wait on the couch first.  Then when it was my turn already, husband was allowed to come in.  Dr. Lee reviewed our medical and reproductive history and verified a few more information.

I was then shown into an examining room where he performed a pelvic exam on me.  Pelvic exam is done to check that your pelvic organs (uterus, tubes and ovaries) are of normal size and shape and located in the normal position; to detect infections that may result in vaginal discharge, pelvic pain or infertility; and to detect abnormalities of the cervix.

After this, he requested for an ultrasound which is done at the far end of the waiting area. 

Ob-Gyne Ultrasound Room

Dr. Lee gave me a sheet of paper, which I need to present to the lady in the Ultrasound Room.  She then gave me a number and I waited outside for my number to be called.  

After the ultrasound, I got the results in a few minutes.  After which, I brought back the results to Dr. Lee for the interpretation.

By the way, just in case you want a copy of the ultrasound result for yourself, you can ask them for one.  You just have to pay an additional of NT6.00 for the reprint. 

The result: I have 2 myoma.  But according to Dr. Lee, they are just small so there is nothing to worry. 

He asked me to stop all my immunotherapy sessions and stop taking aspirin for the immune system problems that I have.  Apparently, he does not believe that the immune system problem has anything to do with me not getting pregnant.  He says that this is only the problem of those who experience habitual miscarriage.   

He then explained to us the IVF procedure.  He also requested for a semen analysis from husband.  He said that in the Philippines, our semen analysis only magnifies up to 200x only, wherein in Taipei, they magnify it up to 1000x.  Through this, we can have a more comprehensive analysis of the sperm and will therefore be able to determine if male factor is involved in our infertility.  Should this be the case, he would perform Intracytoplasmic sperm injection (ICSI), an in vitro fertilization procedure in which a single sperm is injected directly into an egg.

As for me, he requested for a blood test to measure the Anti-Mullerian hormone (AMH), a hormone produce by the ovaries and helps the eggs mature each month.  It is also important in the production of the female sex hormone estrogen.  The level of AMH indicates how well you ovaries are functioning and represents both the quantity and quality of the egg store.  Women with higher AMH value will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved.  In general, having more eggs with IVF gives a higher success rate.  The result of the AMH test will be used to determine what protocol you will follow for the IVF procedure.

  

Protocol 1: Good Ovarian Reserve or AMH > 2.5ng/mL; 
Protocol 2: Moderate Ovarian Reserve or AMH 1.5-2.5ng/mL; 

Protocol 3: Poor Ovarian Reserve or AMH < 1.5ng/mL

Dr. Lee also asked for a retest of my Thyroid Stimulating Hormone (TSH) and prolactin. TSH is produced by the pituitary gland.  It is responsible for controlling thyroid function which is important for all metabolic processes in the body.  A TSH result that is over the expected range can indicate an underactive thyroid which is linked to infertility.  Prolactin is also a  hormone produced by the pituitary gland and in increased amounts when breastfeeding.  High levels can stop ovulation and menstruation.


After the consultation with Dr. Lee, he endorsed me again to Ms. Tsai for further instructions and explanations. 


To be continued... IVF Consultation Part 3: Infertility Treatment Consent Form 

IVF Consultation Part 1: Clinic Evaluation and Tour of the Hospital

Clinic Evaluation with Ms. Tsai

Our appointment was set on August 3, 2011 afternoon.  However, we were asked to go to the hospital at around 10:30 in the morning that day to meet with Ms. Tsai, the assistant of Dr. Lee for the clinic evaluation.  We were supposed to meet Ms. Vanessa at the information desk of the hospital lobby at around 10:30 am, but since we were early, we went directly to the IVF Lab at the 6^th Floor of Mackay Memorial Hospital.

IVF Lab at Mackay Memorial Hospital

We met Ms. Vanessa and Ms. Tsai there.  They are both very kind and accommodating.  They speak English, so you don’t have to worry. 

Ms. Tsai is the assistant of Dr. Lee.  She prepares the patient’s information for Dr. Lee.  We submitted all the photocopies of the documents, test results and other reports to her.  She then started to ask questions about my last menstrual period; symptoms experienced before and during menstruation (light or heavy bleeding, pain); surgeries done and the results; how long have we been trying to conceive; infertility treatments done like how many IUI we’ve tried, what medicines did we take or use, what dosage and for how long, etc.  Basically, she asked for the background of our infertility case. 

The whole interview lasted around an hour.  She then asked us to come back in the afternoon for the consultation with Dr. Lee.

Tour of the Hospital

We met Ms. Vanessa at the information desk of the hospital lobby at around 1:45pm.  She then toured us around the hospital and showed us the different places which we need to go to.  I think she should have done it in the morning but since we went straight to the IVF Lab this morning, she did it in the afternoon before the consultation with Dr. Lee.


To be continued... IVF Consultation Part 2: Consultation with Dr. Robert Lee Kuo-Kuang

Preparing for the Consultation for IVF in Taipei

Borrowed from this site.

Here are the things to do in preparation for the consultation for IVF in Taipei:

1. Set an appointment with Dr. Robert Lee Kuo-Kuang by emailing Vanessa or Clark of Mackay International Medical Service Center thru this email address mmhimsc@ms2.mmh.org.tw.

The clinic of Dr. Lee is every Monday morning, Wednesday afternoon, Friday morning and Saturday morning.

2. Book your plane ticket to Taipei, Taiwan via Philippine Airlines or Cebu Pacific.

3. Apply for your Taipei Visa at Taipei Economic and Cultural Office (TECO) located at 41F, Tower 1, RCBC Plaza, 6819 Ayala Avenue, Makati City, Philippines or you can also apply through a travel agency.  

a. Fill up the Taiwan Visa Application Form, which you can download from this link. 

b. Requirements include the following:  

   2 pcs. 2x2 colored picture, passport size taken within 6 months; 

   valid passport and old passport showing previous visa stamps, if any; 

   bank book or bank certificate; 

   birth certificate issued by NSO

c. Visa fees: 

   Php2,400 – single entry, + 1,200 if with expedite fee for one day processing

   Php4,800 – multiple entry, + 2,400 if with expedite fee for one day processing

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

d. Visa processing will take 4-5 days.

e. 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.  

4. Book your accommodation.

You can also ask Vanessa or Clark to help you book your accommodation.  We stayed at Bailee Hotel during our trip.  Nothing fancy with the hotel.  The room we got was NT1280 per night. 

5. Prepare the documents needed for IVF.

You need to bring the original as well as the photocopies of the following documents: you and your husband’s passports and driver licenses; marriage contract.

6. Have blood tests done.

Bring original and photocopies of the results.  Data must be within 6 months.

For husband: Blood Type (Php100), HIV (Php450), RPR or VDRL (Php150)

For wife: Blood Type (Php100), HIV (Php450), RPR or VDRL (Php150), TSH (Php350), Prolactin – mid morning in between meals, 2-4 hrs after waking up (Php500)

7. Bring the x-ray films of HSG or picture files of HSG in USB drive or compact disc; detailed treatment history of infertility and operation reports if any.

8. Semen analysis will be done in Taipei.  Sexual abstinence of 3-5 days, but not more than 5 days is needed so please prepare accordingly.

You can also check out my previous post on IVF in Taiwan: Mackay Memorial Hospital for additional details.

"There is no telling how many miles you have to run while chasing a dream." - Unknown

Consultation for IVF in Taipei, Taiwan

After several failed IUI, we have decided to stop treatment.  However, since husband and I were going to Taiwan for a business trip, we also took the opportunity to make a consultation with Dr. Robert Lee Kuo-Kuang of Mackay Memorial Hospital.  Talk about not totally giving up, eh?!?

I would like to share with you our experience with regards to the consultation for IVF.  They usually call this “First Stage”, wherein you go to Taipei for 3-4 days for the infertility evaluation.  On the other hand, the IVF procedure itself is called “Second Stage”, wherein you have to stay in Taipei for a longer period of 23 days or more.

While in Taipei, we also scout the place for possible accommodation.  I’ll post pictures of the place we stayed and another place recommended to me by a Filipino couple we met there.  Apparently, there are so many Filipino couples going to Mackay Memorial Hospital for the IVF.  I met around 4 Filipino couples there.

The consultation went well.  We met Dr. Robert Lee.  He is very kind and he patiently answers our questions and explains clearly.  His staff was very accommodating.  Instructions were very clear. 

Husband had his semen analysis, while I had some ultrasound, and blood tests done on me.  Results will be emailed to us after 2 weeks.  

Aside from the business and the consultation, we also toured around Taipei during our free time.  We visited different tourist spots like Taipei 101, Shilin Market, Ximending, Longshan temple, Danshui, Keelung and many other places.  I enjoyed our trip.  The food there is really delicious and not that expensive.  Transportation is very convenient and accessible.  

Please read my succeeding posts for more details.  Happy Reading!

Related Posts:
Things to Prepare for the Consultation
IVF Consultation Part 1: Clinic Evaluation and Tour of Hospital
IVF Consultation Part 2: Consultation with Dr. Robert Lee Kuo-Kuang
IVF Consultation Part 3: Infertility Treatment Consent Form 
IVF Consultation Part 4: Blood Test 
IVF Consultation Part 5: Semen Analysis
IVF Consultation Part 6: Getting the Medicine
IVF Consultation Part 7: Payment

IVF in Taiwan: Mackay Memorial Hospital

IVF is by far the most popular method of assisted conception.  IVF involves fertilizing a woman’s egg outsider her body under controlled laboratory conditions – hence the phrase “test-tube baby” – then placing the fertilized egg back into her womb.

Many people have suggested us to try IVF… I have heard many successful stories.  Some had it done in Singapore, Taiwan, Hong Kong, and even in the US.  But they say that one of the cheapest yet has a high success rate is to have IVF done in Taiwan.

I have talked to quite a lot of people who have done it in Taiwan and I tried to explore on the idea of having it done there in Taiwan.  I have researched on it.  Emailed the doctor in Taiwan and ask about the procedure and all. 

But I did not push through with IVF.  I was thinking then that I am an APAS patient and have not done any immunological work up then.  I was afraid that it would not work and would just be a waste of money.  Though many were successful, there were also a lot who weren’t successful in their first try.   

Anyway, I’ll share with you some details about the IVF in Taiwan just in case you want to give it a try.  Coincidentally, my current OB also endorses her patients to try IVF here at Mackay Memorial Hospital.

I coursed my questions on IVF through Vanessa, the secretary of Dr. Lee Kuo Kuang of Mackay Memorial Hospital and here was the response of Dr. Lee Kuo Kuang regarding my concern.  Please note that this was way back in January 2010.

Q: I have been married for 4.5 years and have not yet been pregnant ever since. I have been to quite a number of doctors already but to no avail... so far I have tried 2 iUi.  My fallopian tubes and uterus are normal. Regular menstruation per month. My last OB told me that I was positive for Category I, II, V for APAS. Attached are my blood test results.  Is IVF a probable solution for me to conceive?

A.I would like to suggest you to enroll into the IVF program because you had tried 2 times for IUI.  The APAS (autoimmune) has no effect on the outcomes of IVF. 

Q. What do I need to bring if I want to have a consultation with Dr. Lee Kuo Kuang? When is the best time to go there? 

A. You may come to Taipei any time except the Lunar New Year from Feb. 11 to Feb. 21, 2010.  Please see the attached file and we can be further discuss the details when you come to Taipei. 

Important details inside the file: (If you want the whole file, email me at debjsyu@yahoo.com and I’ll send you the original file)

Needed tests results:

1. Reports of TSH, prolactin, semen analysis, Human immunodeficient virus (HIV) and syphilis tests in recent 6 months

2. X-ray films of hysterosalpingogram (HSG) or picture files of HSG in USB drive or compact disc in recent 2 years

3. Detail treatment history of infertility, including the dose of FSH or HMG, the response of your ovary (follicle number) and operation report

Procedures of IVF:

1. Infertility Evaluation - bring reports to Taipei to do the infertility evaluation in advance and to plan the IVF; take the examination of AMH that will reveal your ovarian reserve before you are enrolled in the procedures of IVF.

2. Take oral pills for 21 days starting from Day 5.

3. Administer GnRH agonist (Buserelin) injection daily from the 18th day of the menstrual cycle with the oral contraception pills.  Superfact, 5.5ml per vial, bought in the Philippines

2. R-FSH and HMG will be administered on the 3rd day of the next menstrual cycle.  Starting dose depends on the individual ovarian reserve.

3. On the 7th day of the current menstrual cycle, the ultrasound examination will be used to monitor the size and the numbers of follicles.

4. Also on the 3rd, 9th day of current menstruation cycle and the day that we adminster HCG, we will check the E2 level in your blood to predict and evaluate the ovarian response.

5. The doses of R-FSH and HMG will be adjusted according to the response of ovaries.

6. Procedures of ovum pick-up will be performed at 34-36 hours after administering HCG when it is supposed to be between the 13th and 18th days of the current cycle.

7. On the 3rd day after ovum pick-up, the embryo will be transferred.

You should come to Taiwan on the 2nd day of the current menstruation and stay for about 23 days.  You can go home after the embryo transfer.

8. Luteal phase support is provided with 50 mg of progesterone IM injection and vaginal application of Crinone (8%) after ovum pick-up.

9. OPD visit will be arranged for detecting gestational sacs (about 5.5th gestational week) and fetal heart beat (about 6.5th gestational week) with ultrasonic examination in the Philippines.

Cost of the IVF Procedure:

Cost of the IVF procedure including medication, embryo culture etc. is approximately USD4500 in Mackay Memorial Hospital.  That is less than Php200,000.

Documents Needed for IVF

1. You and your husband's passports, original and copy.

2. You and your husband's driver licenses, original and copy.

3. Marriage certificate (official document to prove that the marriage is legal) original and copy -- VERY IMPORTANT! 

4. Report of you and your husband's data of blood type, reports of HIV and syphilis exam (data of HIV and RPR must be within 6 months) original or copy

Lab Opening Hours:

8:30AM - 1:00PM; 2:00PM-3:00PM

  

Q. For the TSH, prolactin semen analysis, HIV and syphilis tests...can we have the tests done here in the Philippines or better if we do it there in Taipei?

A. Examination from the blood sampling for TSH, prolactin HIV, syphilis could be taken both in Phillipines or Taipei, but semen analysis should be performed in Taipei.

Q. For my HSG, I had it done more than 2 years ago.  Is it okay or do I have to recheck it?

A. You don't need to recheck HSG, but bring the film of HCG on compact disc of HSG to Taipei. 

Q. How long should we stay there for the initial consultation or assessment?

A. The first stage you just need to stay three or four days.

Q. Where can we stay? 

A. We'd be glad to help you book the hotel and provide you with the relative information.

Vanessa emailed me a list of the hotels and apartments near the hospital including the prices and the map.  In case you are interested, just email me at debjsyu@yahoo.com and I’ll send you the copy.

For more details on IVF, call Vanessa

International Medical Service Center
Mackay Memorial Hospital

No. 92, Sec. 2 Chung-San North Road,

Taipei 10449, Taiwan, R.O.C.,
Email: mmhimsc@ms2.mmh.org.tw
Tel/Fax: +886-2-25627200
http://www.mmh.org.tw/imsc/index.htm