Most Frequently Asked Questions: Why IVF? Why in Taiwan? Why in Mackay Memorial Hospital?

Photo grabbed here

This is the most frequently asked question in my blog and emails.

Why did you undergo IVF? Why in Taiwan and why in Mackay Memorial Hospital? 

Here's my answer.

These are some of the reasons why I chose to have IVF in Mackay Memorial Hospital in Taipei:

1. Proximity wise, Taiwan is nearer to the Philippines.

2. It was way cheaper to have IVF done in Taiwan compared to the Philippines, Singapore or US in terms of medical expenses, food and accommodation. 

3. Taiwan has a higher success rate in terms of their IVF.

4.  I have personally spoken to quite a number of people who were successful with their IVF with Dr. Robert Lee as their ob-gyne.

5. I find Dr. Robert Lee very professional. He knows what he is doing and I feel comfortable with him.

6. The system in the hospital is very organized.

7. They have an International Medical Service team that will assist you with all the things that you need. They are prompt in answering all your queries through email and they are also the ones who will help you arrange your accommodation there.

8. Love the food in Taipei... and shopping as well!!

9. I also felt that a change of environment would be healthy for us as we were able to escape the stress we have here in the Philippines.  We were able to rest and unwind. It was like our second honeymoon and the IVF was like our side trip instead of the other way around.  We enjoyed the trip very much and the baby is our bonus :)

Why IVF? 

It was recommended to me by my OB then after 3 consecutive failed iui from her.   Though prior to this, we have also tried 2 IUI with another ob.

Given our case, the success rate was 50% according to our ob in Taiwan. That’s a 50-50 chance for us…  and since we have tried everything already, IVF was our last resort.

Plus the fact that  my biological clock was ticking and was not getting any younger, I was determined to give IVF a try even just once only.   I wouldn't want to wake up one day and regret the fact that I did not do something when i could have done something.  

To quote from Mark Twain: “Twenty years from now, you will be more disappointed by the things that you didn’t do than by the ones you did do.  So throw off the bowlines.  Sail away from the safe harbor.  Catch the trade winds in your sails.  Explore.  Dream.  Discover.”

IVF was indeed worth a try... especially  with our dream of having a baby as the prize.

    

Coming Soon...

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.

A 50-50 Chance on IVF

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

I got the results of my blood tests and husband’s semen analysis through email two weeks after the tests were done.  The results of my PRL (prolactin) and TSH were within normal limits.  The level of AMH is 3.36mg/ml, thus should I continue with the IVF, I have to take protocol 1.  To read more about PRL, TSH and AMH, please click here.  

The semen analysis, on the other hand, was also within normal limits.  In addition to the usual semen analysis, sperm staining was also performed.  Sperm are stained and enlarged up to 1000 times to assess the normal morphological proportion, to predict the probability of oocyte fertilization (General sperm analysis only checks up to 100-fold amplification, and staining is not performed.)  This is a stricter classification called the Kruger strict criteria for assessing sperm morphology.     

Given our case, the success rate is 50% according to Dr. Lee.  That’s a 50-50 chance for us… A gamble?!?  Indeed it is!  With all the associated risks and costs involve in IVF, the whole thing can seem like an enormous gamble.  It can feel a lot like playing in casino tables wherein you put down a huge amount of money in the hope of a big payoff – a baby.  And just like gambling, the more money you lose, the more you’re tempted to try just one more time to get that prize.

Honestly, up until now, we are still thinking whether or not to push through with the IVF.  I’m sure everything will be worth it if it is successful, but what if it isn’t?  If you were in my place, would you go for it?!?   

Right now, what I'm doing is I’m trying to increase the odds of our success by finding and doing every possible ways, no matter how small it is, to optimize our fertility...  getting myself ready... physically,  mentally, emotionally, financially and spiritually for this one big fight.  

Should you have some tips and advices, please feel free to leave your messages below.  All these will be very much appreciated.  Thank you very much!     

IVF Consultation Part 7: Payment

Last but not the least... Paying for all the procedures done for the day.

Oops, I think we paid at the cashier first before having the blood tests done and getting the medicine.  From the 2nd floor, we took the escalator down to the 1st floor and the cashier was there already, so we paid first.   Hmm... maybe you can do whatever is more convenient for you.  They did not ask for the receipts anyway.

If you are paying in NT$, you have to pay here.  But if you are going to use your credit card, you have to go to the 7th floor of the hospital.

Cashier of Mackay Memorial Hospital

Here's the breakdown of our billing:

Registration                    - NT$ 150

Doctor's examination - NT$ 300

Medicine (Gynera)        - NT$ 137

Pelvic Exam                    - NT$ 84

Sperm Analysis             - NT$ 1560

Prolactin                          - NT$ 360

TSH                                     - NT$ 432

AMH                                    - NT$ 960

Ultrasound                     - NT$ 778

Pharmacy Service          - NT$ 60

Reprint of Ultrasound   - NT$ 6

Total of our Bill            - NT$ 4827

Generally speaking, I can say that the consultation went well.  They are very systematic and organized there.  In fact, we were able to finish everything in one day, except for the semen analysis which was submitted on another day.  So, we only spent one whole day for the consultation and assessment.  That means we've got more time for eating, shopping and touring around Taipei.  Hehehe!  

So, that concludes the First Stage.  To learn more, you can also visit the website of Mackay Memorial Hospital and Mackay Memorial Hospital International Medical Service Center.  

IVF Consultation Part 6: Getting the Medicine

Almost done with the whole process...

This time, we have to get the oral pills from the pharmacy located at the Ground Floor of Mackay Memorial Hospital.  This is also near the Laboratory.

Pharmacy of Mackay Memorial Hospital

Dr. Lee gave us a slip of paper which we needed to claim the medicine from the pharmacy.  On the paper, you will see a letter and a number.  In our case it was letter C, so we have to line up there.

The medicine he gave us was Gynera, a birth control pill which I have to take for 21 days from the 5th day of my menstruation should we plan to start the IVF procedure.

Front of the Package

Back - Gynera Oral Pills

When we got there, the package was already ready for pick-up.  

To be continued... IVF Consultation Part 7: Payment

IVF Consultation Part 5: Semen Analysis

Borrowed from this site.

For the semen analysis, you have to go to the IVF Lab 6th Floor of Mackay Memorial Hospital.  Back to the place where we met Ms. Tsai early in the morning.

The office hours of the IVF Lab is from Monday to Friday 8:30am - 1:00pm and 2:00-5:00pm; Saturday from 8:30am-1:00pm.

First, you have to make a schedule for the semen analysis with the lady-in-charge.

Then, she'll provide you with a sealed, sterile plastic container with your patient chart number on it.  It must be sealed, so do not accept if seal is broken.

sterile container for the semen analysis

You have to return the container with the semen sample back to the IVF Lab on your scheduled date.

Important things to note:
1. Receiving time is from Monday to Saturday, 8:30am - 12:00nn.
2. Sexual abstinence of 3-5 days, but not more than 5 days is needed.
3. Do not use condom.
4. Directly ejaculate into the container.  Once only.
5. Bring the semen sample to the laboratory within 1.5 hours.
6. Keep the semen sample at room temperature.
7. Bring with you the slip of paper from Dr. Lee.
8. Results will be available after 1 week.

To be continued... IVF Consultation Part 6: Getting the Medicine

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 

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: Lee Women's Hospital (Dr. Maw-Sheng Lee)

Taiwan IVF Center: Lee Women's Hospital

Another doctor in Taiwan, who is famous for IVF is Dr. Maw-Sheng Lee.  I also emailed and inquired about IVF there.  The response below:

Procedure of In-Vitro Fertilization (IVF)

1. The successful pregnancy rate of the first IVF is around 50%.

2. According to our suggestion, it would be better to continue the treatment cycle for 2-3 times. The cumulative successful rate is about 95%.

3.One IVF cycle needs two menstrual cycles, about 2 months to be complete.

4.At first menstrual cycle Day 5, start to take Progyluton one tab. Once a day until Day 25.

5.And at Day 21, start Lupron injection 0.1ml or 0.05ml (more than 42 years old), also Once a day.

6. At 2nd menstrual cycle Day 2 or Day 3, you have to be in our clinic forblood test, vaginal ultrosound, semen storage and start treat with gonodotropin.

7..At secondary menstrual cycle Day 8 come back again for follow up the follicles.

8.The oocytes retriveal day is around on Day 12-16.

9. One IVF treatment cycle needs about NTD:120,000~150,000.(Including: The medicine fee, hormone assay, semen storage and preparation, oocyte pick-up,embryo culture and embryo transfer....etc)

10.Our donor sperm are all Chinese and the cost is NTD:20,000 per case.

11. Egg donor also all Chinese and the cost is NTD:250,000~270,000 per case...

12.The TESA (Testicular Sperm Aspiration)  procedure cost about NTD:21,000.

13. The ICSI procedure cost about NTD:10,000

14. The LAHA procedure cost about NTD:5,000

Please give us, husband's and wife's, infertility summary, English fullname, birthday, Identification No.(Social security No.or driver's license No.) and passport No. to make a certificate for VISA and Cellphone no. and TEL no. and FAX no. for setting your medical record. You have to give us both passport copy and marriage certificate copy.


If you need medicine (Progyluton and Lupron), Please transfer US$260.00 to CITIBANK N.A. TAICHUNG BRANCH, we can mail to you. Please give us your address for mail medicine.  Please ask your bank to remit through:


Beneficiary Bank: CITIBANK N.A. WEN-HSIN BRANCH
Bank Address: IF, 823 SEC.4  WEN-HSIN ROAD , TAICHUNG , TAIWANR.O.C
SWIFT Code: C I T I T W T X
Beneficiary:  MAW-SHENG  LEE
A/C No:  0053034740


Please E-mail (ivftaiwan@gmail.com) or FAX:886-4-22384602 the copy of receipt to us, and we will mail medicines to you.

What is IVF (In Vitro Fertilization)?

1. IVF (In Vitro Fertilization) is an artificial reproductive technique to retrieve oocyte by vaginal ultrasound, select sperms at laboratory, and culture embryos in vitro, then the better embryos will be transfer to uterus, the pregnancy rate of the first IVF in our center is around 45~50%, and it's better than the average pregnancy rate (40%) of other IVF centers around the world.  If we combine laser assisted hatching (LAHA), the pregnancy rate will raise to 50~60%.
2. If you do the IVF treatment for three successful cycles, the pregnancy rate will raise around 90~95%.
3.Ordinary women extrude one oocyte per menstrual cycle, if by ovarian induction; you can get better quality and quantity oocytes. In order to get better oocytes, some medicines will be used in IVF treatment (Ex. Regulation of menstrual cycle, Pituitary inhibitor, and ovarian stimulating agent).

4. Generally, the oocytes for IVF are induced by gonadotropin (ovarian stimulating agent) and the follicle's maturation is observed by vaginal ultrasound, It takes around 4~5 days for follicle's maturation, Oocyte retrieval day is arranged when the follicle's mature. The oocyte retrieval is under vaginal ultrasound guide, through vagina, because it is woundless, and recovery more rapidly.

5. Sperms for IVF must select and purified. First, husband should collect semen in sterilize bottle by masturbation. Then send it to laboratory within 2 hours at room temperature.

6. Laser assisted hatching (LAHA) is a technique to open zona pellucida of embryo's in order to help embryos Implantation.

7. TESA, MESA , and PESA, Intra-cytoplasmic sperm injection(ICSI) is a technique to inject single sperm to an oocyte, It's for severe sperm problems or fertilization failure,It's fertilization rate is around 85% as same as IVF, If there are enough oocytes, the pregnancy rate is around 45~50%.If your husband is azoospermia, he must make to testicular operation, if it's normal, he may use fresh semen sample.

8. Cryopreservation of embryos is a technique to stock extra embryos. If this cycle is pregnant, you can thaw the embryos for next time for another baby. If this cycle fails, you can thaw the embryos for the next cycle, the pregnancy rate by cryo-embryos is around 30%, and it is not necessary to receive medicines again. (embryo strorage fee NTD:6,000/per year)

IVF Treatment Procedure

I.The First month (in your country)

A.Take Progyluton once a day on 5th day of first menstrual cycle until 25th day.

(Take Progyluton for 21 days; Progyluton is a contraceptive agent and it can regulate your menses cycle)

B.Injection Lupron 0.1ml (or 0.05ml more than 42 years old) at 21st day of first menstrual cycle until the oocyte retrieval.

(Lupron is a Pituitary inhibitor controlled and synchronized ovulation for the next cycle).

II.The second month (in Taiwan ) about 3~5 weeks.

You may choice stay on 3 weeks or 5 weeks in Taiwan.

Come back to our clinic at 2nd or 3rd day of the second menstrual cycle for:

1.Blood sampling

2.Ultrasound (tracing the follicle's development, ovarian cyst).

3..Husband takes semen out for storage

Gonal-F (recombinant FSH) by injection for 5 days

Come back to our clinic on the 8th day

Take blood sample, and ultrasound.

Until Oocyte mature

Two more days

Oocyte retrieval ( AM.5~7 o'clock), and husband takes semen out

3~5 days

Embryo transfer (about 3 weeks)

15 days

Pregnancy test (about 5 weeks)

Do you need Hotel reservation and Airport Pick-up? 

(1)Airport Pick-up (4 seats) NTD$2000/car

(2)Airport Pick-up (8 seats) NTD$2300/car

We may arrange The ALICES HOTEL and Airport Pick-up for you( airport to Taichung about 2 hours).

Lee Women's Hospital                     Division of infertility clinic

263, Pei-Tun Road Taichung ,            406 Taiwan Republic of China

TEL: 886-4-22347057                      FAX: 886-4-22384602

Our web: http://www.ivftaiwan.com    E-mail address: ivftaiwan@gmail.com