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!

Blood Test at Manila Endocrine Laboratory

I just had my blood tests done here at Manila Endocrine Laboratory this morning. It's been more than a year since I last checked my LAT, APAS and NK Cells.  Since we're planning to go through IVF, we decided to have these rechecked again and see if there are still problems...  At least, we can still work up on the problems before going to Taiwan for the IVF.  Though our doctor in Taiwan do not believe that my immunological problems are the cause of my infertility, we chose to work up on this side as well.  Better safe than sorry.  This is because I have heard some people who have gone through IVF without fixing their immunological problems first, and they got negative results in the end... 

This is the gate of Manila Endocrine Laboratory.

  

Took this picture while inside the car because it was raining this morning when we went there.

Go straight inside and you'll see this clinic.

This is the blood extraction area.

The tourniquet (tight band) has been placed around my upper arm... and now the medical technician is looking for the vein...

After putting alcohol on the skin over the chosen vein, the needle connected to a syringe was then inserted into  my vein. Ouchy!!!

Extracting bbloooooddd....

After extracting the required amount of blood, the needle was removed.  The small wound was pressed on with cotton for a few minutes to stop bleeding and prevent bruising.  My blood was then placed in these vials. (Only 4 vials in front)

Cost of the tests:
Lymphocytes Antibody Test (LAT) - Php3,500
APAS Test - Php5,000
Primary Immuno Deficiency Panel 1 (for NK Cells) - Php5,800

Total: 14,300

Only a few laboratories do these testings and prices vary.  LAT and APAS tests can be done in PGH-Medical Research Laboratory (Contact Number 5548400 Loc. 3232) every Monday to Friday, 8-10am. Results are released every Friday. Prices are Php3,500 and Php6,410 respectively.

For the Primary Immuno Deficiency Panel 1, you can also have it tested at St. Luke's Global (Contact No. 7897700), 2nd floor pathology for Php5292.  Actually, even if you have it checked at the Manila Endocrine Lab, they will send it to St. Luke's Global for the testing because they are only the ones who can do this kind of testing here in the Philippines.  APAS and LAT testings can also be done in St. Lukes, but are more expensive.

Results:

The results of my APAS tests will be sent to me via email tonight. As for the LAT and NK cells, most probably I will get them on Saturday.  

They run the LAT testings every Friday morning and results are out in the afternoon or by Saturday mornings. So if you want to get your results asap, it would be better to have your blood extracted by Thursday of the week.

For the NK cells test, it usually takes about 2-3 days for the results to come out if you do it in St. Luke's.  So here in Manila Endocrine Lab, results are expected around 3-4 days since they have to bring the blood to  St. Lukes.

Note:  Fasting of 4-6 hours is needed if you are going to do the APAS test.

How to go to Manila Endocrine Laboratory:

That's all for today.  I will update you again of the results as soon as I get them. Till then...

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 3: Infertility Treatment Consent Form

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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 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

Cost of Infertility Treatments

http://www.flickr.com/photos/8011986@N02/

Infertility treatments are expensive.  Unfortunately, here in the Philippines, we do not have infertility health insurance (not one that I know of) like other countries wherein they are given reimbursements for infertility treatments.  Since we do not have this luxury, the financial burden lies solely on us.

As most prices of commodities have gone up, so does the cost of infertility treatments.

In 2006, I had my HSG done at Chinese General Hospital.  For the procedure alone, it costs us Php6,000.  Just recently, I asked my OB for the ongoing rate of HSG, and she said it is around Php10,000 at Cardinal Santos and Php15,000 if in St. Luke’s.

For the laparoscopy and hysteroscopy combined, we paid around Php80,000 for the two procedures.  We opted to have it done at Philippine General Hospital (PGH) because of the price difference.  If we are to do the surgery at Medical City or St. Luke’s, the cost will be around Php150,000 – 200,000.  The same doctor, the same procedures… different hospital, different price.  A very huge price difference at that!

In fairness, the doctors and nurses at PGH were very good and professional.  We chose the private room, which was really big and clean.  The only problem with PGH is the lobby… there were too many people of all sorts.  I didn’t expect much from PGH because it was after all a public hospital.  But with the price I paid for, and the service that I got, I was more than satisfied with the whole experience.

For IUI, it cost around Php6,000 in 2007.  Right now, it is Php10,000 per cycle.  Price differs per OB and also as to where the procedure is to be done.

For the LIT, it costs Php14,000 per donor if blood extraction and processing is done at the Manila Endocrine Laboratory.  Php27,000 if it is done at St. Luke’s Hospital.

Blood tests can also entail a huge amount of money.  Immunological testings can cost almost Php50,000 if you test all categories.  Aside from that, you also need to have some blood tests done from time to time.

For IVF, it will cost around P500,000 if done here in the Philippines.  It would be cheaper if you’ll have IVF done in Taiwan.  It will cost you around Php300,000 for the whole procedure including your stay there.

No wonder, treating infertility is very stressful.  Aside from the emotional stress, there is also the financial burden as to whether you can possibly afford all the treatments needed to bring you a child.  You really have to think about how far or up to what extend you are willing to go.

But of course, when the infertility treatments become successful, you’ll eventually forget all the money you’ve spent and all the pains and heartaches you’ve experienced.  Everything will be worth it.  Seeing your child in your arms makes the infertility journey all worthwhile.  It will definitely be worth the wait… with hope, dreams and faith, we can achieve the impossible.  Just hang in there… Happy Infertility!