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: 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

Special Leave Benefits For Women Who Undergo Surgery

Just in case you have not read about this, here is the March 18, 2011 press released by the Department of Labor and Employment (DOLE) regarding the special two-month leave that will be given to women who need to undergo surgery due to gynecological disorders.  Read on...

DOLE approves special leave for women in the private sector who undergo surgery

Women working in the private sector  who are scheduled to undergo surgery for gynecological disorders can now file for special leave.

This special leave privilege is contained in Department Order No. 112-11 which lays down the guidelines for availing the special leave benefit provided for under Republic Act 9710 (Section 18), known as the Magna Carta of Women (MCW).

Labor and Employment Secretary Rosalinda Dimapilis-Baldoz, who issued the order, said that  the guidelines ensure compliance on the implementation of the special leave benefits  for women employees in the private sector.

 “The two-month leave is in addition to the leave privileges under existing laws,” said Baldoz.

The Civil Service Commission also issued a resolution providing for the same privilege for women employees in the public sector.

Eligible for the special leave benefit are women employed in both the private and public sectors, regardless of age and civil status, with at least six months' aggregate employment service rendered in the 12 months prior to the surgery.

The leave may be for a maximum period of two months per year with full pay, based on the employee's gross monthly compensation following surgery caused by gynecological disorders. 

The special leave benefit shall be granted to a qualified female employee after she has undergone surgery, without prejudice to an employer allowing an employee to receive her pay before or during the surgery.

"It may be used for the period covering the surgery until recuperation. Absence incurred from the pre-surgery period, as well as those in excess of the two months allowed under the special leave benefit, may be charged against the employee's earned leave credits," added Baldoz.

To apply for special leave, a woman employee shall file her  application leave within a reasonable period of time from the expected date of surgery, or within such period as may be provided by company rules or by a collective bargaining agreement.

Gynecological disorders refers to disorders that would require surgical procedures such as, but not limited to, dilation and curettage and those involving female reproductive organs such as vagina, cervix, uterus,  fallopian tubes, ovaries, breast, adnexea, and pelvic floor, as certified by a competent physician.

The benefit is non-cumulative and not convertible to cash, unless otherwise provided for in a collective bargaining agreement (CBA).

The guidelines shall take effect 15 days after its publication in a newspaper of general publication.

Source: DOLE