KATO: 3rd Consultation

My 3rd consultation with KATO was on my CD16, October 29th.

I was glad to find out that I have one dominant follicle on my right ovary. Dr. Perillo did the transvaginal ultrasound. She was accommodating and I felt really comfortable to ask questions. 

She said that I should go back on October 31st, which is my CD18, for the egg retrieval. I got excited because our journey is somehow going somewhere, although I was nervous at the same time because I worried about the quality of my egg.

I was given a nasal spray, Suprecur, which I would use once at midnight. One of the nurses showed us a video on how to use the nasal spray properly. I was also prescribed to take Advil 3x on the next day at noon, 6:00 p.m., and midnight.

Acupuncture for fertility

On October 26th (Saturday), I and hubby went to our acupuncturist for another session. Our appointment was at 10:30 a.m. First, Dr. Ria had to check my pulse and in just a few seconds of doing that she nodded and smiled. She also smiled when I showed her my tongue. So I take that reaction as good news. I hope.

Dr. Ria used 6 needles on my husband, but I didn't see where they were put because she did me first. She used 10 on me -- 3 on the left leg, 2 on the right leg, 2 on the left arm, and 3 on the right arm. I dozed off after that. It was a very nice and relaxing feeling. 

We were supposed to schedule another session on November 2nd, but it's a holiday so we're going to have to wait another week for our 3rd session.

Dr. Ria said we can stop acupuncture sessions when hubby's sperm motility has improved and when I get pregnant.

Studies show that acupuncture can help with fertility by reducing the effects of stress and balancing the hormones. These are the main reasons I go to an acupuncturist. Some women who have undergone IVF claim that acupuncture increased their chances of producing a successful pregnancy, especially when done on the day of the embryo transfer. 

Being licensed and board certified does not guarantee expertise in reproductive disorder, so those choosing to include acupuncture in their treatment regimen should only be treated by an acupuncturist who specializes in fertility.

(image source: http://whitelotuschi.com/Infertility.html)

(Source: http://www.shadygrovefertility.com/acupuncture)
Acupuncture is a form of physical medicine that originated in China over 4,000 years ago. It uses very thin, sterile needles, inserted into specific points on the body, to manipulate and balance the flow of energy through the body. Acupuncture for Fertility can boost your fertility and increase your chances of success when you are trying to conceive.

How does it work?

Oriental medicine has enhanced fertility for thousands of years by balancing the flow of energy through the body. Achieving and maintaining balance is the goal of life. When we are in balance, our bodies function optimally: our organs function well, our sleep is restful, we are resistant to disease, we recover easily from injury, and our reproductive capacity is functional. For a variety of reasons this balance can become disturbed.

Imbalance gives rise to symptoms, including infertility. Acupuncture aims to correct any imbalance, eliminating any and all symptoms that the imbalance caused. Recent studies suggest that acupuncture may increase conception rates. All of the PDtM acupuncturists are highly skilled, licensed professionals who go through a fertility-specific training process, making them true specialists in the field. 

Acupuncture has been hypothesized to help with all stages in the fertility journey from conception to delivery. Some studies have show that acupuncture may help with:

How can acupuncture help with fertility?

• Reduce stress
• Relieve morning sickness
• Alleviate back and post-op pain
• Help with post-partum pain and depression
• Increase live birth rates

KATO: 2nd Consultation

My second consultation at KATO was on October 25th, which was my CD12. After checking in at the reception area, I was called into the testing room. The nurse took my vital signs and everything seemed normal. 

Next I was called into the treatment room for the follicle monitoring. Dr. Mendiola performed the transvaginal ultrasound, which they call in KATO as B-scope. It was a little bit awkward when we exchanged greetings because I was already half naked with both my feet up the stirrups, my vagina exposed to him, when he came. I would say I was more comfortable having transvaginal ultrasound at SLMC-GC because I didn't feel "too naked" there. At KATO, the chair is reclined a little bit low and the stirrups are high that you are positioned like a person about to give birth. There is a curtain between the patient and the doctor, but you can see through it. You are given a towel to cover the naked part of your body. At SLMC-GC on the other hand, the chair is not reclined too low and the stirrups are positioned low, so it feels like you are just sitting. There's a big pillow to support your back and you are given a big sarong-like cloth to cover you, making you feel comfortable and not too exposed. You would  see the doctor face to face, but with my experience, this didn't make me feel awkward.

Dr. Mendiola checked my right ovary first. During my first consultation, only one follicle was seen, but this time there were two. It took Dr. Mendiola longer to check my left ovary and when he spotted a follicle, he said "Ayun!" ["There it is!"], but he lost it. He tried to locate it long enough, but to no avail. He said that all he could see were blood vessels.

The follicles found on my right ovary were still small. I suspect that the follicle on my left ovary was the dominant one (it has always been like this during my previous workups), but unfortunately he couldn't measure it because it was hiding somewhere. Dr. Mendiola told me to be back on my CD16, which is on October 29th. Maybe he was thinking I would ovulate late. I don't know what to expect next. I usually ovulate on my CD14, so I might have ovulated already on my 3rd consultation. This would mean I would start anew on my next cycle. Hopefully, my FSH level has lowered down by then (*crossing fingers*).

...or maybe there was divine intervention...maybe God has another plan for me. Whatever happens next, I leave it all up to God.

What is FSH and what are some natural ways to lower FSH levels?

What is FSH?

FSH (follicle stimulating hormone) is a hormone released by the pituitary gland which stimulates the growth of follicles and has a role in the maturation of oocytes. The measurement of FSH levels in the blood is one of the most widely used tests to assess a woman's ovarian function and is typically taken on day 2 or 3 of a woman's menstrual cycle. If a woman's FSH levels are above what is expected for her age, then she is considered to have "High FSH". 
(Source: http://www.centerforhumanreprod.com/high_fsh.html)

FSH levels fluctuate daily within a woman's cycle, as well as from cycle to cycle. Low levels of FSH indicate a woman's eggs are plentiful and of good quality, while high levels may indicate that the woman's fertility is impaired. This doesn't mean that she's unable to get pregnant and have a healthy pregnancy, but that getting pregnant and having a good pregnancy outcome may be more difficult that for a woman the same age with an average FSH level. 
(Source: http://health.howstuffworks.com/pregnancy-and-parenting/pregnancy/fertility/how-do-high-fsh-levels-affect-getting-pregnant.htm)

What are some natural ways to lower FSH levels?

1. DHEA

Dr. Mendiola of KATO prescribed me to take 75mg of DHEA every day, so I went to Healthy Options to get it. Based on my readings, allow at least 4 months to see results. Some have claimed its impressive results, but others did not see any improvement. I guess it still depends on how your body responds to it. Although studies say this supplement doesn't give significant side effects, some women who used it said they experienced breakouts, falling hair, upset stomach, facial hair growth, and deepening of the voice.

2. Acupuncture

Acupuncture and TCM (traditional Chinese medicine) also have been shown to give amazing results in lowering FSH levels. I swear by acupuncture. Four years ago, my husband used to have severe allergic rhinitis and only four sessions of acupuncture cured it.

On October 19th, I and hubby went to our acupuncturist, Dr. Ria of TCM Health Care, and discussed with her our current situation. Only six needles were used for my husband --3 on his legs (1 on the left, 2 on the right), 1 on each hand, and 1 on the nose. She used six needles on my legs (3 on each leg), 4 on my abdomen, and 1 on my nose. She also used an acupuncture heat lamp over my abdomen. After the session, Dr Ria checked my ears and said that I really have hormonal imbalance. She asked me to have my estradiol and progesterone checked on my CD 21. Hubby and I plan to continue to have acupuncture every week.

3. Wheatgrass

Wheatgrass is one of the superfoods and one of its popular benefits is that it can lower women's FSH levels. I have been drinking wheatgrass on and off in the last 7 months, but now I will be taking it religiously to help me with my hormone problem. Wheatgrass comes in different forms -- pill, powder, and grass. I use the powder form because it is more convenient for me.

4. Flaxseed Oil

I asked Dr. Ria about other supplements that I can take to help me with my hormonal imbalance and she recommended flaxseed oil. I bought a bottle at Healthy Options. 

In regards to fertility, flaxseed oil is used to treat menopausal symptoms, menstrual cramps, female infertility, and endometriosis. Because the hormone-balancing lignans and plant estrogens (phytoestrogens) in flaxseed oil help stabilize a woman's estrogen-progesterone ratio, they can have beneficial effects on the menstrual cycle, and relieve the hot flashes of premenopause and menopause. Flaxseed oil may also improve uterine function and thus treat fertility problems. In addition, the essential fatty acids in flaxseed oil have been shown to block production of prostaglandins, hormone-like substances that, when released in excess amounts during mentruation, can cause the heavy bleeding associated with endometriosis. 
(Source: http://ttcwithherbs.webs.com/flaxseedoil.htm)

KATO: 1st Consultation

I had my period on October 14th, so I called KATO for an appointment and was scheduled at 2:30 p.m. on October 16th because it was my CD3. 

When I got there, hubby was already filling in his information into the medical forms online using KATO's iPad. I borrowed another of KATO's iPad to do mine. The clinic also issued me a card, which has my name and a number. To know when your turn is and where to go, the number on the patient's card is flashed on the screen they have at the lounge area. All the doctors, nurses, and staff members are warm, kind, and friendly.

After filling out all the online forms, I and hubby waited for our numbers to be flashed on the screen. First, we were called into the testing room. The nurse measured our blood pressure, height, and weight. The nurse also extracted some blood from me for the hormone tests -- estradiol, LH, progesterone, FSH, B-HCG, and prolactin. After that, we went back to the patients' lounge to wait for our numbers again to be flashed for the next step.

Next we were called into the consultation room. We met Dr. Mendiola and Dr. Ong-jao. We brought our previous work-up and lab records and submitted them to the nurse at the reception area, so when we got to see the doctors the papers were already with them. Dr. Mendiola reviewed our previos records and gave a short explanation of how follicles work and how fertilization occurs.

After the short talk with the doctors, we had to wait in the patients' lounge again for the next step. I was called into the examination room for the follicle monitoring through transvaginal ultrasound performed by Dr. Ong-jao. At the same time, hubby was doing his thing for the sperm analysis.

It would take 45 minutes to get the results of the tests, but we just stayed in the patients' lounge. There were some reading materials there and a television to keep us occupied while waiting anyway. 

Dr. Mendiola and Dr. Ong-jao discussed the results to us. Compared to hubby's previous sperm analysis, his count improved. There was a problem with motility though. But with IVF, this shouldn't be a big problem. In my case, out of the five hormone tests, I "failed" one -- the FSH. The normal value at this stage of my cycle should be between 4.5 and 10, but to my dismay mine was 37.9 and this not really good. 

Dr. Mendiola explained that my brain was sending the wrong message to my ovaries, so they seem to be overstimulated. This meant that I couldn't undergo minimal stimulation for the IVF. Instead I would rely on the eggs my body produces naturally, meaning I would be doing natural IVF. 

What a stressful day. I'm not losing hope. Lord, thy will be done.

Our 2nd consultation is scheduled on my CD12, which is on October 25th.

Lee Women's Hospital in Taiwan VS. Kato Repro Biotech Center in the Philippines

I thought I have made up my mind about going to Taiwan, but I am still having second thoughts and weighing things between Lee Women's Hospital and Kato Repro Biotech Center. One of the most important things to consider is the budget. I am also particular with the method. 

At first, I was leaning on Taiwan because of the success rate and the possibility that I can have twins. On the other hand, the approach in Lee Women's Hospital is aggressive that some women experience Ovarian Hyperstimulation Syndrome (OHSS) during the process. OHSS is a complication caused by fertility medication, which needs to be addressed before any embryo transfer should be done during the IVF procedure. 

Kato's success rate is also increasing. Its protocol is more of like the natural way to conceiving a baby. They have what they call the Natural Cycle IVF, but this is available to those who are qualified depending on the center's assessment. If for some reason the patient can not have the Natural Cycle IVF, she will be under the Minimal Stimulation IVF. Unlike in Lee Women's Hospital, embryo transfer in Kato takes place on the next cycle after the cycle of egg retrieval. This will give time for woman's body to recover from procedures and medicines during the first cycle of the IVF. This center is very strict about the number of embryos that they implant, which is 1 to 2 only, so there is lesser chance of having twins.

I am still doing some readings and research about these two IVF centers, but what I have come up with so far is a comparison of estimated expenses for the two centers. The costs may change in the future.

TAICHUNG IVF ESTIMATED EXPENSES

(as of September 23, 2013)

One IVF Cycle:

• US$280 (medicine for stimulation)
• US$5,400 (all-in: hospital only)
• Others (if necessary): ICSI – NT$10,000 ; LAHA – NT$5,000 ; Frozen material & technique fee for frozen embryos – NT$10,000
• Air Fare: P5,000 – P10,000 (via Cebu Pacific, depending on the promo)
• Service from airport to hotel: NT$2,000
• Hotel accommodation: ALICE Hotel – NT$900-NT$1,200/day (minimum required stay for the whole procedure is 15 days, ideal is 30 days)
• Others (VISA application, food, transportation within Taichung, laundry service, etc.)

 Note: NT$ = New Taiwan dollar

KATO IVF ESTIMATED EXPENSES

(as of September 23, 2013)

• First Consultation: P1,680
• Succeeding Consultations: P560/visit
• Ultrasound: P560/visit
• Sperm Analysis: P560/test
• Hormone test: P1,496 per hormone per visit (Estradiol, Progesterone, LH, FSH, B-hcg, Prolactin
• Infectious Disease Screening: P2,520/each (husband & wife)

Natural Cycle IVF: P168,000 (package)

Note:

-Package is for qualified/eligible candidates only

-EXCLUSIVE OF  consultation fees, ultrasounds, sperm analysis, hormone testing, infectious disease screening + medicine

-If initial pregnancy test is negative, patients only pay P16,800 (EXCLUSIVE OF consultation fees, ultrasounds, sperm analysis, hormone testing, infectious disease screening + medicine)

Minimal Stimulation IVF: P207,200 (EXCLUSIVE OF consultation fees, ultrasounds, sperm analysis, hormone testing, infectious disease screening + medicine, etc.)

Note: Payment is dependent on each procedure used for the cycle

Back from hiatus

In the past two months that I haven't been able to update this blog, I was just feeling down and couldn't find myself to talk about anything related to getting pregnant. The feeling comes and goes, I'm sure many of those TTC understand this. 

Just recently, my father-in-law had a serious talk with hubby and me. It was about major decisions we had to make. First, it is about deciding on going to Taiwan for an IVF. We have been living in Manila for 9 years now and the second major decision we have to make is about leaving everything in Manila behind and going back to our hometown to give way to my father-in-law and hubby's plans of putting up a business back home. I and hubby drafted our timeline for these plans. There are no final talks yet, but based on my father-in-law's statements, these plans must happen. I don't have any negative feeling about it anyway. I am for these plans.

I am grateful, really, really grateful to my in-laws for offering to help with the funding of our IVF in Taiwan.  Of course the pressure and what ifs are still there, but I am leaving it all up to HIM now. 

There is this blog I have been following that I haven't checked in a long time until today. I am really happy that finally, the blogger got her BFP after an IVF procedure in Taiwan. She had been through a lot of things as far as TTC is concerned, but she never lost hope. She tried everything she could and failure did not hinder her from trying again. Hers is an inspiring story. This is the link to her blog: 

http://infertilityphilippines.blogspot.com/