IVF protocol

I am starting my first round of ivf this week. I am going straigt to the stimulation phase, no suppression drugs. Not sure why, i Know I should ask Dr, but anyone with simialr experience?

I'm might be starting IVF the next cycle as my 3rd IUI has failed. I don't whether I should do another IUI or just go straight to the IVF. I'm seeing the obgyn on Fri. Also, this IUI was done with a second obgyn and first time with full on injections so should I do another round with injections? Confused!

Might I ask you how old you are, and whether doctors have determined the cause of the infertility? If you're still young and you do not have any serious known impediments, maybe it's worth another few tries, since IVF is more invasive and more expensive. I've heard that people try 3 to 6 cycles of IUI generally. I've also done 3 cycles of IUI and 1 cycle of IVM, but am thinking of moving onto IVF after debating going back to more IUI. The main reason is that I have a history of ovarian hyperstimulation from injections (Gonal F), and I want to minimize my expoure by going with the option with the highest success rate. My 3 IUIs were done with Clomid (as opposed to Gonal F due to hyperstimulation), but Clomid had an adverse effect on the thickness of my lining. (As an aside, in case this is relevant to you, doctors I have seen have been divided on whether I have PCOS (incidentally, women with polycystic ovaries tend to get hyperstimulation more easily)).


Did you do one cycle with injections and the rest with Clomid? I sought a second opinion after my 3 IUIs, and the second doctor had suggested that I go for more IUIs, but on Gonal F at a much lower dosage than was given to me by my first doctor. He did not like Clomid because it can cause thin lining in some women. Maybe it's worth trying another IUI with injections in your case? Why did you go off injections after the first round?

Thanks for sharing your experience. I'm feeling so low today coz of the period today. Walking around the IFC like a zombie trying not to think about it.


I'm 34 (35 in Sept!!!!). My first Dr said that I had PCOS and was treated with Metformin and the three IUIs were done with Clomid. I didn't really react with the 2nd and 3rd rounds of Clomid. Then this dragged on for about 9 months and the Dr was on hols for a few cycles so I decided to seek a second opinion.


This Dr says the PCOS isn't a significant factor and I've stopped taking the Metformin. He's traced the problem down to my DH's sperm quality, which my previous Dr didn't really mention anything about!!! This got to me and I'm glad I sought the 2nd opinion. Now...the male factor isn't so easily fixed according to the Dr so that's why he said let's see how this cycle goes and we'll have to sit down and talk about things if it doesn't work out. I guess we're going to sit down on Fri and talk about the options. I personally want to do another cycle of IUI as I was on the lowest dosage (75mg) and I seemed to react quite OK to it. Actually stupid me didn't inject myself properly with that pen thing so I wasn't actually giving myself the right dosage for the first few days, but that didn't affect the growth much.


I'm also going back to Syd for 2 weeks in mid Aug so I wonder if it's OK to travel within the week of an IUI? It's just that I won't be able to do the booster shots...did you have to do those for your treatment?

Couple of thoughts on your message, based on my own experience.

- I'm also 34,and PCOS may or may not be a factor contributing to my subfertility. I think before you decide to what extent PCOS is affecting your fertility, you should be sure you are getting the right medical advice. Might I ask based on what factors your original doctor diagnosed you with PCOS? And based on what factors your second doctor determined PCOS is not a contributing factor? It seems that PCOS is very difficult to diganose, and in my case, doctors have been divided (3 thinking I don't have it, and one thinking I do have it). Because I ovulate regularly and have regular periods (even though bleeding has become extremely light) and am not overweight, most doctors seem to discount PCOS as a possibility even though I have multiple cysts in my ovaries and have acne. I have even gone to "a PCOS expert" at the Queen Mary who was recommended on this site, and felt his diagnostic methodology was not very thorough. Even though only one doctor seems to think I have PCOS, my gut feeling is that I have it based on my own medical history. For me, the strongest proof is that metformin seems to imrpove my cycle (at least based on my BBT chart, and in terms of menstrual flow). It's also improved my acne. If you are a borderline case, some doctors may be too quick in deciding that PCOS is not a factor. I think you owe it to yourself to do some research on your own and assess which doctor's diagnosis makes more sense.


- As for sperm quality, it seems to vary from time to time. My husband has poor motility at times, but at other times, they are normal. What kind of problem does your husband's sperm have? Has the doctor taken a second sample at a later time to make sure the problem is consistent? Assuming that the probelm is not grave, it appears that certain supplements can have positive effects. If the problem is serious, then perhaps IVF would make sense, as they can select an optimal sample of the sperm for fertilization.


- What do you mean when you say you did not respond to Clomid? Did you not ovulate at all or that you only got one follicle? If Clomid was not working well for you, perhaps, it is worth giving the injections a try a few more times, since you seem to have responded well to the injections. Once again, this is assuming your husband's sperms are capable of fertilizing the eggs.


- I'm not quite sure I know what you mean by "booster" shots. Do you mean Ovidurel (to mature the egg and cause its release)? I generally did not travel until after the IUI just to be safe - I just wanted to make sure I was maximizing my chances every time. If you are planning to travel, why not just take a break? The IUI can be expensive (especially with the injections), and in my case, quite painful, so I wanted the doctor to do everything by the book. Also, since you may have PCOS, you may be at risk of hyperstimulation with the injections, and it would be safer if your doctor could monitor you throughout the cycle - especially if you develop too many follicles. (In my case, I only produced 2 eggs on every cycle with Clomid, but when I tried Gonal F, I got severe hyperstimulation with more than 30 eggs and was told to abandon the cycle and refrain from intercourse).


I hope this is helpful! Have a good time in Sydney. It's good for the body and soul to get away occasionally from the constant pressure of fertility treatments. . .

Rose1234

I've done an IVF cycle without suppression. I think it's called the Antagon protocol. The doctor said that I didn't need to be suppressed on account of my age. It certainly made the cycle a lot shorter and easier.

thanks Iolana, the age thing probably explains it for me. I started my injections this morning. Do you mind if I ask you how your cycle went? What was the egg extraction like?

Rose

The cycle went well and although I didn't have a large number of eggs retrieved (only 6), I am now 6 months pregnant! I didn't really suffer any side effects after the egg retrieval, although I was given a bottle of pain killers in case of cramps. I just felt a bit sleepy and a bit gassy afterwards. Good luck with your cycle!

thanks again Iolana and congratulations on the pregnancy. It's great to here success stories -

Dear JH1 and others

We moved to Beijing 6 months ago and found there's not much help for infertility problems. Now we want to try Hongkong. I'd really like to know about costs as we have to travel for the treatment. How much does each IUI cost? Can you do IUI or ICSI if sperm is extracted by MESA (clinical process, not ejaculation) What do you recommend (doctor and hospital) that is reasonably priced and not short on quality. Thank you very much for any info provided!

I did my 3 IUIs with Dr. Alex Doo, who seems very popular on this site. Unfortunately, they were all unsuccessful. I've started seeig another doctor - Dr. Christine Choy, whom I really like. Although I have not had any IUIs with her yet, I plan to continue my fertility treatment with her. I think it's best that you call the various doctor's offices and enquire about the cost (the IUI itself is around $1600 if I remember correctly, but the drugs (esp. if you use injections) can be quite expensive, so make sure you ask for the cost for the whole cycle, not just the IUI itself. Dr. Doo is at 2523 3007. Dr. Choy is at 3112 0480. I found Dr. Choy to be more communicative and circumspect in her treatment approach.

Dear JH1

Thanks a lot for your info. Really appreciate people getting responding. Do you mean HK$ or US$?


Dear all

I am thinking I should go to Prince of Wales hospital and get their advice first. What do you think? SO far I have not tried any clinical procedure but now I am pretty sure there is no other option, one of my tubes is blocked and I am almost 39. I think I will visit at least 2 or more clinics and doctors when I make the first trip. Any other advice is welcome

Hello


Can anyone recommend me an infertility specialist at Queen Mary hospital?


WHen you talk about private doctors e.g. Dr Doo and Dr. Christine Choy, which hospitals are they affiliated with. I imagine they must be to be able to carry out IUI and IVF.


thanks a lot

Hi Newinbeijing

Many of the reproductive docs are affliated with the HK Sanitorium in Happy Valley. I believe their website is www.ivf.com.hk


IUI is done usually in their offices. Some allow you lay for 30mins others expect you to get up more or less immediately.


There are some that used to use a different location for ER and ET than their practice but not a hospital. I think I heard Dr Choy might be one of those or is one of those. Personally I would prefer being in a fully equipped hospital such as the HK Sanitorium in case of any emergency.


I know that you are in BJG planning to come to HK but thought I would pass this info on anyway www.clearpassage.com has very good success rates at unblocking tubes.


Plus if you are using MESA you would also need to find a urologist to do that at the same time or would do that first and freeze it?


Plus if one of your tubes are blocked, the chances are reduced considerably if doing an unmedicated IUI. Plus in your case seeing that DH needs MESA I would have thought that IVF with ICSI is the route you need - the one that offers a better chance of success (IMO).


The repro doc will be able to recommend a urologist that he may work with already. If going to the POW then they will have their own.


I worked out the current rates from one central clinic for IVF with ICSI was just under HK$100,000 this included:


Initial Consulation/Day 3 Blood Tests/Lab Testing x 10 plus pre retrieval during stimulation/Ultrasounds, monitoring x 10/

Retrieval & fertilization inc semen prep(not MESA)/ICSI/Dr fees/Medication (average)/Anaethesia Fee/Hospital fees/lutual blood tests in the 2ww and progesterone injections for the 2ww.


This is based on a 10 day stim phase with daily testing. One can be longer or shorter with daily or every 2 day testing.


Even though DH needs MESA, I would think he could still benefit from taking supplements such as Proxeed.


All the best!

Hi newinbeijing--


Definately don't overlook Dr Philip Ho in Central, 2526-3322. Excellent doctor and also very popular on this site. His IVF proceedures are done at Sanitorium.

(the $$$ listed above are HKD)

I had IUI at Dr. Philip Ho which costs HK$6500 itself + drugs etc. Totally I have paid about HK$10,000. This is talking about last couple of months.