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Posted by myfavoritebags 19 yrs ago
Hello! I am starting out on the infertility highway and I am a little concerned and I was hoping anyone can offer some advice to a newbie. I have PCOS and am in my early 30's and would like to conceive...and Dr. Doo put me on 50 mg clomid. He did an ultrasound on day 9 and there was no ovulation, and gave me 3 days of Gonal-F (75 mg/day for 3 days) and then said he will check me again on Thursday.


I still have no idea why in the world do I need Gonal-F now since it is my first try on fertility medications - (50 mg) Clomid. I thought Gonal-F and other injectibles were for down the road if the higher doses of Clomid do not work at all? Is he introducing these powerful drugs too soon (to make $$$$ on office visits, medication, etc.) - in your personal experiences, do you think am I correct (or just overconcerned)?


Thanks again for your advice!!!!

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COMMENTS
sunnysideup2010 19 yrs ago
Hi there! I also have PCOS and in my early 30s. I don't know about Gonal-F so can only offer you my experience on my road of TTC. I am currently 3 month pregnant :)


With PCOS, I was not ovulating AT ALL. So I needed progesterone to start my cycle, followed by clomid to stimulate ovulation. Wasn't ovulating at low dosage but ovulated (1st time!) when I was on 150mg and hit the jackpot that cycle. BBT charting was my only indicator to show whether I ovulated or not and I have to say it was a great tool for me (and free!).


Why don't you tell your doctor my story and ask whether you can be treated the same way, rather than continuous visits with ultrasound and tests. Give Clomid a try for up to 6 cycles, then move on if it is not working.


Good luck!


Sunny :)




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my thoughts 19 yrs ago
I can't help you with PCOS, but I had 3 (unsuccessful) IUI cycles with Dr Doo and was on Clomid for all 3. The first one at 100 and the next 2 at 150. I was producing eggs on Clomid which is why he didn't recommend I switch to Gonal-F. But then I went for a consult with Dr Ho and he said the only thing he would have done differently is moved me onto Gonal-F, and probably straight away. There are apparently some real problems with the uterine lining with Clomid which don't occur with Gonal-F. But of course Gonal-F cycle is more expensive and requires closer monitoring....


The bottom line though is that ultimately it's your body and you should be comfortable with the course of treatment and the drugs you're taking. So ask Dr Doo. And maybe you want to have a consult with a second doctor and see what they have to say.

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pinkie 19 yrs ago
Hi Sunnyside up- just wondering who your doctor is?

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myfavoritebags 19 yrs ago
Thank you ladies for your excellent advice!!!! I will get a second opinion from Dr. Philip Ho, just in case. However, I feel much better now and feel more knowledgeable about this whole process.

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Poseidon 19 yrs ago
Hi

I am early 30's with PCOS, less than 4 or none a year. my doctor put me on 4 tabs daily for 5 days before an IUI.


Anyone knows what are the success rates IUI for our conditions PCOS ?

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Perthites 19 yrs ago
generaly the success for IUI is about 15% but with PCOS we carry and even higher miscarriage rate, of course ever persons situation is different.

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annieh 19 yrs ago
I have PCOS as well and went through 2 rounds of IUI unsuccessfully. On emotional front it was very tough and physically, I had problems with the last IUI which resulted in some bleeding and pain afterwards. I also didn't feel comfortable with the drugs.


So I am now seeing a Chinese doctor who is qualifed both in Chinese medicine as well as pharmacy. She could tell I had PCOS and has said is there hope, so worth a try.

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Perthites 19 yrs ago
i got pregnant twice and i have PCOS. The first ended in a mispregnacy at 9wwks the second resulted in a healthy fullter pregnancy and our daughter is now 5mths old. I saw Dr Choy and she treatded the PCO with metaformin. As soon as she put me on that i feel pregnant the first time I stayed on the medication until the 14th week of my second pregnancy as PCO carries a higher risk of miscarriage. I did 6 IUI's and one IVF. The Metaformin isn't the most pleasent medication but once your body is use to it you are ok. None of the fertility drugs are very nice and the emtional and finacial stress is great it's hard not to get discouraged but you have to hang in there just try to get thru each day and use this forum for support. Good luck don't lose heart.

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JBB 19 yrs ago
Anyone with PCOS or even symptoms with PCOS are recommended to be on Metformin. They also help egg quality. The side-effects fade away after a while. There is a lot of information out there and some good info can be found on the boards on www.ivfconnections.com There is a board called PCOS.


In HK at the Queen Mary Hospital there is HK PCOS specialist. he is called Dr Ernest Ng and also has a private clinic there.


I am not sure if you know of PCOS dietary needs but Low GI works very well for those with PCOS as does regular work outs (even if it is just a walk a day).


All the very best!

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Poseidon 19 yrs ago
Hi Perthites,

How much do you spends on the per IVF & IUI for the first time ?


Hi JBB,

Do you mean that you're still on Metformin pills while taking progesterone pills on regulates menses ? how many cycles of progesterone trial before IVF/IUI or Gonal F injections ?


Do you has the support group connection /forum for PCOS group ?


regards,

Poseidon

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JH1 19 yrs ago
JBB:


I have seen Dr. Ernest Ng recently. I was actually surprised that he did not seem to be very current in his parameters for diagnosing PCOS. I do not fit the classic profile of a PCOS patient, and he seemed dismissive of factors that suggeted I could have PCOS. I was curious as to how you found out that he was an expert in PCOS? (I am asking because in my case, the diagnosis of PCOS was divided among the doctors I consulted, and I am really keen to find someone who is a real expert in this field.)

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Perthites 19 yrs ago
Cost of IUI really depends on the amount of drugs each person needs some need more than others i didn't need a lot as i was prone to hyper stimulation. IUI procedure was $15,000, blood work on the day of IUI $400.00, consultation $800.00 ultrasound $500.00

I can't remember the cost of the drugs but was on Gonal-F as well as metaformin. I'm sorry can't remmeber the cost of the IVF it was two years ago

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newinbeijing 19 yrs ago
hello, we came to Beijing 6 months ago and now convinced of the lack of help on conception here we are planning to seek help in Hongkong. But we don't know have info except the websites. Can someone please recommend one or two good doctors who treat infertility and can carry out or link us to IUI intrauterine insemination. thanks a lot.

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rose1234 19 yrs ago
Newinbeijing,

I have used Dr. Phillip Ho for all 4 of my IUI's he is very good. You can call Kellie his nurse and she will give you an idea on costs, about that will vary on what type of IUI you have.

Well woman Clinic (852) 2899 2293. You will find losts of recommendations if you search other threads



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newinbeijing 19 yrs ago
Dear rose1234


Thank you very much for your info. Yes, I am doing a lot of internet research and calling clinics. It helps to hear from those who have experience. Thanks a lot again

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ears 19 yrs ago
Hey Newinbeijing,


I've been in BJ for 3 years now and started TTC at the beginning of this year.


Beijing actually has some of the best docs in the world. The docs at the public hospitals see so many patients everyday that they've practically seen everything. The downside is of course they have very little time for each patient.


After coming off the pill a year ago and doing some charting, I realised that I wasn't ovulating and my cycles was very long and erratic (37 to 56 days).


I eventually went to Bayley & Jacksons clinic and did some hormone tests. The doc there recommended I see a specialist at the Peking Union Hospital in Wangfujing.


This is my third month under supervision there and the gyno I see is very efficient, if a little hasty. She sees tons of local patients every morning but because I register through the special care section, I jump the queue.


She put me on Clomid and monitored my eggs, endo lining and hormone levels during the appropriate times throughout my cycle. Unfortunately during my first cycle, we found that my luteal phase was far too short (only 9 days), so I was not able to conceive. On my second cycle, she put me on Clomid and gave me HCG shots to boost my progesterone which helped my luteal phase to lengthen to 14 days. It was a good sign, but I still didn't conceive. I suspect it was because me and DH did not BD at the right times.


This is my third month on Clomid and I also did an IUI. I'll get the result this Friday.


I would recommend the PUMCH to anyone who is willing to see the doctor who has knowledge but no service. Doctors in China are technically very good, but they are terrible when it comes to the emotional side of things. They just tell you the result without explaining much on the reasons behind it, so I tend to do a lot of research on the web after I return from each visit. My gyno there speaks English but we converse in Chinese coz I find it more efficient.


If you're not bothered about not getting 5 star service or environment (no plush decor, but its as hygenic as any hospital in HK), then you could try PUMCH if you live in Beijing. Having gone through a few cycles of Clomid, I realise that its practically a full time endevour. There's monitoring at least twice a week throughout your cycle.


If you decide to go for treatment in HK, even doing just IUI would probably require you to be there for 4-5 days.


Prices at the PUMCH is in line with what you pay in HK, so in that sense you're not getting your money's worth because you don't get the service or special care which you would in Hong Kong.


Prices are:

Doc visit: 200rmb

Scan: 300rmb

HCG shot: 200rmb

Bloodtest: 200-300rmb

IUI: 1000rmb


The gyno I see is Dr. DENG Chengyan.



















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narnia 19 yrs ago
Hi,


I'm on my 4th day of Gonal-F shots (75mg) and for the past few days, I've been feeling rather crampy below and it's really made life miserable in the afternoons everyday. I've noticed that this cramping kicks in about 4hrs after the injection. Has anyone else had this kind of pain? And is it normal? I'm due to see the gyno on Wed, so will ask about it.

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JH1 19 yrs ago
I felt bloated, but did not experience any cramping.

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JJB 19 yrs ago
Hi JHI & Poseidon


Sorry for the delay in replying I am not often on the boards.


JH1

All I remember is that I wrote his name down after reading elsewhere that he was the expert here in HK. What a pity! I guess then the best way to find someone else is to look for an endocrinologist and hope he knows more or is more open minded?!?


I've heard Catherine Choi/Choy is good with PCOS patients for fertility treatment.


Since there is no definate test for PCOS or PCOS-like symptoms you can always find two docs that disagree. I read in a medical paper that PCOS patients might have a good results in the 3 hours GTT but that only after the 4th or 5th hour do they start to display PCOS symptoms. Not sure if this relates to your situation or not.


Poseidon


The sites are:


Read More


and


Read More


They are very informative.


Metformin is taken to regulate glucose intolerance in those with PCOS or PCOS like symptoms with fertility problems. It helps egg quality and prevention of miscarriage (PCOSers have a higher rate of m/c).

The minimum dose is 1500mg daily.

And for minimum 3 months to have an effect on the egg development.


Cheers

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Perthites 19 yrs ago
Actually i got pregnant the very next month after taking metformin i had 4 unsuccessful IUI's and 1 unsuccessful IVF before i went on the metformin. Of course every women will be different and my PCOS symptoms were only infertility/cysts

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JH1 19 yrs ago
Perthites - did Dr. Choy do an oral glucose test/insulin test? Or check for testosterone levels? The only test that Dr. Choy got was a LH/FSH test. I know that none of these tests is individually dispositive, but I just curious, given the disagreement among doctors whether I do have PCOS. My symptoms include cysts, infertility and acne. I think metformin does improve my cycle, but I am also concerned about the implications of taking a drug long term, despite its relative safety as reported.

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newinbeijing 19 yrs ago
Dear ears


Thanks so much for your response and info. That's very kind of you. I'll check the Peking Union hospital. I still have doubts for us here in Beijing though as my hubs and I don't speak any Chinese. I learnt enough from class so far to speak to the taxi driver but that's about it! If you have time, please let me know about the IUI procedure, is it done over two menstrual cycles. And for the actual IUI event, how many days in advance do they monitor you (my interest is to know how many days I have to make trips to the hospital or take days off for Hongkong)


Thanks a lot again

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JJB 19 yrs ago
PCOS TESTS


PCOS is to some extent a diagnosis of exclusion.


There is no one specific test that can be used to diagnose PCOS.


So there can be widespread agreement on what the diagnostic criteria should be.


You usually would have a variety of hormone tests.


Ultrasounds are often used to look for cysts in the ovaries and to see if the internal structures appear normal.


Your doctor will be looking for a combination of laboratory results and clinical findings that suggest PCOS.


If you are diagnosed with PCOS your doctor may order tests such as lipid profiles and glucose levels to monitor your risk of developing future complications such as diabetes and cardiovascular disease


Laboratory Tests


FSH (Follicle Stimulating Hormone), will be normal or low with PCOS

LH (Lutenizing Hormone), will be elevated

LH/FSH ratio. This ratio is normally about 1:1 in premenopausal women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic


Prolactin will be normal or low


Testosterone, total and/or free, usually elevated


DHEAS (may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS

17-ketosteroids (urine metabolites of androgens, used to evaluate adrenal function) elevated or decreased


Estrogens, may be normal or elevated


Sex hormone binding globulin, may be reduced


Androstenedione, may be elevated


hCG (Human chorionic gonadotropin), used to check for pregnancy, negative


CMP (Comprehensive metabolic panel)


Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides)


Glucose, fasting or a glucose tolerance, may be elevated


Insulin, often elevated


TSH (Thyroid stimulating hormone) some who have PCOS are also hypothyroid


Non-Laboratory Tests


Ultrasound, transvaginal and/or pelvic/abdominal are used to evaluate enlarged ovaries. With PCOS the ovaries may be 1.5 to 3 times larger than normal, and characteristically have more than 8 follicles per ovary, with each follicle less than 10 mm in diameter. Often the cysts are lined up on the surface the ovaries, forming the appearance of a "pearl necklace."


These ultrasound findings are not diagnostic.


They are present in more than 90% of women with PCOS but they are also found in up to 25% of women without PCOS.




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JJB 19 yrs ago
NewInBeijing - TIMING


The clinic you choose would be able to give you more details according to your protocol. As so much depends on that. I suggest you visit a couple while you are here and decide then based on what they suggest, what feels right to you and how you interact with them.


What I remember basically is...


An unmedicated IUI - will involve basically blood tests on Day 3. These I suspect you could do in BJG and email/fax the results down to a doc here. Then you need to monitor ovulation by using the ovulation predictor tests and have a couple of ultrasounds before and around the time you expect ovulation.


Medicated IUI is where they supress your ovulation and with testing and scans they estimate your ovulation date and do the IUI accordingly.


IVF has various protocols. For eg you can be suppressed the month before with BCPS/Lupron or Buserlin. Or not.


If suppressed the month before. You can suppress while in BJG and then when your period begins you come to HK and some base line tests (yr doc can agree that you have these in BJG) and stimulation drugs bthen after a couple of days when your E2 has risen you come to HK for more regular scanning and blood tests. These can be daily or every 2 days. And how long this can take is very individualised. Some take 12 days to stim others only 8 or so. Then you have trigger, retrieval 36hrs later and replacement 3 or 5 days later. Many international docs recommend taking it easy for a couple of days after and not flying.


Overall it could be that you would be in HK for about 2 weeks or more.


Are you looking elsewhere for treatment? USA, Bangkok, Cape Town.


Hope this helps.

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ears 19 yrs ago
newinbeijing, my life has basically come to a standstill since I began treatment (Clomid + IUI). I have to visit the doctor at least twice a week throughout the cycle. This is my third cycle. I wasn't monitored during the first (and totally regretted it). Here's a brief breakdown of the past 2 months' visits to the doc.


CD5-CD9: take Clomid once a day. (No need to visit doc)

CD11: Scan to check follicle & endo development.

CD14: Scan to check follicle & endo development.

CD15: HCG shot at 9pm to trigger ovulation in 36-48 hours.

CD17: Sperm collection at 7am, IUI at 9am.

CD24: Progesterone and E2 bloodtest.

CD32: Progesterone, E2 & HCG bloodtest (ie. pregnancy test).


Obviously the number of visits to the doctor various from person to person, and depends on your follicle development. But in most cases, you would need to see the doc at least twice before the IUI procedure (once to check follicle development, and once for the HCG trigger). Then 1 week after the IUI, the doc will have to check your progesterone level to see if you need progesterone support for the luteal phase. So, as JJB points out, 2 weeks is what you will need at least.


If you decide to try out treatment Beijing, then drop me an email. I've been here for 3 years now and know the place quite well. The PUMCH isn't for everyone. Their ER is decent, but for fertility treatment where there is a lot of emotions involved, its not the best place to go. I put up with it coz I speak some Chinese and live in Wangfujing, which means I'm just a minute walk away from the hospital.

















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Poseidon 19 yrs ago
anyone had your Diagnostic Laparoscopy done which included (Anesthesia, Ovarian Drilling, Dye Test, D&C uterus lining & debris clean up) & fixing the block tube ??


How many picture did you ask from your doctor ?


Is my Diagnostic Test mentioned is above is standard procedure on you gals too ?



I am having the Diagnostic Laparoscopy next week 10 Aug 06 (Thomson Medical Centre) dunno what to wear, do you gals / anyone wear 1 piece dress / must take out underwear before the surgery ?


Regards,

Kindly advise



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JJB 19 yrs ago
Hi


Diagnostic Lap is pretty much routine for many on the fertility route.


But not all have/need D&C and fixing blocked tubes.


My doc gave photos and a video. I did not ask for it. But they give it to you because that is what they use to explain what they saw and should you ever need another one they use it as reference. They keep their own copies.


All the best next week.


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Poseidon 19 yrs ago
Hi JJB,

After Lap surgery, how long do you start to walk aroung shopping mall ? 3 hrs do you feels faint after 13 day recuperation ?


Why is there red dot rashes or measles like appear after 8 days from Lap surgery or is it the "Triderm Cream" for primary & secondary infection that I allergic to ?


Do you consume rice after 13 days from porridge stuff ?


Do you take fast food like Burger King or MC Donald on their chicken or fish stuff, Any allergic reactions like red dot rashes or measle itching rash ?


What else could I eat except stay fresh vegetables or fresh fruits ? Green bean after 13 days ?


When do you has your next cycle after lapro ? 23 days or longer with hormone pill or w/out pls ?



Regards,

Appreciates your kind assistance of response.

Thank you.



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JJB 19 yrs ago
Hi Posiedon

By now 13 days post lap surgery you should be feeling more or less back to normal in terms of walking around a mall and in terms of food.


If this rash is new and you have not changed anything in your diet then yes you could have a reaction to the cream. However, it could also be the plaster/bandaid that they used. Some people are allergic to some types.


If you have eaten fast food such as BK and MacD before, then it is highly unlikey that you have developed a rash from that. Try to avoid fast food now. You are on Metformin aren't you? If so, then you should reduce processed food. Try and get a copy of the Food Doctor book and get some ideas what you can eat. I know that many of these books are for the western market and so does not have many suggestions for asian food. One hint is that basmati rice is better than white or brown for example. Make the protein and veg the majority of your plate at meal times.


I cannot remember when AF turned up after the lap. However, without hormones/bcp it can throw it out of cycle for a while. It can end up at 41 days or more. With hormones/bcps then it would be regualated and your period should come when you are on the 7 hormone free days.


All the best! Glad to hear the lap is all over and done with.



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