Happy New Year 2015!

I haven't written for a while now mainly because there are no major changes in my life. I am maintaining status quo which I think is not bad at the moment :) I have given up all hopes of getting pregnant naturally and have also accepted that we may never be parents. We are planning to do the FET next spring/summer. Wonder if a neutral attitude will be beneficial for getting the BFP :) Before I started trying for a baby, whenever I went to church or to temple, I would think I have nothing more to ask for so I just pray for good health for everyone. Then when we started TTC, I started praying for a baby of our own. My prayers are yet to be answered but last night I told Jesus that I don't dare pray for a baby anymore for fear that my last piece of faith will crumble. Funny me aye? I guess this is a desperate attempt to try get Jesus hear me :)

 Christmas has whizzed by (I did wish Jesus a Happy Birthday) and I hope everyone has had a blessed one! I experienced sheer joy watching the kids open their Christmas gifts! I guess that's the joy of giving although we do not get to experience it when we donate to charitable foundations. As it is new year's eve today. I'd like to take this opportunity to wish all my readers a very Happy New Year! May your dreams of becoming parents come true in 2015! All the best of LUCK!! God bless!!

AF arrived 2 days ahead of schedule!

OoOopsie! AF arrived 2 days ahead of schedule this month. I have never had AF show her face early. This is something I will have to monitor for the next few months as a shortening luteal phase isn't very good. So no BFP this month :(

Dr. Lee had advised during the last consult that of all the frozen embryos only the 4BB and 3BB are good enough to be transferred back. He will not consider transferring back the 4CC and the EB (early blastocysts). I am curious to know why these embryos were frozen in the first place if they are not good enough to be used. Although the extra embryos don't incur extra cost for freezing however it will be nice to know. I just may ask him this question when I go back next spring/summer :)

So far the blues have lifted and I am busy doing some Christmas shopping for the kids. My favorite niece's birthday falls on Christmas eve so to be fair have to get her two gifts...the little girl will be so overjoyed!! Can't wait to see her beaming!! :)

The weather has turned a lot colder and hopefully we are going to have a white Christmas again!!

To all my readers - stay warm this season and God bless!!

Love,

Nio

Premenstrual spotting & feeling sad

Ughh~! Spotting again premenstrually!  I have a 14 day luteal phase and it's only 11DPO now! May be it's just how my body is.
Last Sunday, I attended my nephew's 1-year birthday party and all around me, the young ladies are pregnant!  I was happy for them but inside I was so much in pain! My sister's best friend had been trying for a baby for 2 years and is now 4 months pregnant with a boy. It sure wasn't easy for her to get pregnant but she did get pregnant naturally. All this week I felt down in the dumps, feeling sad for myself. Just today, I happened to watch a TVBS Cantonese drama of this lady who was had lost one of her legs and was having a tough time in life. The people with disabilities need so much courage to carry on living as even the activities of daily living are a challenge. I reminded myself that I need to be thankful for everything and cheer up as the best things in life are free! I happened to think of my mom who had undergone radiation and chemotherapy for cancer treatment and suffers everyday from the side effects of these treatments. She is a survivor! With infertility, at least it is not a life-death situation when the patients chooses to go for treatment or not. Dear Hubby also comforted me that whether or not we have kids is fine. We just need to try. If in the end it doesn't work out positively, we still have each other. Although it is not the first time he has said this but I felt really comforted.
Today I also received an email reply from one of my blog readers! Heavens only know how good I felt to be able to connect! If any of you have any query, please do not hesitate to send me an email at xiaonionio@gmail.com. I appreciate all emails and support.

Final Follicle Monitoring Sheet before Egg Retrieval

Hello again!

I referenced the follicle monitoring sheet on other blogs when I was undergoing IVF and thought I'd post my own too so my readers can also refer to it when the need arise. So TADA! here it is:

So far I am still alive and kicking and haven't lost hope yet! :)

Once again, Good Luck and Baby dust to all! :)

Mid-cycle spotting update - BaiFeng Wan supplement

Hi again,

Just wanted to quickly update that I did not experience any mid cycle spotting this month after taking the BaiFeng Wan TCM supplement. I am pretty pleased and comforted that at least my hormones are now in balance because every time I see blood streaks in my CM I feel sad. Hopefully, the premenstrual spotting will go away too this month! I will call this a magic supplement - hahaha!

~~Lots of baby dust to all!~~

Cervical/Abdominal Pressure (Update) - BaiFeng Wan supplement

Hello!

Phew! Thanks be to God! The heaviness/pressure in the cervix/abdomen has not returned ever since I took the BaiFeng Wan supplement. I still experienced premenstrual spotting however this time it was for a shorter duration. After much research, I think I may have kidney/spleen yang deficiency as per TCM (Traditional Chinese Medicine). Currently, I started BaiFeng Wan supplement on day 5 of cycle as the supplement should not be taken for the first 3 days of menstruation. I am taking it twice a day and will stop taking it on 6DPO. With yang deficiency, I experience cold hands and feet in winter. Now I am doing my best to keep myself warm and will start taking korean ginseng in moderation as well to nourish the "Qi". This is because the last time I tested positive for HCG, I was seeing a TCM practitioner who happened to mention that he had given me a lot of ginseng over the course of the treatment. At that time, I experienced colder hands and feet. I now remember that under his TCM treatment, my hands started getting warmer and only the feet were still cold so still a long way to go. TCM I found to be more expensive than IVF in the long run. For my last TCM treatment, I spent around NT$42,000 for 6 months herbal supplements. This is almost half the cost of my first IVF. Anyway, I think I am trying to be my own doctor now, trying to understand my body more and trying to create a good environment for the embryo to implant for a natural pregnancy or an FET pregnancy!

Wish me Luck! =)

Cervical/Abdominal Pressure

Good Day!

Yesterday I made avocado bean salad with baked jerk chicken. Turned out really good. I remember the last time I made jerk chicken with the jerk seasoning and it didn't turn out too well but ofcourse, this time I made a slight change by adding paprika. The result was an absolutely delicious dinner last night. The picture of my small accomplishment below. Today I made some French crepes for tea time however forgot to take a picture.

 

Sorry for the detour, now getting back to the title of this post - cervical/abdominal pressure. I have been experiencing abdominal/cervical pressure since June/July of this year right after I finished the traditional chinese medicine I brought back from Taipei from the earlier trip. I feel the pressure especially when I am standing. It gets better after I sleep however as soon as I stand up for few minutes, I start feeling the pressure again almost to the point where there is a dull pain. It's very bothersome and annoying. My research on the internet suggests incompetent cervix which scared me but usually one finds out when one is pregnant and this is not applicable for non-pregnant women. Anyway, I consulted my mom who made me chinese ginger chicken soup in rice wine. I took the soup and it seemed to go away only to return after a few days. I had some doubts about whether I will be able to maintain the pregnancy if I should get pregnant by IVF. Anyway, I still felt the pressure while I was undergoing IVF but I tried to rest as much as I can and it didn't bother me much as I didn't have to do much housework in Taipei.

After returning from Taipei, I started feeling the abdominal/cervical pressure again, to the extent that I was scared to breathe on a full stomach because it felt heavy like something was going to pop out. I wasn't sure if it was my uterus or my cervix! I was frustrated. My mom happened to ask me on the phone if I was still experiencing the pressure and I confirmed it with her. After a few days, my loving mother bought me over the counter chinese herbal supplement called "Baifeng Wan" (see picture below), translated into English as "White Phoenix Pill". She told me that when she got married her menses was irregular and she took this supplement too and got pregnant later. She said that maybe I was weak and hence the pressure and usually women who are weak in "Qi" (energy) take this. It is time tested formula and this knowledge has been handed down through the ages. I do remember seeing one of these empty pill containers at home when I was small.


Photo taken from http://www.tongrentang.com.au/list.asp?id=69&anid=141&nid=515

 

I was desperately looking for a cure for the cervical pressure hence I took the pills for 6 days, two times each day (morning & night), with warm water and yellow rice wine as per instructions. As this is a time tested supplement, I wasn't skeptical about taking it, besides my mother and older sister had also taken it before. Also internet research suggested no side effects.

 Amazingly, the cervical/abdominal pressure disappeared after the 1st day of taking it. Honestly, it's like magic! I get mid-cycle spotting and spotting before my period as well. As the pills also helps resolve irregular menses, let's hope it resolves the spotting issue as well! I took the supplement only for 6 days because pregnant women should not take it hence I stopped it at 6DPO. I am just so relieved as the cervical/abdominal pressure is now gone. I will only find out next cycle if the spotting issue is resolved as well i.e. if I do not get pregnant naturally :)  I will update as soon as I can. In the meantime, be happy and stay blessed!!

P.S. - A box of 10 capsule of pills costs about CA$10.00. These pills are available from any chinese herbal supplements store in Chinatown. Different stores carry different brands. I believe there are 2 or 3 other brands available. The store my mom went to only carried this brand -Tong Ren Tang.

Total cost of IVF in Taipei, Taiwan

Hello again!

I just wanted to summarize the total amount we spent on IVF at Mackay Memorial Hospital in Taipei, Taiwan.

Our total hospital cost comes to NT$107,247 which is approximately US$3,426  (based on today's FX: 1 NTD = 0.033 USD) or CA$3,937 (today's FX: 1 NTD = 0.04 CAD). Note: this does not include any travelling, food and accomodation costs).

The airfare cost CA$1,450*2 = CA$2,900.

Travelling by public transit is rather cheap when compared to Toronto (approximately 1/6th the cost of public transportation in Toronto). Taxi fares are rather cheap too (we had to take the taxi after ER and ET). We did not incur any accomodation costs as we stayed with DH parents. Food is very affordable in Taipei as well. The major expense were the drug and procedure (ER & ET) cost. The doctor consultations and ultrasounds are very cheap, approximately CA$15 per visit.

Overall, I had a perfect IVF cycle but just didn't get pregnant...haha...may be better luck next time?! :) I am thinking of my dad now who is capable of laughing at life's worst situations. He has such a positive personality, never failing to get up when he stumbles and falls. I think I am starting to live life as he does. Enjoying life's every moment because we never know when God will call. We live only once. Not sure if there is an after life and reincarnation. If there is, we don't know if we will be born again as humans. There are so many life forms on earth and the universe is so vast and infinite. Hard to believe there is no life beyond our galaxy! So let's not let life beat us down. We need to savor life's every moment and do the things that makes us happy (as long as it is moral and ethical).

Cheers!

Post-IVF - Thoughts and emotions

At the start of this IVF journey, I kept thinking about how low and depressed I will feel if the cycle did not work. All the time, money and energy spent. All the daily injections, ultrasounds and hospital visits. The expectations and the hurdles every step of the way. Surprisingly, I did not expect myself to come out of this a happier person! I am so glad I went through this IVF treatment because I was so depressed everyday and every month before the treatment. I am now happy and calm, not angry and living everyday with joy and laughter. I don't cry anymore before I sleep and whenever I think of my niece and nephews. I don't cry anymore when I see my friends' facebook updates on their pregnancy or their newborns. I take it in my stride now to hear good news of friends' or friends of friends' pregnancies. Even watching dramas on tv make me laugh and not cry. Thanks to the decision to undergo IVF, my depression is gone! I haven't felt like this in years and it feels so rejuvenating! I didn't realize I have been depressed for so long! Now the gloom has lifted and it feels like a brand new me! I am so glad I made the trip to Taipei!

I realized that what we need and what we desire can be two different things. Getting pregnant had become an obsession. We 21st century women are so used to being in control and getting what we want. So far in life, as long as we work hard for it, nothing has been unachieveable. However getting pregnant doesn't work that way. Even if we work hard for it, we may not achieve pregnancy hence getting pregnant becomes an obsession. True we all want to start a family however it is not absolute - meaning we can still be happy even if we don't have kids. Life doesn't have to stop and standstill for us if we have trouble getting pregnant. To let our whole mind revolve around this "want" is torturing ourselves! We don't need this depression! We can be happy with or without kids. The key is enjoying the journey and if we tried our best, there should be no regrets!

For me, this is the best time of my life so far. I don't need to work and can sleep in all I want, do the things that make me/us happy. My husband has been supportive all the way. Although he yearns for a baby but he is very rational and knows that this is not something that can be forced to happen and it is all up God Almighty. "At least we tried" is what he keeps reminding me and "No regrets because we tried already". My in-laws are also very supportive so no pressure there as well.

Life is too short to live in depression. Enjoy every moment of it (with or without kids)! We came into this world empty handed. We will leave empty handed. There is nothing in life that we can't absolutely live without. The breath of life is free. Other than that, food and water is in abundance in this present day world. Any one reading this right now would have access to the internet which means they are living the good life. There are so many people out there where reproduction is least of their worries and keeping the stomach full is top most priority. Feel content and be happy!The only person who is most capable of loving/destroying ourselves is our own selves! Love thyself as God loves you! If you are going through IVF, just enjoy the process - doesn't matter the outcome - love yourself and be good to yourself!

I love you and wish you all the best!

Goodbye Taipei for now

The following Monday we went to consult Dr. Lee again. As DH did not want me to have another simulated/medicated cycle, so we had decided on doing a natural cycle FET. We told the doctor that we will do a natural cycle FET however not after a month's rest. We will do it most likely next year as we had to go back to Toronto at the moment. He gave us another follicle monitoring sheet and asked us to return to do the ultrasound before consulting him when we were back in Taipei. I will be almost 36 years old next year. Hopefully, we have made the right decision.

Day 27 (9DPT) - Beta HCG blood test and consultation with Dr. Lee

We woke up early and arrived at the hospital at 7:10 am. After we arrived, we went to the blood test clinic on the 1F and used one of the machines to scan the barcode on the appointment slip. The machine assigned us a number and when it was my turn, I went to the counter to have my blood drawn. My heart was pretty heavy at this point as I was still spotting. We were done by 7:30 am. We then went and had breakfast at the nearby Starbucks. DH comforted me by saying that even if the blood test is a BFN, it is okay as it is illogical to fret over something we never had in the first place. He also said that all that mattered was "at least we tried". I was rather calm having come to terms with the fact that it may be a BFN. We went back to the clinic at 9:30 am. When it was my turn to see Dr. Lee, I was called and I noticed my bHCG result on the computer screen. It was a mere 4.8 miu/ml. Dr. Lee advised us of the bHCG test result and told us that it means I wasn't pregnant. To my surprise, I took it pretty well. No tears and not getting emotional at all. My voice was normal and steady. He then asked us when we will like to do an FET. He said he could do a DET as well however will still advise us against it and to have an SET instead. As mentioned earlier in my blog, Dr. Lee has a conservative approach. He advised us the risks of having twins in case both blastocysts implants and asked us to have patience in the IVF process. We have the patience just not the time to stay in Taipei for so long. We asked Dr. Lee to give us the weekend to think over things a bit and we will return for consultation the following Monday. Also I asked him if the FET will work as the remaining blasts were of a lower grade than the 4AA that was transferred this time. He smiled and said that grades are assigned by the embryologist however it doesn't mean that a grade BB blast will be unsuccessful . After that we left the hospital and went to have Teppanyaki :) I did shed some tears later that day but DH and everyone else was pretty supportive. It didn't matter anymore if it didn't work this time around. It doesn't mean the next time won't work!! Just as DH said we did our best and if it didn't work, it may not be our turn yet to be parents. This is not the end, it is just the beginning! =) All is not lost. I made a mental note to be extra good to myself cause I know that in this world, no one can care more about me than myself!

Day 26 (8DPT) - HPT and Surprise!

On day 26, we decided to take an Home pregnancy test in the morning. I used Clear Blue Digital Pregnancy Test. As I was waiting for the result, I wiped and discovered fresh red blood on the tissue! What a bad surprise! So I wasn't too optimistic then and it was no surprise that the test showed "not pregnant". I was very heart broken. During the day I continued to spot with small clots (Sorry for the TMI) however by night it was a lot less. I still continued with the Crinone inserts as the next day was the blood test. I know that if the spotting stops, there is still hope however if it doesn't, then that means I am definitely not pregnant. DH asked me to remain optimistic however it was really hard for me as I myself know my body best.

Day 23 (5DPT) - Anything that goes up must come down

Yay!! Finally recovered from the flu today though I felt a lot better yesterday. The days immediately following ET was a nightmare. I can stand a cold just not a sore throat. So it's true that anything that goes up must come down sooner or later. Just when you think you can't bear it anymore, it starts becoming better!! =)

I spent the few days after ET resting in bed because of the flu and not because I wanted to be particularly careful. Today is 5DPT (days past transfer) and I have another 3 days to go before the much awaited blood test at 9DPT. I have no symptoms so far except for breast tenderness which I was experiencing even before egg retrieval so no biggie there. The daily homework is just vaginal application of Crinone twice a day and that's it. The instruction was to apply once in the morning when I get up and once at night (no set time indicated). I try to apply at the same time both in the morning and at night so the time gap between each application is 12 hours. My logical reasoning is that this ensures a constant supply of progesterone in the blood stream everyday. The same reasoning was applied to the follicle stimulating injections which I took at approximately the same time everyday - constant flow of hormones in the body. The doctor's assistant instructed to "try" to take the injections at the same time everyday however if it's not at the same time then it's okay too and I have read somewhere that the stims do not have to be at the same time everyday as well. However, I don't want my body to feel like it's on a roller coaster ride everyday - a huge dip and then a big surge in hormones. It's just my personal approach to taking medications - whether it is for IVF or for a UTI. I also try to lie down for 15-20 mins after Crinone application and then move around to optimize absorption of the hormone.

The last few days, while I was resting I couldn't help compare the equipment at IVF Canada and Mackay Memorial Hospital. At IVF Canada, when I underwent IUI, my feet were mounted on metal stirrups hanging from an upright pole like a pendulum. When the speculum was inserted, it was the most uncomfortable experience!! I think the speculum was not the right size? I could feel the entire thing going inside, it was next to painful!! I still flinch when I think of it! At Mackay Memorial Hospital, the embryo transfer  included inserting a speculum however I felt the least discomfort! It was very smooth almost like glided in. There are no stirrups but actual "legrests" (think of armrests? these are legrests!) on the sides, support for the entire leg, very comfortable! I would chose to come back to Mackay Memorial Hospital to do IVF again or if this cycle is negative, they have excellent facilities and most importantly, a great IVF team here. IVF Canada - BUH BYE FOREVER!! Note: I am not promoting Mackay Memorial Hospital. I am just writing an honest, unbiased experience at both IVF clinics. The operation bed has the same leg rests set up at Mackay Memorial Hospital.


~~~~Let the next 3 days roll~~~~~

Day 19 & 20 - Suffering

Holy smokes, my sore throat is getting worse. My nose is runny and I have a cough as well. My good lord, will my embryo survive in my weakened body? In my mind, I am trying to keep optimistic. I frantically searched on Google and looks like a cough and cold will not affect implantation. But I feel really bad today. I wish the pain in my tonsils were gone. I can't even take any antibiotics. Will I survive?? Will my embie survive??

Day 18 - Embryo Transfer

The 5-day embryo transfer was scheduled for 10:00 a.m. We arrived on time and was asked to wait in the waiting room. After about 20 minutes my name was called and Dr. Lee with an embryologist appeared and let us know the below grades of the embryos. We also signed paperwork to freeze the remaining 6 embryos. For information on embryo grading, please refer to the following link: http://www.advancedfertility.com/blastocystimages.htm

1 x 4AA
1 x 4BB
2 x 4CC
1 x 3BB
2 x EB (Early blastocyst)

Dr. Lee will be transferring one grade 4AA blastocyst to me. I was then led to the ET room. My husband was asked to stay behind. The ET process was painless, fast and smooth. I did feel some mild cramps during the process but that was it. I wasn't required to have a full bladder either. Dr. Lee doesn't provide a photo of the embryo as well as they think the embryos are sensitive to light and doesn't want to take the risk. When Dr. Lee was ready, the embryologist brought the embryo from the sliding door that I believe led to the lab and they timed the transfer. It was 15 seconds. I believe the maximum time allowed was 90 seconds. As I was coming down with a cold and sore throat, I asked if that would affect the implantation. I was told it will not affect however to not take any medications and drink lots of water and let the body heal on its own. After the transfer my husband was called to my side. I laid there for around 30 minutes before leaving. The instructions from Dr. Lee was to walk and take the stairs slowly, no jumping or stressful exercise. I can resume normal activities however no sauna and swimming to reduce risk of infection. Just to relax and take it slow and easy.

We then went to pay for the bill which was NT$39,714, approximately US$1,323 or CA$1,461. This includes the cost of everything that day (registration fee, Lab fees, ET fee, fee for freezing the 6 extra embryos for 1 year, supplies of Crinone for the next 9 days, blood test on day 27).

We then took a cab home where I rested for the rest of the day. I will return to the hospital for the BHCG blood test next Friday (Sep 19). I am trying to stay neutral but this is all getting very exciting. We are at the end of this first IVF treatment. Implantation is a big mystery. Wondering if I will have one sticky bean there. I try to brush away all negative thoughts. Hubby said I should think positive however I don't want to be positive and to be dealt a hard blow later. Good Lord, I pray for the best!

Day 14, 15 & 16 - Checking the status with the IVF lab at Mackay Memorial Hospital

We were given instructions to call the IVF lab on day 14. When we called, we were informed that 9 out of 9 eggs were fertilized and looks good at the moment. It is very likely that the transfer will be done on the 5th day after egg retrieval (ER) i.e. day 18. If there was any change, we will be informed via phone. However, the next day (day 15) we received a call from the lab to go to the hospital on day 16 to do a 3-day transfer. I became pretty worried that the embryos weren't developing as expected. We showed up at the IVF lab at 9:30 a.m on day 16. As it was a holiday, the lab was closed. We were given instructions to wait outside. We waited for about 5 minutes before an embryologist appeared and informed us that 4 out of the 9 eggs were doing well and the doctor had advised to let them culture for additional 2 days. I asked the embryologist if there is a risk that the embryos will stop developing if we let it grow for another 2 days. She said that is a possibility however given my age and the number of eggs, she doesn't think there should be any issue. I asked her the number of cells of the embryos and she mentioned 7's, 8 & 9. I was relieved to be sent back home as I prefer a single embryo transfer (SET) to a double embryo transfer (DET). I spent the rest of the day catching up on sleep as I wasn't really able to sleep the night before.

Day 13 - Egg Retrieval (ER)

The ER was scheduled for 8:00 a.m. and I had to arrive at 7:30 a.m. My mother-in-law accompanied me to the hospital. We took the subway (MRT) there. My husband was to arrive later at the 6F IVF lab to deliver the specimen at exactly 8:30 a.m. The operation rooms are on the 7th Floor. I arrived on time at the reception and as soon as the paperwork was completed, I was whisked in to change into the hospital gowns and I was assigned a locker number to stow away my stuffs. After changing, I waited for around 5-8 minutes before a lady appeared and guided me to the operation room. In the operation room, they prepared me and asked few questions, mainly the time of my trigger shots, if I had any allergies to anesthesia, if this was my first ER procedure, when was the last time I had an operation. A nurse also inserted an IV into my hand and it was pretty painful initially but the pain subsided after a while. I never saw Dr. Lee come into the room because I passed out before he came in.

When I woke up, my lower right abdomen was in pain however ignoring the pain, I asked the nurse who was wheeling me out to the recovery area the number eggs retrieved. She said 9 eggs in total retrieved. I was expecting 8 eggs!! Now where did that bonus egg come from?! Anyway, I was pretty happy. After a few minutes, I told her that my right side is hurting and she had to call the doctor. As per the nurse, there was another ER procedure being done and it will take a while for the doctor to come and she cannot give me any pain medication unless the doctor advises. Alright, by the time a doctor arrived after an hour, my pain had subsided so I told him I didn't require any pain meds. I don't recognize this doctor but he told me that there were more eggs retrieved from my right ovary hence more pain there.

I rested there for around 2 hours as the anesthesia wore off. My husband and mom-in-law waiting for me outside was wondering what was going on and paged the nurse desk for me. The nurse asked if I felt good enough to leave and I said I was fine. After that my husband came in and escorted me out. While I was in the operation room, my husband had delivered his specimen, paid the bill and picked up the medications. We had to take the medications to the IVF lab on the 6F where the doctor's assistant gave us instructions on taking the meds and application of Crinone. I also had to make a stop at the injection room to inject 2 vials PIO (progesterone in oil) as Crinone could not be used immediately that day. I was expecting the PIO to hurt as much as Menopur but surprisingly it didn't hurt one bit =)

Oh I forget to mention that while I was in the recovery room, Dr. Lee had spoken with my husband and mom-in-law and advised that 9 eggs were retrieved. He mentioned again about the possibility of a 3-day and 5-day embryo transfer (ET).

After that we caught a taxi home and I went to sleep immediately. My lower abdomen was rather achy the rest of the day so I just rested and rested.

The bill for this visit was NT$30,046 which is equivalent to US$1,005 or CA$1,094. This included the fee for registration, surgery, 2 vials of PIO, 10 sticks of Crinone, anesthesia etc.

We are to call the IVF lab on day 14 to check on the number of fertilized eggs.

Day 11 - Ultrasound and Consult

In the morning, my mom-in-law helped administer my Ganirelix shot at home. After lunch, we went to take the ultrasound at 2:00 p.m. then consulted Dr. Lee. It all went pretty fast. I have 8 follicles now and Dr. Lee confirmed the trigger (2 vials of Ovidrel) will be tonight at 10:00 p.m. and ER (egg retrieval) at 8:00 a.m. on day 13. Dr. Lee thinks the number of follicles is satisfactory. He mentioned that he didn't want to overstimulate as the patient will be in discomfort if there are more than 10 follicles. Honestly, I didn't feel bloated or have any other side effects due to the stims.

He also said that if the embryo is of good quality and developing very well, then they may let it develop to day 5 blastocyst stage for ET and he will only transfer one embryo otherwise he will opt to transfer 2 embryo at day 3. Hence right now, the tentative ET days are either cycle day 16 or day 18. I was then given some forms to sign and had to go pay the bill, take my blood test (E2 and progesterone) and meet the anesthesiologist to do the evaluation. The good news is that I will not have to take PIO (Progesterone in Oil) shots. The nurse mentioned that the PIO has been replaced by Crinone which is just as effective. The IVF lab will provide further instructions on this after ER. On the way out we picked up the trigger shots from the injection pick up counter and went home.

That night I didn't have to go to the hospital for the trigger shots as my mom-in-law helped with that and it didn't hurt one bit. I am getting a bit tired of the shots and was very happy that it is the last of them. Now I'm just waiting for the ovum pick up on day 13. I'm praying for the best.

The bill for this visit was NT$3,112 which is approximately US$104 or CA$113, inclusive of the fee for registration, consult, triggers shots and blood tests.

Day 9 - Ultrasound and Consult

Day 9 ultrasound revealed only 7 follicles only however all of them were greater than 1 cm. There is one particular follicle that was running way ahead of the group at 1.93 cm. Dr. Lee said that this bigger one may have to be forsaken as it may be too old at the time of OPU and we need to harvest the other 6 that are growing at the same pace. He gave instructions on the medications to inject for the next few days. There is a change in the medications this time. Below are the details:

Day 9 - 75 IU Gonal-F, 2 vials of 75 IU Menopur and 1 vial of 0.25 mg Ganirelix
Day 10 - 2 vials of 75 IU Menopur and 1 vial of 0.25 mg Ganirelix
Day 11 - Ultrasound and tentative trigger shot at 10:00 pm (1 vial of Ovidrel)

Dr. Lee set the tentative Ovum Pick Up (OPU) to Day 13 at 8:00 am. This largely depends on the results of my Day 11 ultrasound. He has not yet ordered any E2 blood test. As Ganirelix need to be administered before 12 pm everyday and we decided to have both Ganirelix and Menopur administered by the nurse at the injection room at Mackay Memorial Hospital.

The bill for this visit is NT$9,729 which is approximately US$326 or CA$354. This amount is all inclusive as indicated in my older posts. We paid the bill and picked up the medications from the injection counter. We then followed the blue line on the floor which led us straight to the injection room. We then drew a number from the machine and waited for our turn. When my turn came, I handed the medications to the nurse. She injected Ganirelix first which was easy breezy then came the Menopur injection. Woahh...!! Menopur SUCKS BIG TIME.......!!! It BURNS...!!! My hats off to all the ladies out there that are taking the Menopur shot everyday for their IVF cycle! I am super dreading the Menopur shot tomorrow! :(

I am also getting anxious that only 7 follicles after 8 days of stims and my mind was starting to fill with all negative thoughts. My hubby and MIL comforted me that I only need one. I feel better that they are so positive and supportive. It is interesting to note that Dr. Lee still thinks we are on track. I am hoping for the best and expecting the worst at this point.

Bring on the Menopur tomorrow...!!!

Getting around Taipei, Mackay Memorial Hospital - IMSC and Injection room

For the folks interested in IVF at Mackay Memorial Hospital, this blog http://infertilitynotes.blogspot.tw/ provides more details on accommodation, getting around Taipei and general information about the hospital. However please note that this blog was written 2 years ago, as such the contact person of IMSC at Mackay has changed. Below are the contact details.

Annie Hsu
International Medical Service Center
Mackay Memorial Hospital
Tel: 886-2-2543-3535 extension 3372
Email: mmhimsc@mmh.org.tw

Also note the injection room has different operational procedures now. You do not have to line up your injections as per the blog. Instead, the procedure now is to draw a number from the machine and wait for your number to be displayed on the screen outside. To get to the injection room, simply follow the blue line (on the floor) starting from the injection pick-up counter.

List of commonly use TTC/IVF acronyms/abbreviations

When I first started browsing TTC forums, I was pretty baffled by the acronyms/abbreviations used. So I thought may be some folks will find the below list of commonly used acronyms helpful. Enjoy!

2ww – Two week wait

AF – Aunt Flo/Period

AH – Assisted Hatching

AMH – Anti-Mullerian Hormone

ART – Assisted Reproductive Technology

BBT – Basal Body Temperature

BCP – Birth Control Pill

BD – Baby Dance

BFN – Big Fat Negative

BFP – Big Fat Positive

BMS – Baby Making Sex

COH – Controlled Ovarian Hyperstimulation

CD – Cycle Day

CM – Cervical Mucus

DH/DW/DS/DD – Dear Husband/Wife/Son/Daughter

DPO – Days Past Ovulation

DPR – Days Past Retrieval

DPT – Days Past Transfer

E2 - Estradiol

EDD – Estimated Due Date

EPT – Early Pregnancy Test

ER/ET – Egg Retrieval/Embryo Transfer

EWCM – Egg White Cervical Mucus

FET – Frozen Embryo Transfer

FIL – Father-in-law

FMU – First Morning Urine

FSH – Follicle Stimulating Hormone

HCG – Human Chorionic Gonadotropin

HSG – Hysterosalpingogram

HPT – Home Pregnancy Test

ICSI – Intracytoplasmic Sperm Injection

IF - Infertility

IUI – Intrauterine Insemination

IVF – In-Vitro Fertilization

LAP – Laproscopy

LMP – Last Menstrual Period

LP – Luteal Phase

LPD – Luteal Phase Defect

M/C – Miscarriage

MC – Menstrual Cycle

MIL – Mother-in-law

O – Ovulation

OHSS – Ovarian Hyperstimulation Syndrome

OPK – Ovulation Predictor Kits

OPU – Ovum Pick Up

PCOS/PCOD – Polycystic Ovarian Syndrome/Polycystic Ovarian Disease

PG – Pregnant

PIO – Progesterone in Oil

POAS – Pee on a Stick

RE – Reproductive Endocrinologist

SA – Semen Analysis

SHG – Sonohysterogram

T3/T4 – Thyroid Hormones

TSH – Thyroid Stimulating Hormone

TTC – Trying To Conceive

TMI – Too Much Information

U/S - Ultrasound

 

Day 6 - Ultrasound and consultation with Dr. Robert Kuo-Kuang Lee

I had to wait around 30 minutes for the ultrasound. Once done, the technician completed the follicle monitoring sheet and returned it to me. I then took the sheet to Dr. Lee's clinic which is on the same floor as the ultrasound lab. Within minutes I was called and after around 5 minutes in the waiting area, it was my turn. Dr. Lee looked at the form and started prescribing the doses of the stims for the next couple days. He prescribed the below doses:

Day 6 - 150 iu Gonal-F
Day 7 - 225 iu Gonal-F
Day 8 - 225 iu Gonal-F & 0.5 ml Orgalutran/Ganirelix

I am to return to the hospital to do another ultrasound on day 9 and follow up consult. Actually I was rather disappointed to see the current ultrasound result as it showed only 5 follicles. I asked Dr. Lee if this number was a little too low, he said this number is good. Ahh well...as long as he thinks so!

After that, I was passed to Lisa, the doctor's assistant. She drew the remaining Gonal-F from the 2 used pens for the previous stims into a traditional syringe and gave it to me as day 6 stim. The nice thing about doing ivf here is that they do not like to waste any medication and don't want the patient to incur any additional expense than necessary. I asked her if it is possible to just use the pen to inject instead of drawing the meds into a single syringe. She said that's also possible but that would mean the patient will have to inject twice (75 iu remaining per pen). I was pretty touched that they care enough to ensure that the patient's anxiety and discomfort is minimized!

After I came out of the clinic, I visited Annie at the international medical services center and had a nice chat with her. Then on my way out of the hospital, I picked up the medications from the pharmacy injections pick up counter and went home. I spent only around 2 hours and was all set for the weekend.

The cost of this visit was NT$8,288 which is approximately US$277 or CA$302. This includes the fee for registration, consultation, ultrasound, pharmacy and medications for day 7 & 8 (Gonal-F & Ganirelix). Note that the medications accounts for the major portion of the cost (meds cost was NT$7,580).

In the evening, my mother-in-law helped me inject the 150 iu of Gonal-F as it was in a traditional syringe and I am lucky that my mom-in-law used to be a nurse. With her administration, I did not even shed one drop of blood whereas, I always bleed when I administer the injection myself. I also requested her to help administer the Ganirelix injection for me on day 8. Phew! I feel less anxious now. Praying that I grow more eggs!!

Day 3 to Day 5 - Gonal-F stims 225 iu

It was still a terrifying experience giving myself an injection at home on day 3. Hubby guided me through the process and it helped with him there. On day 4, hubby wasn't home so I had to try solo. It didn't hurt as much as day 3, may be I am slowly getting used to it? I usually stim every night at 9:30 p.m. I am yet to stim today. Tomorrow morning (day 6), I have to be at the hospital at 8:30 am for the ultrasound and the consult with Dr. Robert KK Lee to follow. Based on the ultrasound report (follicle growth), Dr. Lee is going to adjust the dosage of the stims. I hope my ovaries are responding. At this point, I don't feel bloated or have any symptoms of side effects. I have been drinking lots of water though and eating more protein than I usually do. Hopefully, this will help with follicle growth. =)

Day 2 - Consultation with Dr. Robert KK Lee at Mackay Memorial Hospital

On our way to Mackay Memorial Hospital, we boarded the wrong bus and ended up a little late for the appointment. The appointment was at 9:00 am, we reached at 9:15 am and I saw my registered/appointment number "2" displayed outside clinic room 2. This is the room Dr. Robert KK Lee occupies for his practice. The exact location in the hospital is 2F Peace Building, Department of Ob/Gyn, Clinic Room 2.

As I approached the door to knock, the nurse happened to come out of the door and asked me my registered/appointment number. After I let her know she asked me to wait and went to the room next door. The display outside then changed to number "3" and a lady went in. After about 5 minutes the nurse returned to clinic room 2 and after about 10 minutes she came out of the room and called me in (without displaying number "2" outside) to the waiting area inside the room while the lady for appointment #3 was consulting Dr. Lee. As I was waiting, I overheard Dr. Lee congratulate the lady and her husband on their successful IVF. He told them "Congratulations, you are pregnant!". I couldn't help but feel happy for them!! At least it gives me some hope that may be I too will be pregnant soon! =)

When the lady left, I was called and I asked if my husband could come in. They gave me permission and I called my husband in. He asked me details pertaining to my cycle and pulled out my chart/history on his computer. He asked me when the first day of the last and current cycle was and the date I took the last birth control pill. He then gave me a follicle monitoring sheet (誘導排卵監測單) and instructed me to do a baseline ultrasound immediately at the ultrasound lab down the hall and bring the results back to the nurse once done.

Once outside the ultrasound lab, I had to knock and go in to get a number as well as give the follicle monitoring sheet to the service desk. We had to wait 40 minutes for my turn. I went in as soon as my number was displayed outside the lab. Once inside, I had to wait for about 3 minutes before the technician showed up and asked me my name to confirm she has the right patient's follicle monitoring sheet. The ultrasound itself was pretty fast. The process was with minimal discomfort. I went in expecting it to be another uncomfortable process as per prior experience but came out relieved and very impressed. Was it the technician or the equipment that made the difference? I think it was both. The technician was very skilled in my opinion. The equipment looked new and did not make any noise. This was a stark contrast to my experiences in Toronto at different labs for trans-vaginal ultrasounds and with Dr. Woo at IVF Canada for my IUI follicle monitoring. I figured at Mackay Memorial Hospital, they utilize the latest technology and equipment available. Trust me, I am extremely impressed.

After the ultrasound, the nurse gave me back the follicle monitoring sheet and I took it to the nurse at Dr. Lee's clinic. My name was called after around 15 minutes. Once inside, I had to wait at the waiting area again. Just thought it worth mentioning here that the waiting area and the doctor's desk is separated by a curtain. When I initially consulted Dr. Lee in November 2013, I felt odd because I think after having lived in North America for more than a decade, I am so used to being "private". I mentioned it to my husband but he shrugged it off saying this is what makes the system so efficient. True, I observed that in just a matter of 3 hours that day, the doctor saw more than 30 patients. Everything is operationally efficient and orderly. There is no wasting of either the patient's time or the doctor's. Back in Toronto, I have to wait at least 2.5-3 hours before I can see my family doctor, which is a real pain. In order to see a specialist, the patient has to first get a referral from the family doctor. The family doctor's office then contacts the specialist's office, who then gets back to the family doctor with the date and time. Once the family doctor's office get the appointment date and time, the patient will be advised. Sometimes it can take months to get an appointment with a specialist. My father had to wait for than a month to consult an eye specialist for his cataract surgery. In Taiwan, there is no such issue. Anyone can see any specialist any time by booking an appointment. All appointments across the country goes by the number system. Public Healthcare in Canada is awesome and free for all Canadians but it sucks at wait times for crucial health issues.

When it was finally my turn, Dr. Lee advised that he is prescribing 225 iu of Gonal-F for day 2 to day 5 (total 4 days of stims) and I am to go back to see him on day 6. I was instructed to do another ultrasound to check follicle growth before the appointment on day 6 and to always have the follicle monitoring sheet at hand so that it is more convenient for both parties and less time-consuming vs. if they have to pull out their records all the time. I am following protocol 4 for this workup.

I was instructed to pay the bill and pick up the injections first and return to the clinic for the doctor's assistant who will show us how to administer the Gonal-F shot. After we paid the bill and picked up the injections from the pharmacy on the ground floor, I went back to the clinic and sought Dr. Lee's assistant who provided us with two forms to sign, date and return to her on day 6 (Aug 29). The first form was patient's basic information. The 2nd form was the agreement to undergo ART procedure at Mackay Memorial Hospital under the care of Dr. Robert KK Lee. We also gave her a copy of our marriage certificate, passports and driver's license along with HIV and Syphilis test records. She showed me how to prime the Gonal-F pen and administer the shot myself. I must say it was pretty difficult to give myself the shot the first time! Just the sight of the needle made me feel a bit dizzy! It wasn't so bad after the needle inserted into the skin, like a slight pinch.

That concluded our day 2 visit. The total cost of this visit was NT$15,308 which is approximately US$512 or CA$558. This includes the fee for registration, consultation, ultrasound, pharmacist and Gonal-F injections for 4 days. So far so good, fingers still crossed. Baby dust to all! =)

Day 1 - Period arrives

Aunt Flow arrived today. Instructions from the hospital was to see the doctor between cycle day 1 to day 3. Hence, I have an appointment tomorrow morning with Dr. Robert KK Lee.

At the moment, I am feeling excited and anxious at the same time. Excited because we are finally proceeding with a treatment that has the biggest chance of helping me conceive. Anxious mainly because I have been thinking about how to manage my emotions in case the treatment fails? How do I face my in-laws? Will I break down into tears if they say a kind comforting words in case the treatment fails?

Trying to stay positive at the moment. Let's see how tomorrow goes.

Why we chose Dr Robert Kuo-Kuang Lee at Mackay Memorial Hospital for our IVF treatment?

When our IUI failed, we were disappointed and started researching IVF treatment. As my husband is Taiwanese and Taiwan healthcare is considered one of the best in the world, we started looking up top infertility doctors in Taiwan. The two best doctors are Dr. Robert Kuo-Kuang Lee in Taipei and Dr. Maw-Sheng Lee in Taichung.

Dr. Robert Kuo-Kuang Lee holds his clinic at Mackay Memorial Hospital in Taipei. It's like an all-in-one facility where you can get all the tests done under one roof, including all blood tests, ultrasound, HSG etc. This was unlike in Toronto where we had to take a couple of days going to different diagnostic centers to get all the infertility tests done. Honestly, I marvel at the efficiency in the Taiwanese healthcare system and in everything else they do.

Dr. Maw-Sheng Lee operates his own private practice at Lee Women's Hospital in Taichung. I have never been there but based on online reviews, he is older than Dr Robert KK Lee and isn't very fluent in English. He engages a more aggressive treatment strategy than Dr. Robert KK Lee. His clinic is bustling with women and you will feel more like you are in a bazaar. Cost of treatment is more expensive than at Mackay Memorial Hospital. Taichung is an hour or so by bus from Taipei, which was also a consideration.

Cost-wise, it is a little bit cheaper to have IVF done in Taiwan like may be CAD 2,000-4,000 cheaper than Toronto (cost is anywhere between CAD 12K-15K). The International Services Center (IMSC) at Mackay Memorial Hospital (MMH) quoted an estimated cost of USD 6,000-7,000 largely depending on the cost of the stimulation drugs. I also enquired with National Taiwan University Hospital which is also pretty renowned for infertility treatment and was advised an estimated cost of USD 7,000-7,500.

Accommodation-wise, I had my in-laws in Taipei and bro-in-law in Taichung so either location shouldn't be an issue for us however we are more familiar with Taipei than Taichung.

After careful consideration, we decided to pursue IVF treatment under Dr. Robert KK Lee. He is one of the best in the field in Taiwan and is located in Taipei, where we will feel more at home and the cost is affordable.




"It always seems impossible until it is done" -- Nelson Mandela

Last Day of the Birth Control Pill

WooOoOOoHoOOoOoO!!

This was how I felt yesterday as it was the last day of the pill for me (day 25 of cycle). Now we just have to wait until my period arrives. I have already booked an appointment with Dr. Robert Kuo-Kuang Lee at Mackay Memorial Hospital in Taipei, Taiwan on Aug 25th. If my period doesn't arrive by this date, I will have to reschedule with Annie at the IMSC (International Medical Services Center).

We arrived in Taipei on Aug 18th. We decided to arrive days earlier than the appointment date just so we can have time to recuperate from jet lag as there is a 12 hours difference between Taipei and Toronto.

In Toronto, I took the pill everyday at 10:30 am EST (Toronto time). As we took a direct flight to Taipei from Toronto, I also had to take a pill on the plane at 10:30 am EST.  When I arrived in Taipei, I still had 3 more days of pills left so I just took it at 10:30 pm Taipei time which is 10:30 am EST (12 hours difference). Basically, you have to ensure you take the pill at exactly the same time everyday.

Okay, another step completed. We are moving forward with the IVF process. I am so excited!

Supplements for infertility

Like every other woman desperate to get pregnant, I too have gone out and bought supplements hoping to get pregnant naturally. I have tried Royal Jelly, Co Q10, Dong Quai (chinese herb for fertility) and a chinese herbal medication from a chinese doctor (朝春中醫診所，王世耀) in Taipei who is well-known for treating infertile women ,especially those afflicted with endometriosis.

Sadly, none of these supplements helped get me pregnant. I personally think a woman should not blindly take any supplement. I think I was stupid to do it, blinded by my desparation to have a baby. The chinese herbs are very potent and should be prescribed by a licensed chinese medicine practitioner. All other natural supplements are best prescribed by a licensed naturopath doctor.

Also, there are a number of scheming business people out there claiming to be able to help women get pregnant within a short time period and asks for payment upfront for their products with a number of testimonials on their websites. These are too hard sell in my humble opinion. I wouldn't dish out a penny for these scammers.

For more information on supplements for IVF and their effects, I found the information on Manju's blog very helpful. I wish I have come across this earlier in my journey.

Update: Please also see my post regaring the BaiFeng Wan supplement for fertility (TCM supplement).
http://littlenionio.blogspot.ca/2014/10/cervicalabdominal-pressure_13.html

How it all started/Timeline of events

December 2008

It all started when dear husband and I attended a year-end banquet. We met Peggy there with her 1-year old son. She told us how it was difficult for her to get pregnant. She had undergone couple of failed IUI and was mentally preparing to undergo IVF when luckily she got pregnant naturally with her son. She also said that she was going to try again for a 2nd child very soon as it was not easy to conceive for her. At that time I was thinking, "IUI, IVF - what are those treatments?". I didn't really think much over it. I was 29 years old at the time and thought I still have a lot of time to try for a baby.

December 2009

Landed a new job. Very happy. The thought of starting a family did not even cross our minds.

October 2010

Peggy had given birth to her 2nd child. We started thinking about starting a family but wasn't really serious about it. Work had just started to get demanding.

2011

Work got extremely demanding. Long hours, worked till past midnight for the next 6 months, only to show up at the office at 9 a.m. the next day. Felt like I was a zombie. Might sound stupid but I had no idea about ovulation, follicular phase, luteal phase, bbt etc at the time. We ttc on and off during the year hoping I will get pregnant.

2012

I took a 3 months break from work beginning April as I was on the verge of a burnout. I resumed work in July, same intense and stressful environment although I never had to work past 9 p.m. We asked family doctor around mid year for a referral to specialist. He advised hubby to get a sperm analysis done. The report came back normal. He sent us back to try for another 6 months. Finally around year-end he referred us to an Ob/Gyn Dr. George Woo.

2013

Consulted Dr. George Woo Ob/Gyn in January. He sent me back to chart my BBT for 3-4 months.

In May, I missed my period and went for the HCG blood test, came back at 28 HCG level and it turned out to be a chemical pregnancy.

I went back to consult Dr. Woo in June with my BBT charts. He told me I was ovulating however as I tend to spot a few days before my actual period arrived, he prescribed me clomid 50 mg for the next 3 months in hopes of achieving a better quality egg. He mentioned to contact him in case I decide to try IUI. The cost will be around $700. In the meantime, I should get SHG (Sonohysterogram) done.

I tried clomid for the next 2 months and after that wasn't successful, I contacted him to have IUI done in September with clomid 50 mg. He holds his clinic at IVF Canada in Toronto. The SHG report showed I had a polyp in my uterus, Dr Woo and my family doctor did not think this was an issue and need not be surgically removed.

My IUI experience wasn't exactly very memorable. For the first consultation, they couldn't find my file. When the doctor inserted the ultrasound probe and I appeared to be in discomfort, he asked me what was wrong. I told him it wasn't very comfortable and he didn't sound very kind or understanding when he said that was nothing, why should it be uncomfortable. He was also showing a technician (who should technically know how to perform the ultrasound right?) how to find the egg and measure it. During the first ultrasound he said there was an egg in my right ovary but after 2 days, he said it was the left ovary that had an egg. When questioned, he was quiet and ignored my query. The longest I waited to see him was 6 hours, from 10 a.m. in the morning to 4 p.m. in the afternoon. I found his staff very unprofessional although he claimed to be the pioneer of IVF in Canada and a lot of IVF specialists were his students.

After the IUI, I was on progesterone suppositories for 14 days. He instructed me to return for BHCG testing after 12 days however no one gave us further instructions on how to follow up for the results so we assumed the office was going to call us with the results after the blood test. No one called us and we were left in limbo until my period arrive 3 days later.

The IUI with clomid 50 mg had failed. I was disappointed not so much with the failed IUI but with the level of service provided. My husband was disgusted and vowed never to engage Dr Woo's services again. The only thing I appreciated was the BBT charts he asked me to keep else I would never have looked up so much information and learned so much. I also like his BBT chart which has 3 months on a page. Please email me should you need a copy.

A disadvantage of the Canadian Healthcare system is that you cannot directly see a specialist without a referral by your family doctor. At the infertility clinics in Toronto, if you don't have a referral from a family physician, they charge you $200 for the initial consult.

After the failed IUI, we decided that I should resign from work and focus more on starting a family. We planned to go to Taipei in November and consult Dr. Robert Lee from Mackay Memorial Hospital as he is one of the top IVF doctors in Taiwan based on hubby's research.

I saw Dr. Lee in November and he ordered some blood tests and HSG (Hysterosalpingogram) to be done. As we had a trip planned in December which collided with the HSG test period, my HSG was done in January.

2014

In January, Dr. Lee advised to surgically remove the polyp and that was scheduled for February 2014. It turned out that there were more than 1 polyp in my uterus with the biggest one measuring 3 cm. After that it was time for us to return to Toronto and Dr Lee advised to try IUI with injectibles in Toronto at least twice as it has a better outcome than clomid. If that doesn't work, we can return to his clinic for IVF when we are ready.

We tried naturally for the next 5 months. I was also taking chinese herbal medications all the while. In July, we realized that it wasn't working and as my biological clock was ticking, I contacted Mackay Memorial Hospital International Medical Services Center and Annie replied to my emails.

I am currently on Gynera birth control pills for 21 days however I started spotting on day 9. I was alarmed and emailed Annie. She wrote back immediately with instructions from Dr. Lee. If anyone will like to know how it was resolved, please write to me at xiaonionio@gmail.com. The spotting has stopped and I am just waiting to fly to Taipei on August 17th to start my first IVF treatment. Fingers crossed!