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!