Macrophage colony stimulating factor- yes/ no?

http://en.m.wikipedia.org/wiki/Macrophage_colony-stimulating_factor
" Additionally, high levels of CSF-1 expression are observed in the endometrial epithelium of the pregnant uterus as well as high levels of its receptor CSF1R in the placental trophoblast. Studies have shown that activation of trophoblasitc CSF1R by local high levels of CSF-1 is essential for normal embryonic implantation and placental development. More recently, it was discovered that CSF-1 and its receptor CSF1R are implicated in the mammary gland during normal development and neoplastic growth.<sup>[5]"

http://www.hindawi.com/journals/mi/2012/967629/
"</sup>While much research has been dedicated toward circulating cytokines in pregnancy, local cytokine production at the maternal interface may be of greater significance than measurements obtained in the peripheral blood [23]. IL-4, IL-10, and macrophage colony-stimulating factor (m-CSF) production by T cells at the maternal fetal interface is associated with successful pregnancy [23]."

^{http://www.drugs.com/sfx/neupogen-side-effects.html
"}Oncologic effects may occur due to filgrastim (the active ingredient contained in Neupogen) effect as a growth factor with any myeloid tumor.^[Ref]" 

http://www.neutropenia.ca/about/patient-evaluation-and-treatment/treatment-for-severe-chronic-neutropenia
" The SCNIR collects information on SCN patients and pregnancy; however, the number of pregnancies reported to date is relatively small and thus little information is known about the potential effects of G-CSF during pregnancy. Therefore, the use of G-CSF during pregnancy should be evaluated individually with your primary physician, who can weigh the currently known risks and benefits of treatment in the context of your individual situation. Because the safety of G-CSF administration during pregnancy is not yet established, the current recommendation given by the experts of the SCNIR is that if possible, G-CSF should be avoided or minimized during the first trimester. You should discuss this issue with your physician well in advance of any decisions regarding pregnancy. It will then be possible for your physician to review the current pregnancy data with you and develop a plan for G-CSF dosing."

http://www.ptglab.com/Products/G-CSF-R-Antibody-18310-1-AP.htm
" GCSF receptors can be found on neutrophils, myeloid leukemia cells that respond to GCSF, bone marrow cells of neutrophilic granulocyte lineage, and on placental trophoblasts. "

^{http://chemocare.com/chemotherapy/drug-info/granulocyte-colony-stimulating-factor.aspx#.VKS6S38ayK1}



- csf and tropoblast growth factor
- Is there a growth factor for cancer cell? Does csf promote its growth?
- ehem ehem, why am I so particular with cancer. Hey, there is a risk for spleen rupture as well.
- anyway, if csf does not promote growth factor for cancer or tumor, i may give it a try
- wait... Csf promote white blood cell production or neutrophil only? I am thinking it will magnify my nk cell count. 



Ei.... My dear immunologist, I walk to have a long chat with you. Grrr.... I hate "neoplasm". Excuse me. I admit I am an ignoramus. To me, neoplasm is synonymous to tumor or cancer. Grrr... yes or no? Oh no... There gm-csf, gcsf, m-csf sounds like different things?  Google google...

Gonal-f, menopur, cetrotide drug interaction?

I feel dry eyes. A little blur vision. Oh my god...
http://www.ehealthme.com/Menopur-Gonal-f-Cetrotide-3735486

My new year's resolution- avoid stress

What is my new year's resolution? How to avoid stress? I cannot think of solution other than resigning from work. Family business is where my life and work integrates. I cannot stay away from mental stress. I am a short tempered person.

1. Office work at home.
2. Eat less red meat.
3. Eat more fruits and vegetables.
4. Learn to cook.
5. Eliminate processed food in my diet.
6. I wish to have three- week intensive yoga before embryo transfer. (Not everyday... Let us see.). Try to exercise more?
7. 7 pm dinner, sleep at 10pm. Ai... Bad influence husband always sleeps very very late.
8. Less coffee
9. Less sweets

---- "Steptoe and Brydon speculate on the reasons why acute stress responses may raise fasting serum lipids. One possibility may be that stress encourages the body to produce more energy in the form of metabolic fuels - fatty acids and glucose. These substances require the liver to produce and secrete more LDL, which is the principal carrier of cholesterol in the blood. Another reason may be that stress interferes with lipid clearance and a third possibility could be that stress increases production of a number of inflammatory processes like, interleukin 6, tumor necrosis factor and C-Reactive protein that also increase lipid production. "
http://www.medicalnewstoday.com/releases/34047.php

" What are the harmful health effects associated with stress-induced obesity?
Chronic stress can contribute to several harmful physiological events. When body tissues are exposed to high levels of cortisol for extended periods of time, some cellular and tissue alterations may occur. High levels of cortisol cause fat stores and excess circulating fat to be relocated and deposited deep in the abdomen, which left unchecked can develop into or enhance obesity. In addition, hypertension (high blood pressure), hyperlipidemia (elevated lipids), and hyperglycemia (elevated glucose) have been linked to elevated cortisol levels (10,14). Individuals with a high waist-to-hip ratio (which identifies visceral obesity) are at a greater risk for developing cardiovascular disease, type II diabetes mellitus, and cerebrovascular disease (8)."
http://www.livestrong.com/article/272648-liver-function-and-cholesterol-levels/

"Metabolic and Long-Term Health Effects of Elevated Cortisol Levels

• Metabolic effect (cortisol-induced) Chronic health condition
• Increased appetite, accelerated muscle catabolism (breakdown), suppressed fat oxidation, enhanced fat storage Obesity
• Elevated cholesterol and triglyceride levels Heart disease
• Elevated blood pressure Heart disease
• Alterations in brain neurochemistry (involving dopamine and serotonin) Depression/anxiety
• Physical atrophy (shrinkage) of brain cells Alzheimer's disease
• Insulin resistance and elevated blood-sugar levels Diabetes
• Accelerated bone resorption (breakdown) Osteoporosis
• Reduced levels of testosterone and estrogen Suppressed libido (reduced sex drive)
• Suppression of immune-cell number and activity Frequent colds/flu/infection
• Reduced synthesis of brain neurotransmitters Memory/concentration problems http://cortisolconnection.com/ch6_1.php

What to do next if I have implantation failure?

I pray I am not buying false hope on my immunologic treatments. Shhh... I dont believe much in HLA tissue crossmatch. But, I follow religiously my immunologist instructions because I have autoimmune disorder. What to do next if those don't implant?

- neupogen?
- pgs? To detect unbalanced chromosome translocation only. Unbalanced chromosome translocation- no implantation. Down syndrome does not cause implantation failure. I don't believe much in pgs. Mosaic down syndrome maybe undetected by pgs, because we are playing lucky pick on cell sampling.
- fibroid removal? < 2 cm.  I remember morcellator was recalled. Fibroid removal may cause cancer.
- polyp? < 0.3 cm
- blocked left fallopian tube? Not sure...i guess this may cause ectopic pregnancy. Implantation per se, there will be implantation (on the fallopian)

Whatelse, pls share some inputs. On spiritual aspect, I had my pilgrim already.


http://humrep.oxfordjournals.org/content/21/12/3036.full

My christmas giift and neopogen guinea pig

Today is Christmas day. I am stucked in my mom's house for five days. Nothing to do here- just blogging and doing some reflections. Btw, What is my gift from God? I hope the seven embryos are indeed a gift of God. I hope this entails implantation.

According to the nurse, my 5 embryo are of outstanding quality. I don't want another false hope here. Good embryo quality does not guarantee an implantation.  This reminds me of Neupogen. Yay! I am a bit skeptical on its safety.

What is Neupogen?

I am poor in decision making. To use or not to use Neupogen? If I don't use Neupogen and implantation failure happens, I will blame myself for being stubborn.  Neupogen does not guarantee implantation either.

What is wrong if Neupogen is a new drug? New drug= new hope (+ new risk?). If I wait for this drug to mature in the market, I guess I am already in menopausal state! The ultimate question here is whether I want to volunteer to be a Neupogen guinea pig?

My greed

My day5 embryo update: 5 excellent, 2 normal = 7 embryos. They called me to ask how would I want them to be freeze. Five individual test tubes for the five excellent embryos and one test tube for the two embryos? They explained the number of test tubes corresponds to the freezing cost. I said OK!

My greed pushed me to recount my 20 eggs ... 12 fertilized... 9 excellent cleavage... 7 embryos... (5 excellent, 2 normal)... Oh no! I paused for a while. What will happen to the seven after thawing? I was speechless.She then said that my embryo so far is the best embryo they have ever cultured this year. I laughed out loud. She insisted she was not kidding!

5 excellent embryo from 20 eggs. 25% ya. If I did not have hyperstimulation, let us say 12 eggs were retrieved, 25% of 12 eggs is 3 embryo? Then, how many embryo will survive after freezing? Scary... Maybe I am just looking for a safety net.

Btw, how many babies do I want? I prayed for one pregnancy and successful a birth only. After all, I am battling with the pregnancy safety issue. TNF-alpha may flare up. Immune suppressants may cause cancer. 

Day 16

I have been experiencing small amount of orange discharge since day 14. I am helplessly stuck in Guangzhou? I remembered the doctor said my menstruation will come few days after the decapeptyl shot. Observe! Observe! My menstrual period came on Day 16.

What happened to my embryo? From 20 eggs,  12 were fertilized. 9 was of outstanding quality. They said they will grow them into full blast.  Because my embryo quality was outstanding. They said they do day3 freezing with so-so growth embryo only.

Day 13

My pelvic girth is 92 cm. Perhaps, they did a typo error yesterday. It was 82 cm yesterday. I did not notice any bulging around my waist. No tightening of my pants. Re：weight gain, maybe I ate too much in Hong Kong. My weight was 130 pounds on day 4. Now, it is 137 lbs already. No big deal! I can still walk to their clinic. My ovary isn't bursting yet. Then, I was warned of OHSS by the nurse again. OHSS usually occurs after egg collection... Blablabla ... I need to report my weight tomorrow morning. They will call me to update me on my embryo development.
Well it is too late for the warning. I booked my return flight via Guangzhou- Manila.  I am staying in Guangzhou for two days. Because, the plane ticket rebooking fee HK-Manila will costs 862 USD. The budget airline fare to Manila via Guangzhou cost 333 USD. Stingy me!

Day 12

Egg collection today. We got 20 eggs. I just remembered lying on the operating table for less than a minute. No idea on how long did I sleep. I just feel somebody woke me up to make sure that I am still alive. I woke up helplessly dizzy and I have cramps in the pelvic area. I feel nausated. The doctor dropped by to confirm the ICSI procedure. He reminded me that ICSI adds 1 to 2% risk of congenital abnormality.

They checked my urine to make sure that there is no internal hemorrhage. They measured the girth of my pelvic area as a baseline for edema. I admired their professionalism but something very important was skipped! They forgot to weigh me! They just said I need to weigh tomorrow to make sure that there is no weight gain because of water retention. I need to drop by their clinic to let them measure the girth of my pelvic area.

Freezing and embryo transfer

According to the doctor, not all embryo will survive the freezing. Here is our plan: freeze all embryo at the cleavage stage Day3 then cultivate the warmed embryo for another 48 hours to let it reach the blastocyst Day5 stage. Those with arrested growth after thawing means they did not survive the freezing.

https://my.clevelandclinic.org/ccf/media/files/OB_GYN/CP-LB-from-vit-D3-embryos.pdf
http://www.victoriafertility.com/our-services/embryo-freezing-and-transfer/

Day 10

I had my blood extraction at 9 am in the morning. My schedule with the doctor was 10:15 am. It was moved to an earlier slot. My eggs are big. Egg collection on Friday. Wow! I was optimistic that we will have an embryo transfer this cycle. I crossed HK border just to extend my validity of stay in Hong Kong.

I went to Shenzhen during lunch time while I was awaiting for my blood result. When I returned to the clinic, they shared me my bad news. No embryo transfer. My progesterone went up to 1.7 while my estradiol went up to 7900. I have high risk of OHSS. Two days ago, my estradiol was just 1890.

Things are not always smooth sailing. What matters most right now is my safety during/ after the egg retrieval. We discussed what will happen after the egg collection and frozen embryo transfer.

Decapeptyl trigger shot later. My largest follicle size is now 20 mm.

I am indecisve

I am not good at decision making. When will I have IvIg? The hematologist told me before, I should do it again two days prior to embryo transfer. So, when is the embryo transfer? Three or five days after egg collection. Is it 3 or 5? Will it coincide with holiday? My hematologist is having vacation very soon. He said I can have ivig today. But, I declined. I said, Ivig is very costly. It is useless if we will not have an embryo transfer. He said study shows that IvIg can help improve the egg quality. I just have Ivig on Day 1. Hmm... Expensive. I told him that I will drop by his clinic in the late afternoon on Day 10.

Why am I not firm to tell the ivf doctor that I wish to have embryo transfer on the fifth day of egg transfer? And have my Ivig on the third day after the egg collection?

This morning, I was faced with another decision making task. Should I cross Hong Kong border or not? I am permitted to stay until Dec 26 only. My return ticket to Manila is on Dec 31. I will be overstaying in Hong Kong. If I postpone going to Shenzhen til tomorrow, I dont know what will be my condition. Hcg trigger shot may cause cramps, making me unable to go to Shenzhen. If I developed OHSS after egg collection, I may need to be hospitalized. If this happens, I cannot go to Shenzhen. If I go to Shenzhen and my blood result is bad, then my Shenzhen trip is a waste. Should I or should I not go to Shenzhen today? It is 11 am already, my blood test will be out by 2:30 pm. If I dont start my journey to Shenzhen, I will be wasting my 3.5 hours. If I started my journey to Shenzhen at 3 pm, what time will I be back to Hong Kong? What time should I inject my new medicines?

Whatever it takes I still need to wait for 3.5 hours. I started my journey to Shenzhen at 11 am. I got a sad news in the late afternoon.

Day 9

I still feel nausated. I was feeling groggy this morning. I had my breakfast at 10am, lunch at 2:30 and dinner at 7:30pm. At least no more headache for the rest of the day.
Check up tomorrow morning. Wish me luck!

Day 8

I have 24 follicles already. 8 are big follicles. The biggest size is 16mm. Small follicles are useless.

Erase my worries, it is too early to have OHSS. Usually, OHSS is after egg retrieval. If my estradiol level hits 3000 and progesterone hits 1.5, that is the time I need to worry about OHSS. I need  to go back the medications where we have started, GonalF 300 IU + Menopur 150 IU, plus Cetrotide 0.25mg.

Poor shel, pls bear the indigestion and headache for a while.

Day 7

Today is Sunday. I woke up at 7:30 am. I tried to sleep longer but I could not fall asleep. I had my breakfast at 8 am. I was feeling full til 2 pm. Soda water help a little. I had my lunch at 2 pm. I was thinking to have my Gonalf shot or not. Should I call my doctor? Should I just skip the GonalF shot?

I was thinking OHSS can't be too early. I just proceeded with the GonalF. Help me, God! After eating dinner at 7 pm, I felt little cramps. I still have the mucus discharge. My pelvic area is heavy. Call it a day!

Cant sleep... Random thoughts

I cant sleep. I feel uncomfortably bloated. I WANT to fart! Uhmmm... Nothing coming out!

I feel Hong Kong's medical cost is very steep. Don't know... Perhaps, I am comparing it with the Philippine cost. Bingo! I found one cost comparison chart.

http://www.geobaby.com/pregnancy/practical-advice/item/prenatal-charges-and-ob-gyn-fees

Where is my doctor on the list? There you go... Consult:  HKD 2000 ; ultrasound: HKD 1500. How much is the minimum wage in Hong Kong? HKD 40/ hr?  How many hours should a fast food employee work in order to pay for infertility consultation? 75 hours. How many hours of work to fund ivf? 2750 hours. Wa! Unless there is a subsidy or the doctors cost chart is applicable for expat and foreigners only.

In the Philippines, a minimum wage employee needs to work for about 5600 hours to fund her ivf.  So, where is cheaper? ^.^ Whatever... I need to work thousand hours of hard labor in order to build a dream family! I had encountered several obstacles along my journey. Now, the impending OHSS. This is indeed a bumpy journey towards my fertility! I pray that I am on the right path, with the right doctor and the right timing as well.

Ivf in philippines or abroad

In the event of OHSS, I feel I am safer in the Philippines. It is my home!

How about in Hong Kong? Ai ya... Scary... I maybe saved as well but I may burn my pocket. I want to do Ivf in Hong Kong because I learned this doctor has a good success rate. I don't trust much in Filipino embryologist.

I feel nausated. Today is just Day 6. My OHSS worries is not far from becoming a reality.  After taking gonadotropin releasing hormone for 5 days. Here I am, injecting gonadotropin releasing hormome antagonist. The doctor said it is to prevent premature ovulation.Btw, is there a difference seeing a reliever from seeing my doctor? It is just a psychology thing! I believe he will do the same. But, I am just worried OHSS may happen. I have 17 follicles already. Oh my god!

How many obgyne have i seen?

Philippines- 4
Hk-2 (one is the main doctor, the other one is a reliever)

So far, only one in the Philippines had complained that I have polyp. I need to do laparoscopy and polypectomy. I just realized that some doctors are abusive. They would advocate unnecessary treatments. I dont experience menstrual pain, why do I need laparoscopy? I dont experience spotting between periods, why do I need polypectomy? I believe the only way to see small polyp is through saline infusion sonography. Less the 0.3 cm is not clearly seen via regular ultrasound. The doctor who prescribed me to do the polypectomy never did a saline infusion sonography on me. She just told me that my polyp is 1 cm. How do I trust her? Am I a money vending machine? Shhh.... No comment. Only time will tell.

If I am lucky to get pregnant, who will be my new obgyne? I need an obgyne that is expert in immunology. I don't feel like going back to my first obgyne. I feel I am more of a commodity than a patient. I really can't imagine why she insulted me. Autoimmunity is karmic in nature. My clan is bad!

The third obgyne, does not like me. She asked me to go back to her mentor. The fourth obgyne? Aya! I let my reproductive immunologist decide who will be his partner.

Day 6

Day1-day5
Menopur 150 IU, GonalF 300 IU. Headache on day2,3,4. I vomitted on day3.
I have cervical mucus discharge as every as day5. What is happening to me? Am I ovulating very soon?

I went to The Women's Clinic today. I have about 17 follicle. This explains my discomfort. My estrogen is high, this explains the cervical mucus discharge. LH meanwhile rose to 10 already. We stopped the Menopur.

Day6 and Day 7 Gonalf 300 IU, cetrotide 0.25 mg.

Day 1- i saw the measurement of the biggest follicle 0.5 cm
Day 6- the biggest follicle is 1.3 cm

Ivig infusion rate

I heard Ivig before. I heard the former obgyne secretary compute for the grammage based on the patients weight.
I just don't know how much was my dosage.
Headache headache, vomit... Oops maybe that is caused by follicle stimulation drugs.


http://www.calgarylabservices.com/files/CLSForms/TSO1312.pdf
http://www.ecomm.baxter.com/ecatalog/loadResource.do?bid=60331

IVIG and Neupogen

I had my first shot of IVIF on Dec 8. My head is heavy til today. I will have my second shot of IVIG two days before embryo transfer. I am quite scared. After the Lymphocyte immunization therapy and IVIGs, I feel I will cry more if it fails.

The hemotologist said he will use 4 shots Neupogen on me. He explained it promotes the development of the placenta. Growth factor for tropoblast.

Google, google... Whew! I thought neupogen is a TNF-a inhibitor! He said he doesn't want to use tnf-a on me because it sometimes rebounds. Neupogen promotes white blood cell production etc... etc... Ehem! Good Luck Shel! Never mind... I trust!

http://www.preventmiscarriage.com/Reproductive-Immunology/Treatments/Neupogen-Filgrastim-.aspx

Risk of IVF and my obstacles- dumb you do, dumb you dont

What are the risk of IVF?
- during the stimulation, the ovary may twist off, cutting its blood supply. In this case, emergency operation is necessary.
- during the stimulation, the ovary may burst.  In this case, emergency operation is necessary.
- Hemorrhage and infection may happen during/after the egg retrieval. Hemorrhage may result into blood clot. Blood clot may result into stroke.
- ivf may also result in ectopic pregnancy. If this happens, the fallopian tube needs to be surgically removed.
- ovarian hyperstimulation syndrome may cause fluid retention in the internal organs like lungs and etc... If the lungs squeezes the heart, this may cause cardiac arrest that may result to death.
- multiple pregnancy

Did I still miss out something? Surgery, surgery and death... At least, patients are well informed. Ivf is dumb you do, dumb you dont.

With the standard IVF, the sperm and eggs are put into a dish.  Natural selection takes place- survival of the fittest theory holds. It is believed that only the healthy sperms can fertilize those eggs.
My husband has 1% normal sperm morphology. If none of my husband sperms has fertilized any of my eggs, oh my god! So, we will be using ICSI- intra cytoplasmic sperm injection to increase our chance. Since, we have eliminated natural selection process... the success of the fertilization lies in the hands of the embryologist. ICSI increases the risk of birth defect by 2 to 3%.

I have been hearing all the negative side of IVF that afternoon. Now, Am I ready for IVF? I gave him a firm YES!

Thank god, the weather was cooperative. We thought our consultation might be cancelled because of the typhoon in Manila. Luckily, we were able to fly to Hong Kong. We thought we might get stranded in Hong Kong, again our return flight was unaffected by the typhoon.

I am clumsy. I forgot to bring our original marriage contract to Hong Kong. Doctor said soft copy or photocopy is not admissible. If the nurse approve us to sign the contract, we can start the stimulation that day. If she doesn't... Sorry! I have a soft copy in my phone. Wa! I haggled to bring the original marriage contract to Hong Kong when I fly back. No marriage contract, no egg retrieval.

We then signed off the ivf consent form. What shall we do with the excess egg? What should we do with the excess embryo? In the event of any change of marital status (divorce or death), neither of us can benefit from the embryo. The validity of the contract is six months. I was thinking of possible loop holes. Haha, cannot fool them.

I had my IVIG in the late afternoon. I also have started my follicle stimulation.

Day1 to Day5 (Dec8to Dec12) - Menopur 150 iu + GonalF 300 iu
Dec13- blood extraction and check up.

The joys of overcoming infertility

What is the definition of a family? I remember this was taugh to me in grade school: a family consists of father, mother , brother, sister and baby. Can husband and me fit into the definition of a family?

It is my challenge on how to build our own family. I love short cuts, but I reject the idea of adoption. Under the Hong Kong law, ivf doctors must remind patients that adoption is a better alternative to  ivf. My eyes were wide open. 

I wish I could reply: "Can't you understand why I am here in your clinic? Doctor, I want to show the world that I am not infertile. With the advanced technology nowadays, I believe you can help me. Can't you? Now, will you still want me to consider adopting?"

How to calm the untamed dragon inside me? Why do i need to prove to the world that I am infertile? Since, I really need is to fill the emptiness of OUR family, why not consider adoption? Adoption maybe cheaper than IVF + immunologic treatment combined. Adoption is a better alternative than to have pregnancy related complications. Honestly, I don't feel satisfaction when I adopt a baby.  Something is not complete. Ai... Arrogant me or flamboyant me? I need to see psychiarist . Or perhaps it is just a JCDS. Jayden' Coke Deprivation Syndrome... Will discuss this cute syndrome next time. Hehe ^.^

Lazy me says surrogacy is acceptable. Are sperm donation and egg donation acceptable to my standards?

I quietly listened as the doctor explained all the risk of ivf and its procedures. Am I ready?

probability: pgs

If my 8-cell embryo has 6 normal and 2 abnormal cell. If the embryologist is to pick 2 cells at random, what is the probability that both cells are normal?

 answer: = combin(6,2)/combin(8,2)            (microsoft excel)

              = 15/28

              = 53%

My silly instinct says mosaicism at 8-cell embryo level is not reliable. I will not do PGS. I feel if the embryo passed the PGS screening for genetic defect meaning no trisomy, no down syndrome. Mutation can still happen beyond the 8-cell stage. Somatic mosaicism Down syndrome may also happen.

Knock on woods... If I dont get pregnant, maybe I will try to do the PGS on the frozen embryos.

https://www.khanacademy.org/math/precalculus/prob_comb/prob_combinatorics_precalc/e/probability_with_perm_comb
http://paper.wenweipo.com/2004/05/05/MR0405050001.htm

A second look at genetics

I am just an ignoramus. My imaginations has gone wild because of my desperation to have a genetic counselling. I heard one of a friend's friend twins has Down syndrome. Oh my god, pre implantation genetic screening could have helped prevent its occurrence.

http://downsyndrome.about.com/od/whatcausesdownsyndrome/a/mosaic_ro.htm
*   Understanding the cell division process.
" The zygote starts as one cell, duplicates itself and then divides into two cells. Those two cells each duplicate themselves, divide and create four cells. Those four cells duplicate and divide to create eight cells, and so on. This process of cell duplication and division occurs throughout the life of an individual."

* What is Down Syndrome?
"With full trisomy 21, the presence of an extra number 21 chromosome, the error or misdivision of chromosomes occurs in the egg or sperm cell that becomes the zygote. Because this error was at the very beginning of development, every cell that comes from this zygote will have an extra number 21 chromosome.

With mosaic trisomy 21, the error or misdivision occurs after fertilization at some point during early cell division. Because of this, people with mosaic Down syndrome have two cell lines -- one with the normal number of chromosomes, and one with an extra number 21."

* How Mosiac Down syndrome is detected?
It is detected by blood test on the baby or amniocentesis or cvs during pregnancy.

To summarize, I feel pre-implantation genetic screening is not a reliable screening for mosaic Down syndrome. Pre-implantation genetic screening is usually done at eight-cell stage. It is an invasive test wherein two cells are removed from the embryo. And then screened for chromosomal abnormality.
What if mosaicism exist but the cell picked was good?

inspiring story

What is the success rate of my ivf doctor? I did not have the courage to ask yet. So far, I was referred to this doctor by 3 people. And the fourth one was my aunt. Fairy God Father? I learned my lesson, I am not into fantasy this time around.

I checked the web for forums on IVF Hong Kong but there was a handful few only. I saw a China mainlander forum. Wow! Despite of her ivf failures, her determination led her to success. Oopps... Humira! Ehem... Ehem... I am afraid of Humira. Humira is a tumor necrosis factor-alpha inhibitor. Inhibiting the TNF-a can induce cancer.

Let us see what the hematologist will say on Monday.



http://www.ivfbbs.com/read.php?tid=32244&page=1

Of chromosomes... Iui and ivf

I am funny. I was so stressed about my husbands karyotype. The Hong Kong clinic that I am going to does not do PGD, I almost booked another hospital in Taiwan. Wahaha...

Wake up! Why did I do IUI, if I fear that my husband's translocation can cause genetic abnormality to my baby? Is it really the survival of the fittest sperm theory? I believe those with double head, small head, bent tail are sluggish. Those healthy sperm can fertilize my egg first. Btw, is my theory supported by evidence?

IVF with ICSI... I don't want it to be done in Philippines. I complain the experience level of our embryologist here.

Normal morphologic sperm may have abnormal chromosome content. I may still have unbalanced translocated baby with congenital defect. It seems like I never entrust the sperm selection to the embryologist. Oh my god! I just worry too much. Come what may!

Karyotype nightmare

My cousins's classmate has successfully gave birth to a twins few months ago. Wow! It seems Taichung has a reputable success rate ya. But the sad story is one of the twins has Down syndrome. Oh my god, PGS!

My husband's karyotype nightmare is bugging me again. I wish to retest his chromosomes. But my plane ticket is non-rebookable. I hope we can have karyotype done in Hong Kong next week. Help please!

All set for the ivf consultation

We have completed all the bookings for my ivf consultation. I am excited. I was busy this afternoon compiling all my records.

I will fly out this Sunday. I will be back again on Tuesday. Hong kong is just two hour flight away. It is very near! Perhaps, it is faster to reach Hong Kong than from our store going to our warehouse! Traffic.

I am no longer nervous of meeting the hematologist. Relax!

Ivf cost- ouch ouch

I was indecisive few days ago. One of my consideration was the cost. Of course, I like the cheaper, the better- Taiwan or Philippines. Back in my mind, I wish to have ivf done in HK. I just don't know how my husband will react. Because few months ago, he said he prefers Philippines. Hk including the accomodation maybe about three or four times the ivf cost in Manila.

Finally, my husband agreed to support my choice. I hope this is a wise spent money. If unsuccessful, I will cry. I will feel guilty of overspending.

I just remembered  my friend-Susan. She feels sorry whenever she sees kids begging in the streets.  Dear god, why are there so many street children? Why not grant us one child? These street children are deprived of basic education. It seems that their parents are very irresponsible. She will be a very responsible parent.

Why god is so unfair? I laughed out and replied: God is fair! God knows those irresponsible parents have no means to undego a fertility treatment. How much is the iui or ivf? Wahaha... My boomerang hit me! Ouch!

Don't be in despair. It is just about money. We can earn back the money someday. I don't want to regret not having ivf done in this reputable HK clinic in the future. Hmmm... Has anyone regret of staying in five star hotel? Perhaps, it is the other way around.

Who is Dr. Chan?

Google google... who is Dr. Chan? Sounds scary... He is a hematologist / hematological oncologist. I suddenly got phobia in blood and the big C!

I feel nervous.

when to go to have my initial ivf consultation?

My estimated menstrual period is December 10. This means I should have already decided what to do before Dec 15. I should be taking ivf preparation medicine by then. The following cycle - January will be the egg retrieval and embryo transfer cycle. Why I keep on delaying? Maybe a part of me is leaning on the hope that I will get pregnant with this IUI.

If I start my ivf preparation medicine in January, my first menstrual period will be Chinese New Year. Then my next period will be on Feb 26. My last lymphocyte immunization was in October. It will be about five months gap. I don't know my LAT level by then. I complain March egg retrieval and transfer is too far.

I procrastinate because I try to minimize my travel. From third week of October to December 1st week. I flew three times already. Indonesia, China and China. Maybe because of my belief that flying will cause me to become infertile. I am afraid that my IUI will not implant. The reality is I am not optimistic that this IUI will be successful.

Anyway, I  to have my little vacation in Hong Kong. Vacation on tight budget! IVF cost in Hong Kong is very expensive to our standards. This brings me to question again: why Hong Kong? Ooops... Wrong question... The correct question is: why I am poor? Grrrr... I will strive to work harder after I have babies.

Why Hong Kong?  That clinic has 26 years track record. They believe in immunology as a factor for infertiltity.  For now, I don't want to put a period in the end of my sentence. I am afraid of monstrous doctors. I look forward to meeting well mannered doctor. I hope we can cooperate well.

Single or double embryo transfer

How many embryo shall I allow to be transferred to me? The Taipei doctor puts one embryo only. It is believed to be safer. Twin pregnancy poses the risk of preeclampsia, gestational diabetes and pre term labor.

What if  we tranfered one embryo and there was no implantation? What are my overhead cost? Air fare, hotel, and ivig. Whatelse?

What is my view about pregnancy? Pregnancy is dumb I do, dumb I don't. I am willing to take the risk once. If I have a baby already, I can't imagine myself of having my second ivf.

I think, I will allow to put two embryo. Come what may. I surrender to god.

Where to do IVF?

These are my considerations in choosing IVF center:
What is order of my priority?
- success rate (conservative or aggresive?)
- years of service
- location (Ideally, the best place is Philippines)
- cost

I personally believe the success of IVF greatly depends on the embryologist. I have bad experience in one of the IVF center in the Philippines. Their andrologist did a shameful semen analysis. The total sperm count of motile and immotile had exceeded 100%. My husband's morphology was always 1% in Kruger standard. But is lab, he got 7%. Location plays an important factor for our IVF center selection. So, I decided to have IVF in the Philippines. Due to holidays we can have our IVF January. Since, I have been taking viagra and heparin for the uterine biophysical ultrasound. Perhaps, it is wise to try an IUI. So, we tried IUI in a prominent hospital.

My husband semen analysis last week was so great. Is it a miracle or what? Am I just so pessimistic? In the span of 7 days, the semen quality was greatly improved. Is this a case of double standards? The Quezon City people observe Kruger standards. The semen analysis report were done by andrologist. Who does the semen analysis in Global City? Medical technologist but I feel they are interns. I heard them exchanging jokes and I also overheard somebody asking how to make the report. Does he need to just sum up the sperm blablabla? I don't feel like going to this hospital for IVF anymore.

I am thinking to do whether to have IVF with one of the oldest IVF center in the Philippines or just go abroad for treatment?

I guess years of service isn't an important factor, since my choices are all above 10 years already.
Again, what is order of my priority?
- success rate (conservative or aggresive?)
- cost
Taipei, Taichung or Hong Kong?

Taipei
- single embryo transfer; This means lower success rate.
- affordable

Taichung
- one to three embryo transfer
- according to friends: it looks like a production line. Many patients
- don't believe immunology as a factor for infertility. They will believe in immunology only when I have three unsuccessful IVF with grade A embryo. I am not in the position to argue with them.
- affordable

Hong Kong
- one to three embryo transfer
- they do consider immunology
- expensive

This brings down my choices to two: Taipei or Hong Kong.
Taipei- although cheap it has lower success rate. I saw in many blogs implantation failure. Ai... One embryo or two embyo transfer is best for me?

For the meantime, I prefer Hong Kong. My friend called me today, re: new ivf center which uses japanese technology. Ai... I am just riding a merry-go-around. Embryologist experience matters a lot. I want to have ivf in HK.