Submariner
Banned
In case anyone was interested, I thought I would post my observations of the differences between US and HK IVF standards. We are currently using Dr. Philip Ho, but a good friend of ours also happens to be an IVF doctor in the States. So we've had a lot of opportunities discuss with both doctors the differences in procedures and standards.
The primary difference is that Hong Kong (and most of Europe/Australia) is far more conservative when it comes to IVF. The US is much more aggressive. Now before we bring up Octo-mom, aggressive isn't a bad thing unless having extra embryos on ice (or destroyed) is an ethical concern for you. For us, we would have preferred a more aggressive approach to give us more embryos (more embryos = more to choose from, more to save for later in case the first attempt fails, more to use if you want more kids a few years down the line).
Anyway, here is our findings:
1) Our US doc would consider 10 follicles at the outset to be a good minimum standard. Our HK doc was happy with 3 or more.
2) Our US doc would have prescribed a much higher hormone dose to develop more follicles. He recommended starting at 450 units and scaling it down whereas Dr. Ho and Dr. So both recommended 225 units. As a result, of the 8-9 follicles we started with, only 5 became developed. Our US doc says that out of 8-9, he would expect 7 -8 to develop with the higher dosage. Dr. Ho says that a higher dosage might lead to Ovarian Hyperstimulation, but our US doc responded that that was a very low chance and that there are measures they can take to avoid that anyway.
3) Dr. Ho began the trigger when our follicles were between 15m and 22mm. He seemed a bit concerned that the 22mm was getting a bit large. Our US doc recommended that we wait an additional day or two to allow the 15mm to grow to 16mm which is his minimum recommended size. Also, he is comfortable with the follicles getting as large as 26mm.
4) It turns out that we retrieved 5 mature eggs and 2 immature ones. In hindsight, it might have been better to delay a day or two to allow the other two more time. The lab thought that a few more days might have allowed the other 2 to mature as well.
5) As far as the number of embryos to implant, both docs agreed. While HK limits it to 3 and the US has no limits, both docs preferred to transfer only 2, possibly 3 depending on the quality.
At this point, we still don't know how many viable embryos we will have to transfer. Both our US and HK docs are happy as of now because we should have at least 1 or 2 survive until the transfer. But I can say that I would have preferred the more aggressive US approach just to give us peace of mind. It would be nice knowing that we have a few more embryos to transfer for the next cycle if the first cycle fails. But as my friend, the US doc says, you can't argue with success, and Dr. Ho's pregnancy rates are comparable to those in the US (though I would guess he has far less embryos frozen than US docs). Anyway, just food for thought.
The primary difference is that Hong Kong (and most of Europe/Australia) is far more conservative when it comes to IVF. The US is much more aggressive. Now before we bring up Octo-mom, aggressive isn't a bad thing unless having extra embryos on ice (or destroyed) is an ethical concern for you. For us, we would have preferred a more aggressive approach to give us more embryos (more embryos = more to choose from, more to save for later in case the first attempt fails, more to use if you want more kids a few years down the line).
Anyway, here is our findings:
1) Our US doc would consider 10 follicles at the outset to be a good minimum standard. Our HK doc was happy with 3 or more.
2) Our US doc would have prescribed a much higher hormone dose to develop more follicles. He recommended starting at 450 units and scaling it down whereas Dr. Ho and Dr. So both recommended 225 units. As a result, of the 8-9 follicles we started with, only 5 became developed. Our US doc says that out of 8-9, he would expect 7 -8 to develop with the higher dosage. Dr. Ho says that a higher dosage might lead to Ovarian Hyperstimulation, but our US doc responded that that was a very low chance and that there are measures they can take to avoid that anyway.
3) Dr. Ho began the trigger when our follicles were between 15m and 22mm. He seemed a bit concerned that the 22mm was getting a bit large. Our US doc recommended that we wait an additional day or two to allow the 15mm to grow to 16mm which is his minimum recommended size. Also, he is comfortable with the follicles getting as large as 26mm.
4) It turns out that we retrieved 5 mature eggs and 2 immature ones. In hindsight, it might have been better to delay a day or two to allow the other two more time. The lab thought that a few more days might have allowed the other 2 to mature as well.
5) As far as the number of embryos to implant, both docs agreed. While HK limits it to 3 and the US has no limits, both docs preferred to transfer only 2, possibly 3 depending on the quality.
At this point, we still don't know how many viable embryos we will have to transfer. Both our US and HK docs are happy as of now because we should have at least 1 or 2 survive until the transfer. But I can say that I would have preferred the more aggressive US approach just to give us peace of mind. It would be nice knowing that we have a few more embryos to transfer for the next cycle if the first cycle fails. But as my friend, the US doc says, you can't argue with success, and Dr. Ho's pregnancy rates are comparable to those in the US (though I would guess he has far less embryos frozen than US docs). Anyway, just food for thought.