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FYI: IVF in Hong Kong vs. the United States

  1. #1
    Submariner is offline Banned
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    FYI: IVF in Hong Kong vs. the United States

    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.

  2. #2
    splitting snow is offline Registered User
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    hi Submariner,

    thanks for sharing your thoughts, i also am going to IVF with Dr Ho this month, waiting for my cycle to start. We did have the same discussion and he told me his target for egg collection is 6-12, because he doesn't want to over stimulate the ovaries, like you said.

    im very anxious, since this is my first time, i had 2 failed IUIs previously. i hope yours is going well! pls post your update if you don't mind.

    ss

  3. #3
    rebekah is offline Registered User
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    Just as an aside, a friend of mine in the US developed OHSS and it was terribly painful. She's now about 7 weeks pregnant but she was quite miserable from stimulation forward. I also hear that there are some recommendations to turn down the aggressiveness in the US, but in any case I wish you both success!

  4. #4
    Submariner is offline Banned
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    Our first attempt did not succeed. We had several embryos last through to Day 5 in good quality, but none implanted. Had Dr. Ho been more aggressive, we would have enough embryos to freeze for a second attempt. Please note, this is not a criticism of Dr. Ho as his methods are standard practice in HK.

    As far as Ovarian Hyper-stimulation, with competent, knowledgeable doctors, this should be a non-issue. The more follicles you develop, the higher the chance of hyper-stimulation, but that chance does not become worth considering until you have about 12 or more follicles. Even then, the chance is extremely low. Because your follicles can be easily counted, a doctor should know whether you are at risk for hyper-stimulation and if so, prescribe medication that will prevent it (I don't recall the name of this medication, but it is widely available).

    Furthermore, while an increased dose like 6 ampules/day (450) might put someone at a higher risk for hyper-stimulation, it will do so only if that dosage is sustained. Starting with 450 for a few days and then decreasing it should have no measurable impact on the chances of hyper-stimulation.

    So to summarize:
    1) Chance of hyper-stimulation is extremely low
    2) A temporary boost of 6 ampules for a few days should not increase the chance of hyper-stimulation
    3) Even if one were to become at risk for hyper-stimulation, it can be easily averted with the right preventative medication.

    Please note, I am not a doctor. My best friend in the US is a published IVF doc, and he provided me with all of this information. Take it for what it's worth.

  5. #5
    ssheng is offline Registered User
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    What about cost in HK vs. the US?

  6. #6
    splitting snow is offline Registered User
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    ssheng, both Dr Ho's & Dr Lo's costs for IVF are about HKD80k, while it varies in the US depending on the States you go to, ranging from $7500-15000.

    Submariner, thanks for sharing again. I am starting my stimulation tomorrow, and will be going there today for some blood tests with my husband. I agree with you that we want to do it the more aggressive way to "guarantee" enough eggs for the 2nd or possibly 3rd round of treatment. We are going to let Dr Ho know that that is what we want to do, unless the laws in HK restrict it.

    I am sorry that your 1st round didn't work for you, I hope you succeed the next time. With that said, are you still planning to see Dr Ho for any further treatments?

    I did my IUI with Dr Lo, and he gave me three 150ml shots of Ovidrel prior to the trigger shot, then told me to come the day after the trigger shot to do the actual IUI. I asked Idy (the nurse) if they would do an ultra-sound before or after the IUI to ensure that I had ovulated after the trigger, and she simply told me that "you will definitely ovulate after the trigger shots, everybody does...." But why not just check to be sure??? Also, my husband and I both think that the reason Dr Lo wanted me to do the IUI that day is because it was a Friday, and even though my follicle wasn't that big, (can't remember exactly how big) he decided to trigger, and without checking if the shot worked!!! My first IUI was done in China, and they had given me a few shots to trigger ovulation and it DID NOT HAPPEN, my egg ended up being over 30mm big when it finally ovulated on its own, and the doctor said that was too big and hence useless. So I didn't like it when IDY told me matter-of-factly that "everybody ovulates 24-36 hours after the trigger shot"!!!

    This is just my personal experience and is something to think about.
    ss

  7. #7
    Submariner is offline Banned
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    Good luck, SS! We did not do IUI because of the lower chance for success. Had we been younger, I think we would have given IUI a few tries first, but considering our "advanced age", we decided to go directly to IVF. We are planning to continue with Dr. Ho, but after a month or two of acupuncture. Honestly, I don't know how important the IVF doc is to the entire process. Even my friend admitted that far more impactful to your chance of success is the lab and embryologist, not the doctor. But the cost doesn't vary too much in HK so might as well continue with someone we know.

  8. #8
    splitting snow is offline Registered User
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    Hi Submariner,
    Thanks! I just went for my check-up today on my 5th day of Gonal-F, after reading your posts, my husband & I decided to be more aggressive for our 1st IVF. We talked to Dr Ho about it, and he agreed to give us 300ml/day. I had an ultrasound this morning, and there were 3-4 eggs ranging from 12-16mm in size on the right, and 2-3 about the same size on the left. Kelly gave me 4 more days worth of Gonal-F (also 300ml/day) to take home, and I will see him again on Wednesday.
    I am really excited about this and I really hope this is it for us, since it has been more than 2 years of ttc.
    And yes, I agree that the ivf doc isn't all that important after comparing the stats of Dr Lo & Dr Ho. But I do like Dr Ho and his staff better, even though his price is higher, I guess you pay what you get....
    Good luck on your acupunture treatment!
    ss

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