Forums  Gender Selection Gender Prediction Gender Disappointment Gender Odds

Farah IVF hospital, Amman, Jordan. Our experience and review. October 2010.

Magnolia

Posts: 144

Joined 28-Oct-10

28-Oct-10 7:00 pm

--------------------------------------------------------------
Translation?  Yes! ( A kind of...) Example, IN GENDER on  German language  ....
Click here, change the language on the top and click translate.
(If you get errors - “monkeys problems", that`s because forum-server is too busy. Just try later.) --------------------------------------------------------------
This post will be updated .
Feel free to ask questions HERE. We will gladly answer them. Opening an account is very easy now.
If you insist on e-mail, use:  "desire4magnolia@gmail.com" and have in mind that:
- e-mails discussing ethics, morals, religion or any similar topic will be ignored and deleted;
- if you are a journalist, no data or statistics of any kind will be given to you.
--------------------------------------------------------------


Hi all.
First, we want to say thank you, to all of you for being such a wonderfully opened, sincere, and very brave women. We (me and my wife) sincerely thank you again... 


****************** Disclaimer ******************


I have started writing this down two days after we came back from Amman, without knowing the final results (2week wait). I will try to be as objective as possible about everything, without being emotionally distracted by the experience we had.
So, NO mantra talks.
Always have in mind that this post is created from people that are not in any way qualified for any medical advices or anything similar. This is internet. For any medical advices talk with your real doctors.

You are looking at our modest try to create one debunked and simplified, real-world user-guide, for Hi-Tech IVF with Preimplantation Genetic Diagnosis (screening) with alll the others hi-tech features.
I will try to explain and present you our research, our choices we made, procedures we had and what have we learned from our experience.
We hope that someone will find our research information usefull.     

****************** Who are we? ******************


We are Southeastern Europeans, married couple 39 years old, with one 11 years old daughter. We never had any fertility problems and we are in a very good health. We used to be heavy smokers. I quit 5 years ago. My wife is just a recreational smoker with few cigarettes per day. Healthy food and lots of sporting activities are parts of our life. We have no history of any serious medical problem. We do enjoy our drinks from time to time or during the weekends. We approached 40`s, and we decided to have one and only one try.

To sum it up, our motives for IVF with PGD were:
- PGD for detecting abnormal fertilized eggs will boost 30% our chances for transferring healthy  embryos vs. classic IVF without PGD;
- PGD that includes genetic chromosome screening for chromosome 21 (to detect extra chromosome 21 = "trisomy 21"  = "Down syndrome") ;
- PGD that includes genetic chromosome screening for chromosome 23 (to detect "X,X" or "X,Y" and perform a family balancing with  "X,Y" via gender selection);
- Our age. ( 40! )   
Although we didn’t try to conceive until now I am sure it would  took minimum 14 ~ 48 months (if we were very lucky!) in trying to conceive our second child. By now we were "almost too late" for IVF, so we had no time left at all. This is a very expensive process for us and also we didn't want to push our luck.


****************** First things first. Things you need to understand. ******************

   
Everyone should understand why this forum section is called INTERNATIONAL HIGH TECH.
Understanding this part will help you in asking important questions about methods, procedures and choices you have when you talk with your doctors.


1. STANDARD IVF (In Vitro Fertilization) - (STANDARD "BASIC" IVF procedure performed and allowed everywhere.)
a. Hormonally controlling the ovulatory process, removing eggs (ova) from the woman's ovaries.
b. Letting sperm fertilize them  in a fluid medium .
c. The fertilized egg(s) (zygotes or embryos) is(are) transferred to the woman`s uterus with the intent to establish a successful pregnancy.



- - - - - - - - -   HI -TECH IVF procedures. Something completely different.  - - - - - - - - -

2. IVF + PGD ( Preimplantation Genetic Diagnosis ) - (PGD, Hi-Tech procedure allowed everywhere.)
a. Hormonally controlling the ovulatory process, removing eggs (ova) from the woman's ovaries.
b. Letting sperm fertilize them  in a fluid medium or with ICSI (Intracytoplasmic Sperm Injection).
c. PGD - screening and analyzing fertilized eggs. ( Virtual 3D-PGD simulation video  and   real PGD-lab procedure video.)  .
Single cell or two are removed from an 8-cell fertilized embryo through an opening in the outer protective coat. The procedure is carried out under the microscope without damaging its ability to continue to develop normally (because at this stage of development none of the embryo cells have become specialized). The cell is then analyzed for abnormality or presence of genetic disorders.
Chromosomes are structures in each cell of our body that carry our genetic information, or genes, in the form of DNA. Cells are tested for abnormal number of chromosomes. That’s "genetic screening" for detecting  genetic disorders. Beside eliminating presence of any genetic disorders,  embryo gender is also detected for every fertilized egg during this screening.
d. Only randomly selected but already screened and analyzed fertilized egg(s) (zygotes or embryos) is(are) transferred to the woman`s uterus with the intent to establish a successful pregnancy.

3. IVF + PGD + EGS (embryo, gender selection) - (EGS, Hi-Tech procedure - NOT allowed everywhere.)
a. Hormonally controlling the ovulatory process, removing eggs (ova) from the woman's ovaries.
b. Letting sperm fertilize them  in a fluid medium or with ICSI (Intracytoplasmic Sperm Injection).
c. PGD - screening and analyzing fertilized eggs. ( Virtual 3D-PGD simulation video  and   real PGD-lab procedure video.)  .
Single cell or two are removed from an 8-cell fertilized embryo through an opening in the outer protective coat. The procedure is carried out under the microscope without damaging its ability to continue to develop normally (because at this stage of development none of the embryo cells have become specialized). The cell is then analyzed for abnormality or presence of genetic disorders.
Chromosomes are structures in each cell of our body that carry our genetic information, or genes, in the form of DNA. Cells are tested for abnormal number of chromosomes. That’s "genetic screening" for detecting  genetic disorders. Beside eliminating presence of any genetic disorders,  embryo gender is also detected for every fertilized egg during this screening.
d. The woman selects from the screened and analyzed fertilized eggs, those that match her criteria. (Or she cancels the transfer.)
e. Selected fertilized egg(s) (zygotes or embryos) is(are) transferred to the woman`s uterus with the intent to establish a successful pregnancy.


4. IVF + PGD + EGS + EMBRYO HATCHING - (EH, Hi-Tech procedure - allowed everywhere.)
Embryo hatching - before transferring the embryo back to the womb, embryologist makes a tiny hole in the outer wall (zona pellucida) of the embryo to make the hatching process easier. Usually this is done by applying an acidic chemical or thermally via laser beam.

We were not interested in EH. I will try to explain why but have in mind that this is my personal research and conclusion only. (Yes, Farah offers the procedure.)
Egg hatching is good but not for everyone. Actually it should be good just in few cases.
This is "general rule" for egg hatching.  Who Can Use Assisted Hatching?
- women over the age of 37;
- women with elevated FSH on day 3 of their menstrual cycle;
- couples who have experienced failed IVF cycles;
- couples whose embryos have a particularly thick zona pellicuda;
Now pay attention to those three videos. Embryo shell is already being traumatized twice with:
1. ICSI procedure;
2. PGD procedure;
In my opinion, additionally processing (destroying) embryo outer wall with chemical or temperature (laser) procedure is adding additional risk for damaging a healthy embryo.
3. Now, pay attention to this temperature (laser beam) procedure for the actual "embryo hatching".
How  close to the cells, laser (temperature) beam is destroying the outer wall of the embryo. How risky is that? Add to that all the others risks and you will get the picture. Failing at least twice with good embryos would (maybe) made us consider additional "egg-hatching". And we were almost 40! 

5. MICROSORT + IVF + PGD + EGS + EMBRYO HATCHING   (MS, Hi-Tech procedure - NOT allowed everywhere. Yet.)
- The latest "feature", Microsort,  is the fourth method. (Not offered in Farah. Yet. Waiting for FDA aproval.) MicroSort is a technique for separating the two types of semen found in sperm, X sperm and Y sperm. An XSort increases your chances of conceiving a girl to about 91%, and a YSort boosts your odds of conceiving a boy to about 76%.MicroSort is a technique for separating the two types of semen found in sperm, X sperm and Y sperm. An XSort increases your chances of conceiving a girl to about 91%, and a YSort boosts your odds of conceiving a boy to about 76%.

**************************************************************

I hope that now you can see the difference in the procedures that IVF centers are using and offering.
For PGD you must have a HIGH TECH lab with HIGH TECH trained personal with skills to perform very, VERY delicate micro-manipulation procedures.   
- Fertilization types:  in a fluid medium or with ICSI (Intracytoplasmic Sperm Injection).
- Medications for stim. protocol used.
- Success rates ...
- Do they use Microsort before fertilization?       
- At the end do you have the choice to freeze all good embryos that remained after the embryo transfer for later use?
- etc.

I strongly recommend you to check out this LAB video for Standard IVF.
- Both fertilization methods are used. ( Fluid medium and ICSI.)
- U can see the actual work and the procedure.
- Its for  Standard IVF only. (No PGD)
LAB Video1: Inside the IVF Lab ;          
LAB Video2: Actual ICSI fertilization process.
  (Fast forward to 00:58)
ICSI 3  and   ICSI 4  .


****************** PGD latest safety reports ******************

I received lots of e-mails with one question. "Is PGD a safe procedure for the embryo?"
My answer to all of them was: "Read the disclaimer, I don`t know. This is what science says... "
1. "BBC News reports" about the largest PGD research ever done:
2. Same news here...
3. The research report in PDF -> "Report on a consecutive series of 581 children born after blastomere biopsy for preimplantation genetic diagnosis".
4. I also recommended you to read this research, "Cognitive and Motor Assessments". It`s  International Collaborative Study of Intracytoplasmic Sperm Injection–Conceived, In Vitro Fertilization–Conceived, and Naturally Conceived 5-Year-Old Child Outcomes: Cognitive and Motor Assessments 


****************** IVF Success rate (%) ******************

"IVF success rate percentage"  that will be given to you is a very important number. But you must know - that`s just one part of the big puzzle. If you don’t understand how that “success rate” is created, your "success estimate %"  can mislead you a LOT.
Success rate numbers are average for all the clients and all the hospitals/countries/regions. That’s a very, VERY general statistical number!
What you must know is how to project that rate to yourself.
Evaluate your OWN success rate factors like age, general health, fertility problems, IVF specific problems like hormone results, stimulation response, egg quality and finally fertilization and PGD success rate.
Example: "The age of the woman has a significant effect on her fertility and the live birth rate decreases significantly from the age 35 years when the woman is using her own eggs."  There are lots of factors you must consider. On page 8 you can find more detailed info, data, links and discussions about success rate.

Have in mind that in our case we would NEVER EVER, not  even in our wildest dream try IVF-PGD if I took those success numbers blindly. Let me repeat. We were "almost too late" for IVF. Our success rate estimate was 14% ~ 21%.
You just have to find a way to evaluate yourself and try to maximize that "%" in every step. Making choice, was our very important, next step.


****************** The choice. ******************

The first thing that I have learned is that you must dig deep and collect all possible information that you can find and have a clear picture about what you want to achieve, where and how. Higher probability for success is directly connected with those things.

Farah IVF  hospital in Jordan was my first choice.
Why Farah?
Its simple. Internet is full with real information and actual usable data. Not just mantra talks.

I am posting few links with academic research papers where Farah was (is) directly involved. Try Googling them and you will find lots of them.
I picked those about PGD, Sex Selection, IVF, ICSI. If I post links about their Doctors or their personnel I will need one month just to sort them.

Important! A Must! Read the "Clinical results" chapter ( from page 9 - 12 )
University of Birmingham, UK
Sex selection - A survey of laboratory methods and clinical results

Practical Preimplantation Genetic Diagnosis , Yury Verlinsky and Anver Kuliev.
Single-Cell Genetic Analysis
DNA Analysis , FISH Analysis

A.R.T. and Science, Volume 2, Number 4 , April 2003
ICSI with round spermatids to by-pass azoospermia has major limitations
PAGE 8

Oxford Journals, Abstracts of the 18th Annual meeting of the ESHRE, Vienna, Austria
ART – Technical aspects PAGE 2


American Society for Reproductive Medicine
FERTILITY AND STERILITY, Chromosomal abnormalities in embryos derived from testicular sperm extraction


JJBS , Jordan Journal of Biological Sciences
Effect of Sperm Chromatin Integrity on Parameters of In Vitro Fertilization


Fertility and Sterility®
Official Journal of the American Society for Reproductive Medicine
Fertility and Sterility®


Global Fertility services, Dr. Archana Dhawan Bajaj DNB. MNAMS, M.Med Sci in Assisted Reproductive Technology, University of Nottingham. U. K.
SCOPE OF THE HYSTEROSCOPE IN SUBFERTILITY PAGE 2

American Society for Reproductive Medicine
Predictive value of sperm fluorescence in situ hybridization analysis on the outcomeof preimplantation genetic diagnosis for translocations


About Farah Doctor`s and personnel, I decided to post something that I found in Farah`s cafeteria, framed and hanged on the wall. I took a picture of it and I advise you to read it. It`s an 1987 article (2 pages) from the newspaper "Jerusalem star".
Dr.Zaid Kiliani interview about the IVF success in Jordan. Life from test tube" and "How it started"
TIp: Download the file. (Higher resolution and much easier to read.)


******************** The Problem ********************

With Farah I had one huge problem. Establishing contact with Farah was  “mission impossible”. This was very hard.
The only alternative option we had was North Cyprus.
All clinic`s from North Cyprus looked the same. No real history or any statistical and usable data exept the basic info on their websites and few personal experiences by other people posted on  forums. Ahmed from North Cyprus Fertility Clinic was very easy to communicate. Their background check was "OK-ish" and we decided to go in North Cyprus. They prepared as a protocol (based on the data we provided) and we discussed all the steps that we should take.
I repeat, Ahmed (intl. coordinator ) in North Cyprus Fertility Clinic was very helpful, responsive and that's the only reason why we shifted towards North Cyprus. I am sure that whatever he says - he delivers. Regarding the IVF-PGD success there, we had no idea what to expect. We could not find any valid information or data we could use.
Two weeks before we started the North Cyprus Fertility Clinic protocol at our home, I started sending emails to Farah again. Twice per day, every day.
I also started calling Farah few times per day. Somehow just one week before we started North Cyprus Fertility Clinic protocol I managed to find their extension codes.
Then I got on the phone a person that found my email. That person replied and finally the communication started. I have sent my wife's hormone tests and her general health conditions. That was receptionist from the Dr. Amal Dakkak desk. They told us that we are most welcome to have our PGD in their center.
I asked about the protocol and after three days they wrote me that we should follow a protocol that our (local) IVF specialist recommends. At that time we didn't have any local protocol. Just one from North Cyprus Fertility Clinic . They encouraged us to use local protocol because it doesn't matter what kind of hormone results we have if they can't examine my wife. At that point, I insisted, few times to recommend us a protocol and I got one.
"Based on my wife`s age and the data we provided, Dr. Amal Dakkak recommended a short protocol. Again there was a strong recommendation that our local IVF specialist should give us a protocol that we should follow."
So , we did exactly that.
Our home IVF specialist said, that based on my wife age, short protocol will be probably recommended. Day later, during the examinations and ultra scan our local  IVF specialist was very positively surprised and she recommended long protocol. And she  added, "without any doubts ".


****************** The Protocol ******************


Protocol, protocol protocol. What’s the big deal about the protocol. Well it is a big deal . I will try to explain with few words.
When normal ovulation occurs, just one egg is released/produced from the ovary. If woman is provoked and stimulated she can produce much, much  more.
That depends from woman’s "ovarian reserve capacity" that is measured on hormonal test day. Depending on those results, physical examination and ultra-scan, IVF specialist as “chef” has to create a "hormonal stimulation recipe" with correct dosage that will stimulate the woman to “produce and cook” lots of eggs. That "recipe" is "hormone stimulation protocol".  Quality of that “recipe” and “chef” that is monitoring this “cooking” process via ultra scans and e2 blood levels are vital for getting eggs with high quality. When eggs are big enough, cooked enough and ready in every way possible, our “chef” will add the final “ingredient” called "hCG maturation hormone injection". That means that after 35~36 hours, eggs are "mature" and ready for retrieval and fertilization.

Our protocol:
- Hormone suppression - Suprefact 0.5ml.
- Hormone stimulation - Fostimon 225iu.
All details about the medications can be found in a separate section named "LOG: Time-line, medication and supplements".

I have learned few things about the protocol.
1. You must educate yourself. (Google is your friend)
2. You are the person that must micro-manage your own protocol. LOG everything. Its Important!
3. Always insist on ultra sound scan. Every second or third day. During the ultra sound scan track and record the follicle (egg shell) growth.
4. Track and LOG your Estradiol level(E2). Might be very helpful. Do that with your ultra sound scans.
5. Time your daily injections, few hours before the actual flight time. (I will explain later.)
6. Update the "transfer hospital" with every (and only) important details and make sure that they received that information.
7. Always be polite and friendly.

Download our LOG from here . (Excell 2007 / 2003 and PDF format ).

- Hormone Stimulation at home IVF center.
As you can see from our LOG , there were 20 follicles (egg "shell"). They were growing very nice and we started wondering about the next step. That`s triggering the oocytes (eggs) to go through the last stage of maturation, before they can be retrieved.
This last growth is triggered with "human chorionic gonadotropin" (hCG) injection.
Timing this shot is vital. If it's given too early, the eggs will not have matured enough.  If given too late, the eggs may be “too old” and won't fertilize properly.
The daily ultrasounds at the end of the last step are meant to time this trigger shot just right. Usually, the hCG injection is given when four or more follicles have grown to be 18 to 20mm in size and your estradiol levels are greater than 2,000pg/ML.

There are lots of (horror) posts here, explaining how the hCG injection was given too early at the local IVF center. We were afraid that something similar might happen to us. We told Dr. Amal that we would like their decision  for hCG injection. She agreed with us immediately and we scheduled our flight, three days in advance (I will explain how to hold your seats until the last moment.) The last day at our home hospital  3 hours before the flight, Estradiol jumped to 4200pg/ml. Stimulation dose was cut to half and we were warned about possibility for over-stimulation. After that last hormone injection at our home hospital we went at the airport. (This is why you need to time your injection few hours before your flight. If needed you can continue with the stimulation in your second hospital without being interrupted. We had our stims with us.)
Anyway, from our home airport I phoned Farah and I insisted on going directly to them for ultra sound scan, at midnight. We didn't want to wait until the morning (next day) when our first ultra sound scan was scheduled. (Estradiol level was high and we took that as a warning sign.)


****************** Jordan (Day one) ******************

From the airport in Amman we got a taxi and we went directly to Farah. Doctor waited for us, did a scan and blood test. Then they phoned Dr. Amal. They were discussing for 15 minutes. They were counting, measuring and they finally decided to go with the hCG injection. We went to the hotel and next morning (8 hours later) we came back. Dr. Amal Dakkak examined my wife and she confirmed that hCG injection at 01:00 AM earler that night,  was an excellent decision and that everything is superb. Estradiol blood level was down to 3200.
Now I want to add few words here.
That morning was our actual first day in Jordan. Night before that when everything is dark and quiet you can't get a clear picture, especially when you arrive for the first time in a foreign country. That morning was the first time when we realized that Farah is not a joke. Lots of people, working around in high tech labs and lots of patients. I mean lots of them from everywhere!
Dr. Amal welcomed us with highest professionalism. She explained us, step by step what will happen and what we should expect. We had 100 questions to ask but after our meeting with her we had none. She covered all of them during her talk. At the same time Dr.Kilani came to meet us and actually they examined my wife together.
At this point I am trying to be very objective but sometimes things are very simple. They are probably one of the best professionals in their job. Period ...
So, that morning egg collection was scheduled...


****************** Egg retrieval (collection) and  fertilization (Day 2) ******************

Results? 29 eggs. What can I say more? I knew that my wife had some super human capabilities but this was beyond my expectation...
Anyway, that day I had to do my part first. At 10.00 AM. we went on the fifth floor and we were given a room and a plastic cup. On the plastic sperm container you write yours and your wife's name by yourself. I was little worried about the timing because the egg collection should happen exactly 36 hours after hCG injection. We had 2 hours until that time. In those two hours a nurse checked my wife few times before they took her to the "operation room" . They did the egg collection exactly on time. I waited in the room for 40 minutes before they returned her. She continued to sleep. After one hour she had a light hospital meal and they gave us the results.
As I said 29 eggs and 50% were grade 1.
Fertilization happened 2 hours later.
Important note: Have in mind that fertilization of the eggs is done with ICSI by default as a standard procedure. (Video.)

We were given a tel. number to call for fertilization results. Next two days we went for a sightseeing around Amman, Dead Sea and of course, Petra.  ( I will explain about Amman and Petra in additional posts.)
After 48 hours we were told that 12 eggs fertilized. They became  embryos. We should be in the hospital for PGD results and hopefully latter for embryo transfer (back into my wife’s ovaries) next day at 11:30AM. We arrived at 10.00AM.


****************** Embryo transfer day.(Day 5) ******************

Again we had a meeting with Dr. Amal. PGD results arrived at 11.00. There were three X,Y embryos, grade 1, screened for "Trisomy 21" or "Down Syndrome". And that's all we wanted to know. We were given the same room on the sixth floor and we waited. At 14:00 a nurse came and she informed us that Dr.Kilani will arrive in the next 15 minutes and the procedure will start. That's exactly what happened. He came to our room and we had a nice relaxing talk. He told us that they picked two most promising X,Y embryos and they won't freeze anything. Fifteen minutes later everything was finished. My wife had to rest for one hour and then she should continue with her normal life. (No heavy duties of course.)
That's exactly what we did.


****************** Back Home (Day six) ******************

Next day we arrived, back home. I started writing this down two days after we arrived home and those are our simple conclusions.

 

 

Magnolia

Posts: 144

Joined 28-Oct-10

28-Oct-10 7:03 pm

****************** Our Conclusions ******************

Farah is very clean, modern and very professional hospital. If we had to go again we would pick Farah again without any doubts.
Farah is a very serious institution and the experience they have collected over the years is probably unique.
Establishing a good communication is the only downside that needs improvement.
Note: do not expect a "five star" HOTEL service experience. You won`t get that.
Expect "five star" IVF CENTER and HOSPITAL experience!.
I spoke with their head embryologist, head nurse, their head IVF doctor and their head of the IVF department. I can't remember that I have ever spoken with the head of any hotel anywhere and we are not some important couple or VIP`s.( I wrote all this because I noticed, most of the times people are trying to compare their IVF experience with their summer holidays. This is wrong. Very, very wrong. Of course it may look like a holiday but that can only be a bonus for you. That`s always something second. ( And I still haven`t written anything about how beautiful, Amman and Petra are. )
We got what we came for and much, much more...

****************** Our Results (Update) ******************

- 13 days after the transfer we did our first home pregnancy test. We used 3 different brands. All were BFP! (BIG FAT POSITIVE)
- 15 days after the transfer we did a blood test. BFP and hCG level was 1200!
- Betabase info, indicated twins.
- 5 weeks and 2 days after the transfer, (used online pregnancy calculator) ultrasound detected one embryo.
- 7 weeks and 3 days after the transfer, (used online pregnancy calculator)  ultrasound detected one embryo and  strong heart-beat. 
- Additional calculators . Here and  here.  



****************** LOG: Time-line, medications and supplements. ******************


In case you didn’t, please download the protocol LOG. It will be much easier for you to understand the details.

Pre-test. (Your general health status.)
Its a small price to pay to make sure that your cycle won’t be canceled because of some trivial condition.
- Go to your gynecologist, have a deep ultra sound scan and ask not just about your health but also about your reproductive status and potential.
- Question to ask: If I get pregnant today, do you thing something might create problem?
- Know what to look for : Link 1 (Cyst)    and   Link 2 (Estrogen levels) .
- Go to your dentist and fix everything you need to fix.
- If you haven’t already started taking folic-acid you should start now. ( Folic Acid – 0.4 mg. One per day.)

Test. (Hormone-blood test.)
1. Day one of the menstrual cycle -1st day bleeding.
2. Day two of the menstrual cycle - 2nd day bleeding - prepare for next day hormone tests - no eating or drinking for 12 hours before the test.
3. Day three of the menstrual cycle - 3rd day bleeding. Hormone test day.
- FSH  (FSH stands for follicle-stimulating hormone. Measurements of FSH can be determined through a simple blood test. Levels of this hormone directly correlate to the number of eggs that you have "on reserve" in your ovaries.)
- ESTRADIOL – Estradiol test is performed in order to determine a woman's ovarian reserve. It is also performed in order to confirm a woman's FSH test
- LH – LH helps regulate ovulation and turn empty follicles into corpus
- PROLACTIN – Prolactin is a hormone that plays a role in fertility by inhibiting follicle stimulating hormone (FSH) and gonadotropin-releasing hormone (GnRH), the hormones that trigger ovulation and allow eggs to develop and mature. Prolactin (also called luteotropic hormone) is also associated with the production of breast milk.)
- CBC - Complete blood count - blood test to check the complete blood count rather than just a red or white blood count.  The doctor wants to know if an infection is going on.
- FBS -  Fasting blood sugar  measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes.
- TSH -  Measures the amount of thyroid stimulating hormone (TSH) in your blood. Tests are conducted to find out if she has any thyroid hormone problems that may be preventing ovulation.
You can get some basic info about your hormone results here! Also, some good explanation, here!
Additional required tests taking in consideration that they don't accept cases with positive HIV or HCV.
- HIV - AIDS.
- HCV - hepatitis C.
- HBsAg - hepatitis B surface antigen.
Additional test you should consider that day:
- For both of you: Full blood and urine test.
Same day results :
- If you are NOT OK with all the tests, go to the 1-st point, month or two later.
- If you ARE OK with all the tests, and feel healthy enough, go to the 4th , next step.
4. Go to your local IVF specialist. Present ALL your results, inform him about your plan and ask for hormonal stimulation protocol.
(You can do this in few different places to get different opinions. )
5. Send those results to Farah if you plan to have full stimulation protocol with them.
Protocol for hormonal stimulation should start on your second day of your next menstrual cycle,
All other details are explained in the post above and in the LOG itself.
Tip: try this online IVF Cycle Scheduler for Long Protocol!  
Time - line simulation. (Example, 28 days menstrual cycle in March.)
AT HOME (After pretesting was done .)
01.March - (First day bleeding) First Menstrual cycle starts. (Next, second menstrual cycle should start on 29thMarch.)
03.March - (Third day bleeding) - Hormonal tests day. Same day, or ASAP send the results to Farah and ask for their opinion and advice.
21. March hormone suppression should start but that depends from the protocol and what arrangement you have. This can be different.  
29.March - (First day bleeding) As predicted your menstrual cycle starts.
AT FARAH:
30.March - (Second day bleeding) - day two of the cycle, daily injections, monitor follicular growth by ultrasound and hormonal assay.
+ 10-12 days  -  final maturation injection;
+ 34 hours – Egg retrieval (collection) and  fertilization;
+ 3days PGD and Egg transfer;
+1 day , back home;
+12 days, first pregnancy tests.

6. Important: educate yourself about OHSS but don’t get scared!
- Why electrolytes like Gatorade or IsoSport are OK for OHSS symptoms?
Protein and electrolytes both will pull extra fluid into your intravascular system and keep it from accumulating in your abdominal cavity. It will replenish and refresh your fluids. It should regulate your fluid intake and urine outtake.
7. After hCG was given the hospital prescribed:
- Some antibiotics
- Duphastone (Dydrogesterone) 3x1 per day.
- Cyclogest (Progesterone) - 400mg. (Vaginally  before night sleep.)
8. After the egg transfer:
- Duphastone (Dydrogesterone) 3x1 per day. ( For 12 days or If tested positive, 3 months.)
- Cyclogest (Progesterone) - 400mg. (Vaginally  before night sleep. For 12 days or If tested positive, 3 months. )
- Baby Aspirin - 81g one per day. ( For 12 days. If tested positive 3 months. )
9. Food supplements we are using , for almost two months.
Lots of Honey, IsoStar electrolyte drink, Whey Protein shakes.
And no coffee at all :)

 

Magnolia

Posts: 144

Joined 28-Oct-10

28-Oct-10 7:03 pm

 

****************** Financial part ******************

Its very simple.
First day we paid in advance 2500JD = 2530 EUR = 3520 USD = 2200GBP.
This covered everything that happened at Farah hospital written in my post starting from day one in Jordan until we left. On the last day, during the “hospital check out” they returned us 100JD because we over paid. We left that amount as a donation to the hospital. Additionally we bought prescribed medication at the pharmacy on the ground floor for 40JD.
The total cost for everything for us at Farah, was 2500JD.
This is their price list:
- Oocyte retrieval 1010 JD;
- Embryo Transfer 340 JD;
- Lab work 350 JD;
- PGD for each embryo 75 JD.
- If you want to have a full procedure with stimulation part included in Jordan,  you have to add 600JD for full hormone stimulation. (Total of 19-22 days on your own arrangement.)
- Additionally we bought prescribed medication at the pharmacy for total  40-JD ( After hCG injection - some antibiotics,  Duphastone (Dydrogesterone) 3x1 per day and  Cyclogest (Progesterone) - 400mg.)
So, that would be a total of:
A - 2550-JD = 2530EUR = 3600USD = 2240GBP without hormone stimulation part. (This is what we had - from day1 till we left Jordan.)
or
B - 3100-JD = 3070EUR = 4380USD = 2720GBP with hormone stimulation included. (17 -22 days)
This is cheap. Period…..

****************** Communicating with Farah ******************

As I said I had a huge problem contacting Farah.
Email rules:

- I discovered that emails with PDF, ZIP and RAR attachments are rejected by their filters.
- MS Office attachments are OK. (DOC and XLS files. )
- Their email: farah1@go.com.jo.
- Their web site: http://www.farah-hospital.org/
- Their IVF web site:  http://www.farah-hospital.org/ivf/index.html
Best time to send an email is around 09:00. Fifteen minutes later, call them. Insist on finding your email with the information you send. It will be much easier to present yourself.
Current local time in Jordan -> Click here .
Farah Tel number: 00-96264603555.
- After you hear a voice, dial “9” for English.
- Than dial 5003. This is the extension code for the IVF department. Start talking and ask them about your email. Re-send it if they haven’t got it. They will find it if they received it. They all speak English very good.

TIp: my VERY strong advice for your first email:
- Do not send emails with general questions. Go straight to the point and be explicit.
- Tell them who you are, what you want and when you want.
- Add to your email your general health information, hormone test results, menstrual history.
Also send them additionall tests required by Farah:
- HIV, HCV, HBsAg for husband
- HIV, HCV, HBsAg, CBC, FBS, TSH, for wife, taking in consideration that they don't accept cases with positive HIV or HCV.

In one short and complete email, you must show that you know what are trying to do and you know what you are talking about.
Be explicit. This will save you lots of time and they will have a clear picture for you. They are busy. They are very, very busy.

 

Magnolia

Posts: 144

Joined 28-Oct-10

28-Oct-10 7:05 pm



****************** Getting around Amman ******************

Personal safety is high in Amman and Jordan in general.
It is safe to walk in the city at any time of day. (Very strong army and police.)
People are polite, friendly, modern and very proud.
Few times kids approached us to tell us out of nowhere, “Welcome” !
That was very cute and I do believe that’s the only word they know. That says a lot.
People are mostly working very hard all day. Have in mind that Jordan has no oil at all...

1. TAXI
Use only "Yellow taxi" with green sticker on the door. They are licensed and they charge by taxi meter.
There are lots of them on every corner. Drivers were polite but they don’t speak English a lot.
Tip: always have a small hotel card to show to the driver even if you think your hotel is well known.

Prices and Places:
- Airport to Amman City center. Taxi drivers charge 18 - 25JD. (Depends from the time of your arrival and how much he has to wait.) Anything above that just reject. Distance - 35km.
- Downtown Amman - Most of the time you won’t pay more than 1.5 – 2.0JD with tip included for any destination within 5km.
- Petra and Dead Sea
For our trip to Petra we made an all day arrangement with one taxi driver.
08:00 pick-up returned at 21.45 for 75JD.
Half day at Dead sea - 30JD.
The taxi driver was very polite and professional. His name is Atif , he is approximately 50 years old and he speaks English satisfactory.
This is his mobile number : 0795939096. He will gladly talk about history, politics, local problems and other places to visit. (Later he admitted that he went inside Petra for the first time with us but he drove tourists hundreds of times.) Last day (transfer day) he figured out why we went to Farah and he was driving veeery carefully. Even on the smallest bump he was saying “I am so very sorry” :) He also explained us that most of Farah patients are sheiks from the gulf countries because that’s the most famous “Maternity” hospital in the region.
No need to mention that he drove us back to the airport for 25JD at 04.00AM.

2. Hotels:
Brand hotels are expensive. 180JD per day. If you want that and you can afford that, be their guest :)
We used Arab Tower hotel. We paid 200JD total for 6 days! I won’t recommend it because it’s to risky to recommend a hotel to someone you never met. But have in mind that If we go again in Amman we would definitely go there again. Nice and clean, free WI-FI but very small toilets. We had their largest suite in the center of Amman. We were next to all the shops, bazaars and in the center of the old city. (4 km from Farah.)
Anyway, there are lots of hotels. Anything that is not branded you can book for less than 60JD per day. But you must haggle. Specially if you are staying for a week.
- Our hotel - Arab Tower Hotel – 35JD per room per day. burj_al.arabhotel@hotmail.com (no website.)
- Hisham hotel (Best reviews) – less than 80 per room per day (must haggle!) info@hishamhotel.com.jo - http://www.hishamhotel.com.jo/
Important: always ask for confirmation that the price offered is with all the taxes included!

Main source to pick a hotel : Booking.com
How to use the site.
- On the left, add the dates.
- On the left, unmark "I still dont know the dates".
- On the left, hit "Search" .
- On the left , filter (check) the price range.
- Read the reviews for the hotels.
- Next to the name of the listed hotels, click on the Show map.

Learn the Amman geography.
Farah is very near to the city center as Point "A".
- On the left corner of the map, click on "View Larger Map" .
- New window will open.
- Enter the name of your hotel on left side as " Point B"
- Click on "get directions".
- The results will be shown on the left side.
You will get details about km and directions.
Additionally, you can activate and view area photos.
(Don’t click - place the mouse over the “satellite” frame and click on photos. Photos will show up . Zoom to point a and you will see the picture of Farah.)



View Larger Map


3. Places you must see:

The Amman citadel and the small museum inside. (On the hill in the city center.) When you leave the Citadel walk down to the Roman Amphitheatre.
Lots of shops and restaurants and sweetshops. You can find lots of shops with hand-crafted souvenirs.
Also try those “on_the_street_corner_fresh_juice_from_anything_take_away”.

Dead Sea
Going there and knowing that you can’t swim is little frustrating.
If you want you can visit the Baptism site. It’s on the way to the Dead Sea. One hour to get there and there you get on a small bus. That’s additionally 50min tour.

Petra.
It’s not one of the world wonders for nothing.
Go and check yourself. I can’t explain what we experienced there.

Tip: Additional walk to the monastery in Petra, up on the mountains is not that long (40min.)
You won’t regret that walk. That’s the only thing that I guarantee.
Something very funny happened there. (See “Reality Check Place” part.)
Also go by yourself. Not with organized groups. It will cost you the same and you wont have to run all the time.
And yes, leave Amman at 08:00 in the morning.)

“Reality Check Place”
When you need a familiar place in Amman or you can’t find something that you need just get a taxi and go to the Carrefour Mall. (9km 3.5-4JD)
Thats a huge 6 floor mall  with 2 floor Carrefour store where you can find familiar products that you need.
Tip: I would suggest you to go there the first day and get yourself a local Orange SIM card for tourist with, additional (must ask) 200mb internet package. (15JD). Ask them to activate everything on the spot or you will have problems. Give that number to Farah. I used that number a lot.
Have a hot drink there (not coffee) and organize yourself. Have a reality check :)

The funniest thing...
My wife showed some OSS symptoms (but apparently we were very wrong) and as a precaution we started looking around Amman for any IsoSport or Gatorade electrolyte drink. We could not find that anywhere. Two days later we finally found Gatorade, cold and all possible flavors.
Where?
Believe it or not, on the top of the hill at Petra, after 40minuts walk up in the monastery sold by the locals in the improvised restaurant. That was hilarious.

****************** Flight Booking ******************

Who will decide if you are ready for the trigger shot ?  
Local IVF center or Transfer  hospital.  

1. If your local IVF center decides, than:
- You must find the reliable Airline company with at least 2 flights per day (Must have for more options.)
- Find a reliable  Airline company and talk with them and explain why you need your last minute option so they can update you daily about the seat availability. They will do that. Ask for their manager, speak frankly and explain your situation.

2. If  Farah decides then:
- Plan in details when your stimulation will start and book a flight on the 8th or 9th  stim. day and continue with stims at Farah until the hCG is given.

3. Again,  If  Farah decides then:
- Find a reliable  Airline company and talk with them and explain why you need your last minute option so they can update you daily about the seat availability. They will do that. Ask for their manager, speak frankly and explain your situation.

4. If you are doing everything ( stimulation + pgd  + transfer ) in one IVF center, than your next menst.cycle date should be your flight date. (Minus day or two. )

Tips:
- In case number 2 and 3 you need to take your stims with yourself  in case you need to continue with them in Amman.
- I asked from Farah and we were given a letter to present to customs authorities if someone asks about the stim medications.
- Also have everything you need for the complete process in your hand-luggage with you. Not in your suitcases. (Just to be sure!)
- Airline company always have much larger visibility about the flight status. Do not book via the travel agent. Book directly  from the Airline company. It’s much easier for them to reschedule their own flight.  Get some mobile numbers too.
- Yes, dates  must be open.  
- At: http://www.expedia.com  can click on “Preview seat availability” button and get the status of the seats available. The airline company must support that option.


****************** Weather ******************

Current local time in Jordan -> Click here .


I would highly recommend , NOT to travel at summer time. It’s not about how high the temperature is. It’s the climate in total.
Try to go there between February and second half of May or between second half of September and end of November.

….Will continue with the nicest local food restaurants…. We enjoyed some unique tastes.

 

Posts: 83

Joined 2-Oct-09

30-Oct-10 1:42 pm

 

Congratulations! 

I would like to say thank you for posting your experience, well said, I also had the treatment at Farah this year, and am now 15 weeks pregnant

I also was very happy with th Dr Kilani, Dr Amal, staff, hospital, etc

Even now if I have any problems I e-mail them, and they always try thier best to reply as soon as they can.

I wish them even more success for the future, as they have played a huge role in to making my dream possible!

Good luck & Best wishes to you both!!!! 

Baby Girl  Baby Girl  Baby Girl  Baby Boy IVF/PGD Jul 2010 Farah Hospital Amman BFP, Due April 2011

 

Magnolia

Posts: 144

Joined 28-Oct-10

1-Nov-10 10:30 am
Saira, Congratulations ! I hope everything will be perfect for you.  We plan to post some links about Farah that helped us in our decision . Also additional info about our medications, (before and after.) We will add some usefulll information about affordable but nice hotels, goggle maps info and tel. number from our taxi driver.

 

Maria

Posts: 9,138

Joined 30-Sep-08

Forum Leader Top Poster
1-Nov-10 10:42 am

Thank you so much for all the valuable information. I have been torn between Jordan and a US cycle but with little to no real information on Jordan I decided to look for a US cycle...VERY EXPENSIVE and beyond my financial means. There is a big difference between $20,000 and $5,000-6,000 for a cycle.Congratulations on your BFP and thank you once again for this detail post Agree

2005
2009
coming in 2014

Posts: 241

Joined 25-Feb-09

1-Nov-10 11:33 am

desire4magnolia:
We plan to post some links about Farah that helped us in our decision . Also additional info about our medications, (before and after.) We will add some usefulll information about affordable but nice hotels, goggle maps info and tel. number from our taxi driver.

 

That would be very nice. Thanks a lot for your post. Farah is one of my options, so any info is more then welcome for me. 

LOVE my Baby Boy 2005 Baby Boy 2009

Baby Girl to be our next

2 failed HT attempts in Europe

email: iglittleladybug4me@yahoo.com

Magnolia

Posts: 144

Joined 28-Oct-10

4-Nov-10 8:24 pm

I updated the info about some of the Farah Academic work, and hotels, prices, getting around etc. Hope you will find them usefull.

 

Tracey

Posts: 1,261

Joined 29-Jul-10

Top Poster
Gold

Gold Membership

5-Nov-10 11:19 am

I can not thank you enough for your detailed post and the generosity you display in the time you took to write out each and every detail. Thank you so so much. I think you have swayed me to the better hospital. I do not care for the hotel. I just needed to hear that Farah is all they say it is.

CONGRATULATIONS TO YOU BOTH !!!

'05 '07 '09, our sway  due June 19th By c-section!!! A sister for our boys!! 

Magnolia

Posts: 144

Joined 28-Oct-10

7-Nov-10 3:26 pm
Thank you for your kind words..
We hope that everything will be perfect for you and you will have a successful cycle !

 

Magnolia

Posts: 144

Joined 28-Oct-10

7-Nov-10 6:26 pm
I updated all the parts with lots of additional informations.
Added the final part: “LOG: Time-line, medications and supplements”.
Also I posted the 1987 article from "Jerusalem Star" about IVF in Jordan.

 

Maria

Posts: 9,138

Joined 30-Sep-08

Forum Leader Top Poster
7-Nov-10 9:18 pm

 Thank you very much D4M Agree

2005
2009
coming in 2014

Tracey

Posts: 1,261

Joined 29-Jul-10

Top Poster
Gold

Gold Membership

10-Nov-10 9:51 am

desire4magnolia:
Thank you for your kind words..
We hope that everything will be perfect for you and you will have a successful cycle !

 

Thank you, I hope some of your good luck rubs off onto us !! Thanks again for the post, my DH read it after me and it convinced him we should go there and try them.

'05 '07 '09, our sway  due June 19th By c-section!!! A sister for our boys!! 

Posts: 65

Joined 3-Nov-09

10-Nov-10 10:36 am

Thank you so much for telling us about your experience in farah, you have swayed me in my decision also to try there also but not for couple of years, thank you for taking alot of your time to write your experience it is very much appreciated for those of us hoping to get our desired gender, it was well written and you have included lots of info so thank you,when i read it first some of it i didn't understand some of it  but in time with more study i should be a pro! Happy Smile

Baby Boy'04Baby Boy'08'[Baby Boy'10'

Page: of 18