Category Archives: Informative artikel

Surrogacy is a reproductive method where one woman carries a pregnancy for another and, after the birth of the child, hands it over to its biological parents.

It represents a suitable alternative for couples where assisted reproductive techniques have not led to the desired pregnancy, or pregnancy could be life-threatening or in the case of a homosexual couple.

INDICATIONS FOR SURROGACY

From a medical perspective, conditions in which surrogacy would be appropriate include:

1. Absence of a uterus or severe defects of the reproductive system
2. Multiple failed IVF attempts
3. Severe form of antiphospholipid syndrome, lupus or thrombophilia
4. Advanced stage of chronic kidney disease
5. Need for life-saving treatment, which is contraindicated during pregnancy – for example chemotherapy.

TYPES:

Depending on the genetic relationship between the surrogate mother and the child, there are 2 types of surrogacy:

1. Traditional – in this case, the oocyte that will be fertilized belongs to the surrogate mother and, accordingly, the child will carry her genes.
2. Gestational – gametes from future parents or donor eggs/sperm are used. In the second option, the child will be genetically related to only one of the future parents.

In addition, it also can be:

1. Altruistic – the surrogate does not receive payment for the service. Only medical costs are covered.
2. Commercial – the surrogate receives a commission outside of medical costs.

SURROGACY AROUND THE WORLD

Surrogacy laws vary widely from country to country. Additionally, the conditions for hiring a surrogate are also not the same around the world.

In most European countries such as France, Austria, Germany, Italy, etc. surrogacy is prohibited by law. In some countries, such as Belgium, The United Kingdom and the Netherlands, it is allowed, but only when it is done altruistically, i.e. without additional payment.

Ukraine, Russia and Georgia are among the countries with the most liberal surrogacy laws. Even commercial surrogacy is allowed there and there are numerous agencies that offer it. This is also the reason for the so-called „reproductive tourism“ to these countries.

SURROGATE MOTHERHOOD IN BULGARIA

At the moment, surrogacy in Bulgaria is not allowed and is not applied as a possible alternative for couples with reproductive problems. The woman who gave birth to the child is considered its mother. In 2010, an attempt was made for a draft law aimed to legitimize surrogacy in our country. According to that, only altruistic surrogacy would be allowed, and only for married couples. For now, however, this option remains impossible in Bulgaria, and couples wishing to become parents in this way have to travel abroad.

КАКВО ПРИЧИНЯВА ИНФЕРТИЛИТЕТ ПРИ ЖЕНИТЕ?

ПОВТАРЯЩА СЕ НЕУСПЕШНА ИМПЛАНТАЦИЯ И ИН ВИТРО: КАКВО ТРЯБВА ДА ЗНАЕМ?

IMPLANTATION FAILURE – WHAT ARE THE GENERAL REASONS?

The success rate of in vitro fertilization is determined by various factors. This means that several cycles often have to be carried out until the desired pregnancy is achieved. It is no secret that the process is often long and associated with many emotions.

Although there is no official definition of recurrent implantation failure (RIF), it is generally accepted that it is when pregnancy has not occurred after at least 3 transfers of healthy embryos.

The reasons for this serious problem can be both on the part of the woman and on the part of the embryo. In this article, we will present some of the most common factors contributing to RIF.

MOTHER’S AGE

  Studies show that IVF is most successful in women up to the age of 35. With increasing age, cases of aneuploidy (abnormal number of chromosomes) in the resulting embryos increase, leading to a higher number of failed implantations. Interestingly, such a difference in in vitro success was observed to a much lesser extent when donor eggs were used, supporting the idea that maternal age affects egg quality.

UTERINE ANATOMY ABNORMALITIES

Various conditions such as fibroids, hydrosalpinx or congenital abnormalities of the uterus can prevent implantation. They are usually diagnosed before the in vitro cycle has started. At the discretion of your obstetrician-gynecologist, you may be offered surgical treatment.

IMMUNOLOGICAL PROBLEMS

When RIF cannot be explained by another reason, the next step is looking for an immune system abnormality. Among the most common immunological causes of implantation failure are:

1. Elevated levels of some antibodies – antiphospholipid, anticardiolipin, anti-β2 glycoprotein-I antibodies, as well as lupus anticoagulant, typically seen in women with antiphospholipid syndrome, are associated with recurrent implantation failure.
2. Some features of the woman’s immune system – imbalance between Th1 and Th2 cells, as well as abnormally increased activity of uterine NK cells.

A RECEPTIVE ENDOMETRIUM

The endometrium (uterine lining) undergoes significant changes in its morphology during the menstrual cycle, without which pregnancy could not occur. Under the influence of estrogens and progesterone, the thickness of the endometrium increases to about 8mm. In addition, there is a period called the „implantation window“, around 19-21 days, when the uterus is receptive to the embryo and implantation can occur. In a certain percentage of women, this period of uterine receptivity is shifted from the normal time, resulting in infertility.

Recurrent IVF implantation failure is a complex problem. The various reasons that can lead to it determine the availability of different methods of treatment.

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In the following lines, we will pay attention to the main tests that pregnant women will have to undergo in the next 9 months.

For expectant new mothers, pregnancy and childbirth can be full of uncertainty and worry. Between being overwhelmed with new information and adjusting to the changes your body is going through, pregnancy can be quite a challenge. Yes, fears and anxieties are normal, but it’s important not to let these feelings completely overwhelm you.

We prepare in many ways for the arrival of the little baby, from designing the perfect nursery to the right diets and exercises. But, it is important not to forget to tune our consciousness to the truly amazing experience that comes with the appearance of new life in the world.

Any pregnancy is established with a urine or blood pregnancy test (testing the levels of ß-hCG- pregnancy hormone). It is recommended that the first examination with an obstetrician-gynecologist be done about 10 days after the delay of the menstrual cycle.

The main tests during pregnancy in the different periods are the following:

Regular examination of PCC, urine and blood sugar

Examination of the pregnant woman’s blood group and Rh (Rhesus factor).

Early biochemical screening – 11-13 weeks – early fetal morphology

Sexually transmitted infections

Microbiological examination of vaginal discharge and smear test

Late fetal morphology

You will likely have many thoughts and questions during your pregnancy. Coping with symptoms and making lifestyle and daily routine changes can be overwhelming at times.

Here are some tips to help you relax during this time:

Take time for yourself – every day

Do something that you like and that is just for you.

Talk to your loved ones, friends, and family – about everything that bothers you.

Be active every day (if this is not prohibited for medical reasons)

Exercise releases endorphins that will improve your mood. You don’t have to do strength training or go to the gym. Just try to incorporate different activities into your daily routine, be it a walk outside.

Be realistic about how much you can do (whether at work, at home, or in your social life)

 Balance your diet

Do not hesitate to ask your gynecologist about anything that interests you.

If you are concerned, talk to your supervising OB/GYN or midwife.

Source: Аптеки Запад – Онлайн аптека с грижа за Вас! | APTEKIZAPAD.BG

FACTORS FOR A HIGH RISK PREGNANCY

There are many risk factors that could lead to pregnancy complications. Many of them can be managed, which means that every mother-to-be should be aware of them so that she can take the necessary measures.

CHRONIC DISEASES AND PREGNANCY

The control of chronic diseases is important not only for our quality of life, but also for the normal course of pregnancy. Many chronic diseases exacerbate during pregnancy, which necessitates more frequent check-ups, taking medications, tests and increased stress for the expectant mother.

Hypertension. Uncontrolled high blood pressure (over 140/90mmHg) increases the risk of developing preeclampsia and low birth weight of the fetus. Therefore, it is mandatory to measure your blood pressure during your regular pregnancy check-ups, as well as at home.

Diabetes. If you are planning a pregnancy, you should consult with your endocrinologist regarding a possible change in your diabetes therapy. Poorly controlled diabetes in the first weeks of pregnancy can lead to birth defects, and later fetal macrosomia (a larger than normal baby) and hypoglycemia (low blood sugar) at birth.

Thyroid disease. Both increased and decreased thyroid function have been linked to heart problems and fetal neurodevelopmental disorders.

Being overweight. Excess weight is associated with an increased risk of developing gestational diabetes and giving birth to a large fetus, which could necessitate a cesarean delivery. High-grade obesity before getting pregnant is associated with fetal heart defects. It is important to optimize your weight if you are planning a pregnancy or if you are already pregnant – not to gain more than the recommended weight.

HIV/AIDS and other infections. HIV can be transmitted to the fetus during pregnancy, childbirth or breastfeeding. These days, there are medications for both mother and baby that greatly reduce the risk of transmission. If you want to get pregnant, it is highly recommended to get tested for HIV, as well as other transmissible infections (gonorrhea, chlamydia, syphilis, hepatitis B and C).

HARMFUL LIFESTYLE FACTORS

Alcohol. According to research, there is no safe amount of alcohol you can consume during pregnancy. Children of women who drank alcohol during pregnancy may suffer from FASDs (Fetal alcoholic spectrum disorders), which could manifest as disorders of the nervous system, behavior and intellectual development.

Smoking. Smoking, including passive smoking, during pregnancy is associated with an increased risk of miscarriage, stillbirth, and sudden infant death syndrome. If you’re trying for a baby, it’s best to quit smoking before you get pregnant.

Drug use. Like alcohol and cigarettes, drugs (including marijuana) can negatively affect fetal development and increase the risk of sudden death or stillbirth.

Sedentary lifestyle. If you have no contraindications – moderate workouts and walks are extremely beneficial for pregnant women. Exercise prevents obesity during pregnancy and may help with easier labor.

If you have concerns about your health and how it may affect a current or future pregnancy, talk to your OB/GYN. They will give you valuable advice on how to reduce the risks of possible complications.

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„Wish! 2023“ Campaign donates two in vitro procedures at New Life clinic.

For another year, New Life Clinic and its partners donate two in-vitro procedures with included stimulation and tests to couples with reproductive problems.

The „Wish“ campaign has been a tradition for the medical center for years and regularly starts in the most magical month of the year – December, and its end is announced on Midwives ‚Day in the new year – 21.01.

Again in 2023, the campaign will make the dream of two Bulgarian families come true by donating two in vitro procedures.

For more information follow the link: https://newlifeclinic.bg/%d0%bf%d0%be%d0%b6%d0%b5%d0%bb%d0%b0%d0%b9-%d1%81%d0%b8/

After in vitro fertilization, the fertilized eggs (already embryos) are grown in a special medium for 2 to 6 days (liquid containing nutrients), after which they are ready to be transferred into the patient’s uterus. This procedure is known as embryo transfer (ET).

WHAT DOES EMBRYO TRANSFER LOOK LIKE?

Embryo transfer is a quick and painless procedure lasting 15-30 minutes. A speculum is inserted into the patient’s vagina and the cervix is ​​cleaned.

After confirming the patient’s identity, the embryologist aspirates the embryos into a catheter. Then they give the catheter to the gynecologist, who inserts it through the cervical canal into the uterine cavity while visualizing it with an ultrasound.

Once the tip of the catheter reaches the optimal position for ET, the gynecologist deposits the embryos into the uterine cavity. The catheter is then withdrawn and the embryologist checks it to make sure all the embryos have been transferred.

After the procedure, the patient remains for observation in the gynecological chair for about 30 minutes.

WHAT CAN I DO AFTER MY EMBRYO TRANSFER?

 After embryo transfer, you don’t need to make any  huge changes to your lifestyle. However, it is important to get enough rest, but not to lie down all the time. Avoid strenuous exercise, sex, and hot temperatures (bath, sauna, sunbathing, etc.). Stop drinking alcohol and smoking, and take your prescribed medications.

 And most importantly, take time for yourself and your partner, because you deserve it.

SYMPTOMS OF A SUCCESSFUL EMBRYO TRANSFER

 The only certain way to know if the embryo transfer was successful is through a pregnancy test. Many women experience pregnancy-like symptoms about a week after ET. However, this is not a guarantee of a positive result, because it may be caused by the hormonal medications that are taken before and after the procedure.

 The most common symptoms after ET are:

light vaginal bleeding

breast tenderness

frequent urination

mild abdominal cramping or lower back pain

fatigue

It is also possible to feel absolutely nothing different and still be pregnant.

WHEN SHOULD I TAKE A PREGNANCY TEST?

 Many women are tempted to take a pregnancy test the day after the procedure. This is not recommended because you can get a false negative result. The production of hCG (the hormone we test to confirm a pregnancy) begins around the 6th day after embryo transfer.

 We advise you to take a pregnancy test no earlier than the 16th day after the procedure, when the hCG level is high enough for the result to be reliable. You can take either a blood test or an at-home pregnancy test. It is important to notify your fertility clinic immediately, even if the result is negative.

The skin, which is the largest organ in the human body, is composed of three layers – epidermis, dermis and hypodermis, as in the newborn it undergoes development during the first few months of life. At birth, its top layer is still very thin, not fully mature and easily injured. During the first weeks or longer for premature babies, the skin matures and develops its natural protective barrier and adapts to the new environment. You may notice that it is more sensitive and dry at times, but this is normal with adequate care and should calm down within three months.

Good skin care practices will help maintain the integrity of the baby’s skin barrier and can help prevent skin problems in the future. This includes proper cleansing, moisturizing and sun protection.

Bathing – how often?

Bathing frequency and time of day are based on your newborn’s individual needs. Use a mild soap-free cleanser if needed. Choose products that do not contain fragrances, botanicals and antibacterial agents, as these can be irritating to sensitive baby skin. After the bath, pat the skin dry, paying attention to skin folds. The use of baby powder or talc is not recommended.

Moisturizing and hydration

Apply a thick, unscented moisturizer daily at the first sign of dryness. Thicker creams are more effective than lotions.

Changing diapers

The diaper area is exposed to constant moisture, clogging and friction, which can irritate and damage the skin, causing a rash. To prevent this: Change your baby’s diapers often. Cleaning when changing is done with lukewarm water and soft disposable towels or a cotton swab. If necessary, a soap-free cleanser with a neutral pH can be used. If possible, leave your baby as much diaper time as possible

The clothes

Light, loose, soft clothes and cotton bedding are best. Be careful not to overheat your baby. Avoid rough, prickly fabrics that come into direct contact with the skin. To wash your baby’s clothes, use a mild, unscented detergent.

Sun protection – important and necessary

Baby skin is sensitive to the harmful effects of UV light. Babies under 6 months of age should be kept out of direct sunlight. When outdoors, light clothing, hats, stroller shades, and shade are the best protection against the sun’s harmful UV rays. When we have direct exposure to sunlight, a broad-spectrum SPF 50+ sunscreen should be applied. Choose a sunscreen suitable for babies or those with sensitive skin. Apply sunscreen 15-20 minutes before going outside and reapply every two hours. If the sunscreen causes a reaction on your baby’s skin, stop using the product.

Cosmetics

There is a wide variety of products on the market, which often leads us to the question „What should I choose?“

Generally speaking, it is recommended that baby cosmetics be as free from dyes, fragrances and aggressive chemical components as possible, as well as having a neutral ph.

SOURCE: APTEKI ZAPAD

Normally pregnancy lasts 40 weeks starting from the date of your last period. Additionally, those 40 weeks are divided into 3 trimesters: first trimester – from the beginning to the 13th week of gestation; second trimester – from 14 to 27 weeks of gestation; third trimester – from 28 weeks of gestation until birth.

 Each stage of pregnancy is associated with many and mostly positive emotions, but it has its own peculiarities . However, sometimes problems can  occur for which every woman should be prepared.

 GENITAL BLEEDING

 Light bleeding or spotting is common during the first trimester. In most cases, it is not a cause for concern, especially if it is not accompanied by other symptoms (for example, abdominal pain). However, it is absolutely necessary that you get examined by an obstetrician-gynecologist to rule out some serious complications.

NAUSEA AND VOMITING

 Almost all pregnant women experience nausea or vomiting during the first trimester. This is due to increased levels of hCG (human chorionic gonadotropin). Sometimes the vomiting is so intense that it poses a serious risk to the mother (extreme dehydration and inability to take in nutrients), which in turn affects the baby. Such a condition is called hyperemesis gravidarum and is fortunately rare.

MISCARRIAGE

 Most miscarriages occur in the first trimester. The reasons for them are plenty: chromosomal abnormalities in the embryo, infections, endocrine and autoimmune disorders, etc. Symptoms of miscarriage include severe abdominal pain, vaginal bleeding, nausea and/or vomiting.

ECTOPIC PREGNANCY

 An ectopic pregnancy is implantation of the embryo outside the uterine cavity, most often in one of the fallopian tubes. Because the fallopian tubes cannot increase in size like the uterus, the growth of the implanted embryo can cause them to rupture. The characteristic symptoms are amenorrhea (absence of menstruation for a few months), severe pain on one side of the abdomen, bleeding. Ruptured ectopic pregnancy as well as miscarriage require urgent medical intervention.

CAN I PREVENT SOME PROBLEMS?

Unfortunately, most first trimester complications are beyond the pregnant woman’s control. What you can do is take care of both your emotional and physical health: stick to a balanced diet and exercise regime, stop smoking and alcohol consumption. And most importantly – if you have concerns that something is wrong, seek promptly medical help!

Основни правила на хранене, когато се опитвате да забременеете

СПОНТАНЕН АБОРТ

Early menopause or „premature ovarian insufficiency“ describes a condition where the function of the ovaries is reduced and they produce mature oocytes significantly less often than normally (every month). The term “premature ovarian insufficiency” is used when the woman is under 40. The important thing in this case is that, although more difficult, getting pregnant is possible.

CAN IN VITRO FERTILIZATION CAUSE EARLY MENOPAUSE?

 There are myths that the treatment of infertility by in vitro fertilization causes a serious side effect – early menopause. These perceptions are due to the fact that controlled ovarian hyperstimulation (COHS) aims at the maturation of 10-20 follicles, instead of 1-2, as in a normal menstrual cycle, thus hypothetically reducing the ovarian reserve.

 The truth is that during a normal menstrual cycle (one without COHS), approximately 10-20 follicles begin to mature in a woman’s ovaries but only 1-2 reach ovulation . The rest are simply absorbed by the body.

 Another reason for the early menopause myth are some side effects caused by fertility medications: fluid retention, mood swings, hot flashes, headache. These unpleasant sensations largely resemble the symptoms of menopause, but disappear after finishing your fertility treatment.

 In conclusion, no, IVF does not cause early menopause. On the contrary, it is an opportunity for women suffering from this problem to become mothers.

TREATMENT OPTIONS

Premature ovarian insufficiency can have many causes. Depending on your diagnosis, your obstetrician-gynecologist will inform you about the possible solutions in your case.

If you are undergoing cancer treatment, we advise you to freeze your eggs before the treatment begins. According to the Center for Assisted Reproduction’s new regulations, the state will now finance egg freezing for cancer patients. The reason is that frozen eggs can be stored for years and their quality corresponds to your age at the time of freezing. In other words, they are of better quality, not only because they have not been exposed to the toxic effects of chemo- or radiation therapy, but also because of their younger biological age.

If your obstetrician-gynecologist decides that you can try IVF with your own eggs, it must be taken into account that when the ovarian reserve is exhausted, both the number and the quality of the eggs are  reduced.

There are other options for conception, such as using donor eggs. You can use an egg  from an anonymous donor or from a relative. New Life Medical Center has a donor egg program. We work with one of the largest donor egg banks in Europe to offer you more opportunities to make your dream come true.

If you’re keen to start planning your family, it’s a good idea to check your ovarian reserve. Anti-Mullerian hormone (AMH) is considered the most objective hormonal indicator of ovarian reserve. The test can be done in any laboratory, on any day of your menstrual cycle.

If you think that you might be at risk of premature ovarian failure, we recommend that you schedule an appointment with a reproductive specialist.

There is no identical answer for how long the process of trying to conceive should take, as the path for each of us is different.

Statistics show that approximately one in seven couples may have difficulty trying to conceive. Whether it’s a question of blocked tubes, polycystic ovaries, a bad sperm test result, endometriosis, or an unexplained infertility factor, the struggles every couple goes through are something that’s still rarely talked about. Although there may be a number of reasons why they keep their experiences secret, knowing what to expect can help patients in the overall process of choosing a clinic, doctor and the most appropriate treatment method.

Fertility evaluation is essential to determine the cause of infertility and choose the best course of treatment and assisted reproduction technique. In the following lines, we will pay attention to the main reasons related to the male and female factor of infertility, as well as when we should contact a reproductive specialist.

About a 1/3 of infertility cases are related to the so-called female factor. The reasons why a woman cannot conceive spontaneously are numerous, as the treatment is different depending on the specific case.

Some of them are:

DISORDERS IN OVULATION

Ovulation disorders are observed in nearly 40% of women suffering from infertility. Among them, polycystic ovary syndrome and prematurely exhausted ovarian reserve are the most common.

ENDOMETRIOSIS AND THE ACCESSORY OF FALLOPIAN TUBE

Obstruction of the fallopian tubes can be due to endometriosis, past sexually transmitted infections or surgical interventions. It prevents fertilization, as well as the movement of the embryo to the uterine cavity (implantation). One of the mandatory tests in the diagnosis of infertility is the hysterosalpingography – a procedure assessing the patency of the fallopian tubes. Endometriosis is the growth of endometrial tissue (i.e. the lining) in places outside the uterine cavity (uterine musculature, ovaries, tubes, internal sex organs, fallopian tubes and other organs). In the case where the endometriosis is in the tubes, this leads to the formation of adhesions that can block the fallopian tubes and prevent the sperm from reaching the egg and fertilization from taking place. Endometriosis is estimated to occur in 8-15% of the female population of childbearing age.

STRUCTURAL ABNORMALITIES

A large part of the congenital structural anomalies is asymptomatic and are discovered incidentally, when searching for the cause of an irregular cycle, prophylactic examination, infertility or spontaneous abortion. This group includes various congenital anomalies in the shape of the uterus – unicornuate, bicornuate uterus, double uterus, septum (partial or complete partition in the uterine cavity), etc. This includes adhesions that are the result of infections, trauma or surgical interventions that can disrupt implantation, leading to reproductive problems.

CAUSES OF FAILURE OF GETTING PREGNANT ARE NOT JUST A WOMAN’S PROBLEM

Male factor of infertility, which is about 50% of cases of infertility in a couple, can be due to a number of causes that include genetic factors, past illnesses, trauma, medications, and general aspects of health and lifestyle. These factors can contribute to problems related to spermatogenesis or sperm release. Regardless of the reasons, their diagnosis begins with an examination by a urologist. After taking a detailed history of past illnesses, infections, especially in childhood, operations, etc., as well as the current objective condition, the necessary tests and laboratory tests are prescribed.

A basic and indicative study is the SPERMOGRAM, which in most cases can give the diagnosis of male infertility. In the standard sperm analysis, four main parameters are examined – volume, concentration (of spermatozoa in seminal fluid in mil/ml), motility (of spermatozoa in percentage), morphology (of spermatozoa in percentage). The reference values ​​of the World Health Organization (WHO) and the Kruger criterion for morphology are used in determining the conclusion. The extended spermogram differs from the ordinary one in that it includes an additional more detailed analysis and evaluation of the morphology of the spermatozoa. In order for the spermogram to be accurate, the man must have 3-5 days of sexual abstinence, no alcohol during these days and no antibiotics in the last month.

REPRODUCTIVE SPECIALIST – WHEN?

With regular sexual intercourse, without protection, if pregnancy does not occur:

For women under 36 years old – up to 1 year

For women over 36 years old – up to 6 months

The path of one dream to become a reality is always different, but you should never lose faith in achieving it!

Source : Apteki Zapad

POLYCYSTIC OVARY SYNDROME AND IVF