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WHAT’S THE DOULA’S ROLE DURING CHILDBIRTH?

Recently giving birth with a doula has become all the rage. It might seem like something new but in fact, doulas have been around for centuries. It’s not a coincidence that many paintings of women giving birth depict a few other women, helping the mother. The word “doula” comes from Greek and means “a woman who serves”.

The doula is a companion who has undergone the required training. They are not doctors or midwifes and they do not examine the pregnant woman or give her medication. Hiring a doula doesn’t exempt you from going to your OB/GYN appointments.

Doulas can help before, during or after childbirth. When you need them the most, is up to you. You can discuss this with your doula at your first meeting, which is usually around the third trimester.

HOW CAN THE DOULA HELP?

The job of the doula is to prepare future parents for the birth and initial upbringing of the child, as well as to offer emotional support. They are the people you can always look for when you need advice.

As already mentioned, doulas are not medical professionals. They work in collaboration with the medical team. However, each doula is aware of the childbirth process. To facilitate childbirth, they can offer various breathing techniques and non-medication analgesia. These include walks, massages, warm showers or changes in the position of the body.

Doulas are mediators between doctors and women during the delivery. They can explain to the woman the upcoming manipulations so she can make an informed decision. Doulas do not impose their opinion and do not question medical decisions.

DOULAS IN BULGARIA

The association of Bulgarian Doulas has existed for several years now. It consists of about 20 women and one man who are qualified to practice this profession. Unfortunately, they do not have members from Plovdiv, but they will be happy to answer your questions.

Studies have shown that women who give birth with a doula are more relaxed and less likely to suffer complications or need analgesia. Doula-assisted childbirth can definitely be a unique experience, but remember that you should always inform the hospital you’ve chosen beforehand.

SPERM VITALITY TEST – WHICH PATIENTS COULD BENEFIT FROM IT?

A sperm vitality test shows what percentage of the spermatozoa in the sample are vital (alive). Patients are usually referred for this test after a low percentage of sperm motility is detected on semen analysis. The results of the sperm vitality test give important information to the treating urologist about diagnosing and treating the possible cause of infertility.

The sperm vitality test is also an important tool when a couple with male factor infertility is about to undergo an IVF procedure. The oocytes of these couples are fertilized by IntraCytoplasmic Sperm Injection (ICSI). During ICSI the embryologist selects a single spermatozoa and injects it in one oocyte. As a rule the spermatozoa selected are always with the best available motility and morphology. In cases of very low or no motility, sperm vitality test is used to select viable spermatozoa, since only they can fertilize oocytes.

There are different types of vitality tests. The 2 most commonly used are the Hypo-osmotic Swelling (HOS) test and the Eosin Nigrosin test.

The advantage of the HOS test is that spermatozoa are still alive and can be used for ICSI following the test. During the test spermatozoa are put in hypo-osmotic solution (i.e. in solution with lower concentration of solutes compared to the inside of the spermatozoa). Due to osmosis, water starts coming into the spermatozoa and if their membrane is functional (i.e. if they are alive), their tails start swelling and curling. This process is completely reversible and those spermatozoa can be used for ICSI after they are washed.

The Eosin Nigrosin test also distinguishes between viable and non-viable spermatozoa on the basis of their membrane integrity. Viable sperm do not let the red dye eosin penetrate their membrane and thus remain white, while non-viable sperm turn red. Nigrosin is a dark dye which improves contrast and makes it easier to distinguish viable and non-viable spermatozoa. The Eosin Nigrosin is often preferred for diagnostic purposes, as it is faster than the HOS test. However, sperm cannot be used for ICSI afterwards.

According to the World Health Organization (WHO) the reference value for sperm vitality is 58%. If less than 58% of your spermatozoa/those of your partner are non-viable, it is strongly recommended to consult with a urologist, specializing in fertility issues.

WHY NEW LIFE CLINIC IS A SUITABLE PLACE FOR PEOPLE FROM DIFFERENT NATIONALITIES?

New Life Clinic with its world-class Israeli know-how is among the leading centers for reproductive medicine in Bulgaria. The quality of our services is the reason for more and more patients of different nationalities to seek our medical help.

Nowadays medical tourism is more popular than ever. On a global scale nearly 30,000 couples annually travel abroad for assisted reproductive procedures with Israel being one of the popular destinations. Due to the fact that in Israel the government pays for all reproductive procedures until the birth of two children, assisted reproduction is very highly developed. New Life fertility center applies Israeli know-how in Bulgaria thus giving thousands of couples, both Bulgarian and foreign, the chance to take advantage of it.

WORLD CLASS QUALITY

The entire team of specialists at New Life has successfully completed a prestigious training program at the Israeli hospitals Hadassah Hospital, Jerusalem and Assuta Hospital, Rishon Lezion.

MULTILINGUAL STAFF

New Life clinic is foreign-friendly, because the language barrier is not a problem for us.  A number of our highly educated staff members speak English, while some speak German, Russian, Greek or Hebrew, as well.

CONVINIENT LOCATION

New Life Fertility Center is in the immediate vicinity of the Central Railway Station in Plovdiv as well as Bus Station “Rodopi”. This central location close to public transportation was chosen in order to make it easier for patients from other cities and countries to get to us.

If you have any questions, do not hesitate to get in touch with us by messaging our Facebook page or calling our free number 0 800 13 006.

For years the biological significance of the female orgasm has been a subject of debate. Evidently, a woman can conceive without it. But does it help? Two popular hypotheses say “Yes”.

ORGASMS MAKE THE UTERUS CONTRACT

As many of you have probably heart fertilization takes place in the Fallopian tubes. For spermatozoa going through the vagina, the cervix, the uterus and along the tube is very long and time-consuming. It takes hours or even days. Most of the spermatozoa die before they even reach the Fallopian tubes. The oocyte also has a short life span after ovulation – about 48 hours. In other words even if enough spermatozoa reach the ampulla region of the Fallopian tube, where fertilization takes place, their arrival has to coincide with ovulation (+/- 1 day). That explains why even if everything is OK with both partners, conceiving naturally usually takes months, sometimes more than a year.

HYPOTHESIS 1. THE UPSUCK HYPOTHESIS

The vagina and the uterus are made of extremely powerful muscles. When the woman climaxes, the muscle contraction creates a vacuum which literally sucks up the sperm towards the uterine cavity and the Fallopian tubes. This dramatically increases the number of spermatozoa which reach the Fallopian tubes and increases the chance of fertilization.

It is believed that if the woman gets an orgasm about a minute before the man, the amount of sperm retained inside the uterus is greater, which increases the chances of conception.

HYPOTHESIS 2. THE SLEEPY HYPOTHESIS

Do you feel sleepy after sex? This is your body’s way of telling you that you should lie down. During intercourse the sperm is deposited in the vagina. Motile spermatozoa move into the cervix where they cannot fall out from due to gravity. However, sperm moving into the cervix takes time. Therefore, it is recommended that the woman does not get up right away since sperm will start leaking out.

FUN FACT: A few days before ovulation, estrogen levels are the highest. Then the probability of having orgasm is also the greatest.

Orgasms have many benefits beyond pleasure. They are thought to reduce stress, migraine spells, strengthen the immune system, and last but not least, the relationship with your partner. Whether they help with conception, we leave for you to find out 😉

Тestosterone and its synthetic derivatives have been used to increase muscle mass for a long time. Although forbidden for professional athletes, they are sometimes used by men practicing amateur sports. Along with their effects on  physical appearance and libido, steroids also affects male fertility.

WHAT HAPPENS IN THE BODY WHEN YOU TAKE ANABOLIC STEROIDS ?

Testosterone stimulates spermatogenesis. When a man is taking extra testosterone, its internal production in the testes is inhibited and spermatogenesis is disturbed. The result is reduced amount to a complete absence of sperm in the semen, which can be detected by a regular semen analysis. This effect is very often observed when anabolic steroid administration is not prescribed or overseen by a physician.

Some couples have problems conceiving because of anabolic steroids intake by the male partner. Although their use may lead to complete suppression of spermatogenesis, this condition is in most cases reversible. The longer the drugs were taken, the longer the recovery of spermatogenesis takes. Improvement of semen analysis results can be observed after at least 3 months following discontinuation of the anabolic steroids. After that many couples get pregnant naturally. In rare cases, long-term use of steroids leads to permanent suppression  and male infertility.

ANABOLIC STEROIDS AND ASSISTED REPRODUCTION

Even if the man hasn’t used anabolic steroids for a long time, sometimes there are indications for in vitro fertilization (IVF) or intrauterine insemination (IUI). This could be caused by a female infertility factor. If this is your case, you must inform the treating fertility specialist that you have taken steroids in the past.

Anabolic steroids are strictly prohibited prior to an assisted reproductive procedure (IUI or IVF). ANABOLIC STEROID INTAKE NOT PRESCRIBED BY A PHYSICIAN ESPECIALLY PRIOR TO AN ASSISTED REPRODUCTIVE PROCEDURE HAS STRONG NEGATIVE IMPACT ON THE OUTCOME OF THE PROCEDURE.

If you use or have used steroids and you have been trying to get your partner pregnant for more than a year, consult with a reproductive medicine specialist. They will refer you for the necessary hormonal tests (e.g. for testosterone, follicle stimulating and luteinizing hormone) and semen analysis. This will give you information about your hormonal profile and sperm count. If necessary you will be prescribed medication that will improve hormonal imbalance and stimulate spermatogenesis.

An in vitro fertilization (IVF) procedure normally starts with hormonal stimulation, proceeds with oocyte recovery trough an ovarian puncture, oocyte fertilization, culturing of the resulting embryos and concludes with an embryo transfer procedure. The step considered by many to be the most technically complicated is the oocyte fertilization step. This is especially true if fertilization is carried out by the IntraCytoplasmic Sperm Injection (ICSI) method. The other main method of fertilization is called Conventional In Vitro Fertilization.

What is ICSI fertilization?

ICSI fertilization is mainly used in male factor infertility cases. The nature of the procedure allows oocytes to be fertilized even in the presence of only single motile spermatozoa with good morphology. This is achieved as the embryologist catches these single spermatozoa by means of the so called micromanipulator (See Fig.). Each of the selected spermatozoa is separately immobilized, aspirated in the injection micropipette and injected into a single oocyte.

What is the difference between ICSI and IMSI?

IMSI is an improved version of ICSI (IntraCytoplasmic Sperm Injection) which allows the embryologist to look at spermatozoa at a much higher magnification (x 6000), compared to x600 or less for the standard ICSI procedure. The higher magnification allows much more detailed visualization of subcellular structures like the acrosome, the head, the midpiece, the cytoplasmic droplet or the tail of the spermatozoon. Therefore, with IMSI a much more precise selection of spermatozoa is achieved. Following the selection of particular spermatozoa, the IMSI procedure is identical to ICSI.

The IMSI method is useful for patients with a very low percentage of spermatozoa with normal morphology. Although it is more laborious and much more time-consuming, for those patients it is definitely beneficial. In some cases the IMSI procedure is also recommended for couples with a few unsuccessful ICSI cycles as well as couples with recurrent abortions. Talk to your reproductive specialist to find out which is the most suitable method in your case!

We have published articles, dedicated to endometriosis in the past. Undoubtedly, the one question which interests many of you the most is “Can I conceive naturally if I have endometriosis?” In this article we address this question specifically.

What is endometriosis?

Endometriosis is a condition in which cells from the uterine lining / endometrium / is found in atypical sites – Fallopian tubes, ovaries and even intestines. These outgrowths are influenced by sex hormone levels. They react in very much the same way that the lining of the uterus does (bleeds cyclically every month). This is a prerequisite for the development of inflammation that results in the formation of adhesions that may lead to issues in the future, including such related to conception.

Conception and endometriosis

In general women with mild forms of endometriosis have the same chance of getting pregnant naturally as women without this condition. In middle and severe forms of endometriosis, issues associated with natural conception may occur. These issues are most often caused by adhesions in the fallopian tubes or endometrial outgrowths in the ovaries. Fallopian tube adhesions partially or completely obstruct the transportation of the egg along the tube while endometrial growths in the ovaries can affect ovarian reserve. Depending on the exact cause, the treating obstetrician-gynecologist directs the patient to the most suitable method of treatment which would allow the patient to conceive. Methods of treatment include conservative treatment with medication, intrauterine insemination (IUI), in vitro fertilization (IVF) or surgical removal of endometrial growths.

It is very important to know that endometriosis is diagnosed only histologically. In other words a  diagnosis is put forward only after a laparoscopic surgery and histological tests. Endometriosis is by no means a verdict especially when it comes to conception. Some minor changes in lifestyle can help natural conception. For example, a diet rich in fruit and vegetables along with regular physical activity suppresses inflammatory processes, which cause adhesions and tissue damage.

 We must not forget that the most important thing when it comes to any medical condition is early diagnosis, which allows timely and successful treatment.

Polycystic ovary syndrome or PCOS is a hormonal condition. It is characterized by irregular ovulation or the lack thereof, irregular menstruation, ovarian cysts and insulin resistance.

Close to 20% of women worldwide have PCOS. Often, but not necessarily, they are overweight. These women have increased levels of androgens which get converted into estrogens in the fatty tissue. The more fatty tissue a woman has, the more estrogen she has. When estrogen levels get too high, ovulation is impaired.

Polycystic Ovary Syndrome and Pregnancy

Most women with PCOS conceive naturally shortly after they lose weight and restore their hormonal balance. If weight loss alone does not lead to pregnancy, they can start taking drugs that stimulate ovulation and inhibit androgen conversion. With such medication, these women usually conceive naturally or through intrauterine insemination (IUI).

The belief that the only way for a woman with PCOS to conceive is through IVF is completely wrong. IVF is considered only when the more conservative methods have proven unsuccessful.