Category Archives: Informative articles

Before starting an in vitro procedure, both partners undergo a series of fertility and general health tests. These tests not only ensure the safety and effectiveness of the treatment, but also provide valuable insight into potential challenges and strategies to optimize success.

SEROLOGICAL TESTS

The first type of tests that are done are the blood ones for HIV, Hepatitis B, Hepatitis C and Syphilis. These are the most common serious transmissible diseases (transmitted from person to person), which is why the directives on cells and tissues of the European Union, as well as the Bulgarian legislation, require that all in vitro patients be tested for them. A positive result does not always require termination of the procedure. According to the Bulgarian law, the procedure can continue if “the treatment facility has equipment and a validated procedure for processing and separate storage” of the infected biological material.

Blood tests for HIV, Hepatitis B, Hepatitis C and Syphilis should be done NO sooner than 3 months before the day of the procedure (ovarian follicle puncture). If they are older than three months, they are no longer valid.

In the presence of risk factors (e.g. travel to countries with an increased incidence of malaria, cytomegalovirus, etc.), additional blood tests are required.

MICROBIOLOGICAL TESTS

Both the woman and the man undergo a microbiological examination – of vaginal discharge and, respectively, of semen. The test shows whether these secretions contain microorganisms (e.g. bacteria, fungi) and what types. In men, it is mandatory to do urine test for chlamydia. The presence of certain species requires antibiotic/antimycotic treatment before the procedure. Microbiological tests of both partners should be done NO EARLIER than 30 days before the puncture.

HORMONES

Hormonal testing is absolutely essential in evaluating your fertility and determining the next steps in your treatment. They include:

• Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) – are tested on day 3-5 of the menstrual cycle.
• Anti-Müllerian hormone – gives important information about the ovarian reserve.
• Prolactin (PRL). It is examined 4 hours after waking up. 2-3 days before the test, there should be no sexual contact and breast stimulation, because this can lead to false positive results. Stress and certain medications also affect the results.

ADDITIONAL TESTS

Depending on your medical history, you will be recommended additional tests, including:

• Thyroid function test (TSH, fT3, fT4, TAT, MAT);
• Oral glucose tolerance test. Its goal is the early detection of insulin resistance and diabetes. If you are already diagnosed with any of these diseases it is necessary that they are well controlled before starting IVF.
• Screening for antiphospholipid syndrome;
• Genetic testing
• Vitamin B12.

WHICH TESTS ARE REQUIRED FOR MEN?

As a first step, you will be required to do is a semen analysis. It is absolutely mandatory because it can diagnose or rule out male factor for infertility. The reproductive medicine specialist can also order additional tests – for example, testosterone.

To obtain the most accurate results, always adhere to the necessary preparation for a certain test. If you have questions or uncertainties, do not hesitate to contact your medical provider.

АНТИМЮЛЕРОВ ХОРМОН

Controlled ovarian hyperstimulation (COH) involves the administration of exogenous hormones to stimulate the ovaries to produce multiple mature follicles simultaneously. Apart from providing more mature eggs, the other purpose of COH is to prevent premature spontaneous ovulation, ensuring a successful follicular puncture.

COH is conducted on the basis of established protocols. The medications used can be tablets or injections that you can administer yourself. Depending on overall health, ovarian reserve, age and many other factors, the most suitable protocol will be selected for you.

As soon as you start taking fertility drugs, your OBGYN will start monitoring the growth and development of your follicles – a procedure called folliculometry. This involves frequent visits to the clinic, so it is important to choose a place to which you have easy and convenient transportation.

OVARIAN RESERVE AND COH

Ovarian reserve is among the most important factors determining the success of the in vitro procedure. It has been found that controlled ovarian hyperstimulation (COH) may be less successful in women with diminished ovarian reserve for several reasons, including:

Decreased response to stimulation: Women with diminished ovarian reserve may respond less well to administered medications due to fewer follicles present in the ovaries.

Ovarian reserve is closely related to egg quality. Women with diminished ovarian reserve may have lower quality eggs, which can affect fertilization rates and embryo development. Poor egg quality can lead to more frequent implantation failures and a higher risk of miscarriage.

In women with diminished ovarian reserve, cancellation of COH could happen more often. One of the reasons is an unsatisfactory response to the medications used. The other reason is the predisposition to ovarian hyperstimulation syndrome. Although it sounds scary, such a decision is reached extremely rarely and only in the presence of absolute indications.

WHAT ARE THE TREATMENT OPTIONS?

The IVF protocols used today have been developed to be successful in the treatment of infertility in women with a variety of problems. Your obstetrician-gynecologist will decide which protocol is most suitable for you depending on your individual case.

In cases of diminished ovarian reserve, you may be offered the use of donor eggs or embryos as an alternative. This bypasses the limitations associated with ovarian reserve and can significantly improve the chances of achieving a successful in vitro pregnancy.

Ovarian reserve plays a critical role in predicting IVF outcomes. It affects the body’s response to ovarian hyperstimulation, the quality of eggs and embryos produced, and ultimately the likelihood of achieving a successful pregnancy. That’s why reproductive medicine specialists pay so much attention to it when creating a treatment plan for couples with infertility.

PREMATURE OVARIAN FAILURE

Insulin resistance (IR), a condition in which the body’s cells become less sensitive to the hormone insulin, plays a critical role in various aspects of health, including reproductive health. This metabolic disorder is increasingly associated with difficulties in achieving and maintaining a healthy pregnancy.

EFFECT ON OVULATION

Elevated insulin levels stimulate the ovaries to produce excess androgens and estrogen (male and female sex hormones), which suppress ovulation. The most recognizable characteristic of chronic anovulation irregular periods or even missing your period for months. This is an alarming symptom that you should notify your gynecologist about.

POLYCYSTIC OVARIAN SYNDROME

Insulin resistance and subsequent hormonal disturbances are closely related to polycystic ovarian syndrome (PCOS). PCOS is a complex condition that presents with a number of symptoms, including:

• increased androgen levels
• impaired glucose tolerance
• excess weight or obesity
• multiple ovarian cysts
• irregular menstruation
• skin manifestations: increased hair growth (hirsutism), acne, hyperpigmentation
• mental health problems: depression, anxiety, etc.

The consequences of PCOS do not only include infertility. The syndrome is associated with an increased risk of developing type 2 diabetes as well as heart disease.

WHY DOES INSULIN RESISTANCE INTERFERE WITH PREGNANCY?

On the one hand, insulin resistance suppresses ovulation, and without ovulation, fertilization cannot occur.

On the other hand, IR affects the endometrium (uterine lining). Studies have shown that in women with IR, there is a reduced receptivity of the endometrium to the embryo, which would prevent implantation, respectively the achievement of a successful pregnancy.

Last but not least, maternal IR can be a risk factor for miscarriage and fetal complications.

HOW DO I INCREASE MY CHANCES OF GETTING PREGNANT?

While insulin resistance can pose a fertility challenge, the good news is that lifestyle changes can help improve your reproductive health. They include:

• Appropriate diet. Switching to a balanced low glycemic index diet helps stabilize blood sugar levels. This means eating more fruits and vegetables, whole grains, lean meats, fish, dairy products, and healthy fats. Aim to make gradual changes to your diet so they can become a lifestyle.
• Physical activity increases insulin sensitivity. Both aerobic and weight exercises have shown positive effects on reproductive health. Workouts that are too intense, especially if you are inexperienced, can become demotivating. So start with some small changes such as daily walks or using the stairs.
• Make sure you dedicate enough time to sleep and rest. Adults should sleep at least 7 hours. Chronic sleep deprivation is associated with an increased risk of developing insulin resistance.
• Consultations with specialists. Sometimes lifestyle changes aren’t enough. Therefore, it is necessary that your condition be monitored not only by a gynecologist, but also by an endocrinologist, who, if necessary, will prescribe treatment.

Insulin resistance, with its implications for reproductive health, poses challenges to women who wish to conceive. However, active lifestyle changes and timely medical attention can greatly improve your chances of getting pregnant.

ВЛИЯНИЕ НА ЗАТЛЪСТЯВАНЕТО ВЪРХУ РЕПРОДУКТИВНОТО ЗДРАВЕ

How insulin resistance affects your chances of conceiving

GESTATIONAL DIABETES

In vitro fertilization (IVF) is a revolutionary step in reproductive medicine, offering hope to couples struggling with infertility. One intriguing aspect of IVF is its association with an increased likelihood of twin pregnancies. As the demand for assisted reproductive techniques increases, understanding the considerations surrounding twin pregnancy resulting from IVF becomes paramount.

IVF IN A NUTSHELL

IVF is an assisted reproductive technique in which, after hormonal stimulation and ovarian follicle puncture, fertilization of eggs takes place outside the body, with the resulting embryo(s) subsequently implanted in the uterus. Depositing the embryos into the uterine cavity is called embryo transfer. The best quality embryos are selected for the transfer. Usually 1 to 3 embryos are transferred, depending on the patient’s age and medical history.

WHY ARE TWINS MORE COMMON WITH IVF?

Twin pregnancy with IVF is usually explained by the transfer of several embryos. Identical twins are quite rare. Current recommendations favor the transfer of 1 embryo, except in some very specific cases. The transfer of more than one embryo is affected by various factors, including the age of the woman, the quality of the embryos and the presence of previous unsuccessful IVF attempts.

RISKS ASSOCIATED WITH TWIN PREGNANCY

While the prospect of twins can be exciting, it presents challenges for expectant parents and their chosen medical team. Twin pregnancies are considered high risk because of the increased likelihood of complications for both the mother and the babies. They include:

Occurrence of potentially life-threatening complications for the mother such as pre-eclampsia and hemorrhages. Pregnant women with twins also have an increased risk of developing gestational diabetes.

Twins are often born preterm (before 37 weeks of gestation) and they may have low birth weight (under 2.5kg). In the case of twins, it is more common for one or both babies to remain for observation and treatment in a neonatal unit.

If you are expecting twins, this does not mean that you will necessarily have a complicated pregnancy. However, it is possible to visit your obstetrician-gynecologist for more frequent check-ups. That’s why it’s of utmost importance to choose a medical team you trust.

This extremely dynamic period lays the foundation for good health for the future. One of the key components to ensure a healthy start is regular preventive examinations (child consultation) during the child’s first year. They play a vital role in monitoring child development, diagnosing potential problems early, and providing basic guidance on how to raise a child.

In this article, we will emphasize the essence of preventive examinations of children in their first year. Preventive examinations for children up to the age of 18 are regulated in the Children’s Health Program of the National Health Insurance Fund (NHIF). They are completely free.

The first year of a child’s life is a remarkable journey filled with rapid growth, constant change and countless milestones.

WHO CAN CARRY OUT PREVENTIVE EXAMINATIONS FOR CHILDREN?

It is imperative that parents choose a general practitioner (GP) for their child as soon as possible after birth.

To reduce stress, it is advisable to find out about your options before the birth. The initial selection of a general practitioner is carried out with the “Registration form for the initial selection of a general practitioner”, which can be printed from the website of the NHIF, and is filled in together with the relevant doctor. If the parents wish, the follow-up of the child’s health status until reaching the age of 18 can be carried out by a pediatrician. For this, a one-time referral from the GP is required. Despite this possibility, the child’s immunizations are carried out by the GP.

PREVENTIVE EXAMINATIONS AFTER BIRTH

Until reaching the age of one month, the newborn has the right to two preventive examinations. The first must be done within 24 hours of discharge from the maternity ward, which explains why it is important to choose a doctor for the child as quickly as possible. If this has not happened, the first examination takes place within 24 hours after the choice of GP or pediatrician. During the first examination, a detailed anamnesis will be taken regarding the birth: how it went, were there any complications. Have the records from the maternity ward ready for your child’s doctor to review. The child will then be examined. You will be given guidance and advice on baby care – breastfeeding, hygiene, sleep, etc. Don’t be afraid to ask questions, no one expects you to know everything about parenting. The second examination usually takes place 1-2 weeks after the first. According to the requirements, the baby is examined at home until the 28th day after birth.

FROM 1 MONTH TO 1 YEAR Your child is subject to a monthly preventive examination (child consultation).

Different activities are planned for each visit to the GP (examinations, immunizations according to the current Immunization Calendar, etc.). What they all have in common is that you will be questioned about the health of the child (taking an anamnesis), he will be examined, weighed, height, chest and head circumference will be measured. One of the most important components of a child’s consultation is the assessment of neuropsychological development. Through it, the doctor dynamically tracks the motor, speech and behavioral changes that are characteristic of the individual stages of child development.

AT 1 AND 4 MONTHS, the baby is subject to examination of the hip joints.

It aims at early detection of hip dysplasia. An examination by an orthopedist can be scheduled at discretion.

AT 6 MONTHS, an ultrasound of the baby’s excretory system is scheduled.

A general assessment of hearing and vision is performed. This is the time for the first preventive laboratory tests – blood and urine. If necessary, additional tests are appointed.

AT 1 YEAR laboratory tests are repeated.

Hearing and vision are again assessed. After reaching 1 year of age, child consultations are held at greater intervals. The described activities are the mandatory minimum determined by the competent institutions. If necessary, your child will be referred for relevant additional tests (laboratory, imaging, microbiological, etc.), as well as consultations with a specialist. Preventive examinations in the first year are indispensable in terms of timely diagnosis and solution of potential health problems. By investing in our children’s health from the very beginning, we not only protect their immediate well-being, but also lay the foundation for a fulfilling life.

BREASTFEEDING: WHY IS IT GOOD FOR BOTH YOU AND YOUR CHILD?

It is believed that the beginning of stem cells research was established in the 1960s by Canadian scientists Ernest McCulloch and James Till.

Simply said, they are unique in their ability to divide, multiply, replace damaged cells and become cells characteristic of different tissues.

Sources of stem cells are bone marrow, the circulation, or blood taken from the umbilical cord after birth. Their formation begins in the very initial phase of embryo development – at the age of 3-5 days.

Most often, they are needed for the treatment of certain malignant or genetic diseases that are passed on in the family. Scientific research in the field of stem cells gives many people hope for the treatment of diseases such as Diabetes, Alzheimer’s, Rheumatoid Arthritis, Parkinson’s, Multiple Sclerosis, Cerebral Palsy, Osteoarthritis, etc.

How are they retrieved after birth?

First of all, it is absolutely painless and safe for the baby and the mother. The umbilical cord contains two types of stem cells: hematopoietic, found in the blood of the umbilical cord, and mesenchymal, found in the tissue of the umbilical cord. Usually, both blood and part of the umbilical cord itself are taken immediately after it is cut. The whole procedure happens in the process of birth itself in a special sterile, pre-provided set. After transportation to the relevant laboratory, samples are taken for the presence of sexually transmitted infections such as spina bifida, syphilis, hepatitis, etc. and a sterility test. The number and viability of the isolated cells is determined, and if the results meet the standards, freezing is started. According to some scientists, the term for the storage can be unlimited if the cells are stored under the required conditions.

Types :

• Embryonic stem cells – collected immediately after the birth of the child
• Adult /somatic/ stem cells – found in tissues, such as bone marrow, blood
• Hematopoietic – Generated during embryonic development
• Mesenchymal stem cells – originate from the connective tissue that surrounds the body’s organs.
• Induced pluripotent stem cells – created in a laboratory

Whether another family member can use the stored cord-derived stem cells or a so-called allogeneic transplant can only be determined after tissue-compatible antigen testing is done to determine the degree of genetic proximity that would allow their use.

HOW LONG DO STEM CELLS KEEP?

Generally speaking, the storage period lasts until the onset of disease necessitating treatment by their transplantation. If not used at an earlier stage, the stem cells are stored for a period of 20 years.

After its expiration, the contract with the respective bank can be renewed by the already grown child. If you want guaranteed access to your donated stem cells, you must store them personally in a tissue bank of your choice. The other option for stem cell donation is to the National Public Umbilical Cord Stem Cell Donor Bank. There, the storage is free, but the difference with private tissue banks is that in the public one, the preserved biological material is made available to the people who need it, whether they are donors or those in need.

Source: AptekiZapad

STEM CELLS HARVESTING AT BIRTH

BICORNUATE UTERUS – WHAT DOES IT MEAN?

One of the causes of infertility in women is congenital anomalies of the reproductive system. One of them is the bicornuate uterus.

It is caused by incomplete fusion of 2 embryonic structures called Müllerian ducts. This means that 2 “horns” are formed in the upper part of the uterus, which give it a heart-like shape.

SYMPTOMS

The condition is usually asymptomatic. It is possible for women to suffer from painful or heavier periods. If there are other congenital anomalies (usually of the kidneys) complaints from the urinary-excretory system could be expected. In women trying to conceive, spontaneous abortions are more frequent.

PREGNANCY AND BICORNUATE UTERUS

Pregnancy in women with a bicornuate uterus is considered risky but not contraindicated. Expect more frequent OBGYN visits, as well as the possibility of the baby being born prematurely. Due to the unusual shape of the uterus, in about 50% of cases the fetus is  breech, which means a higher frequency of c-sections.

Other possible pregnancy complications in women with a bicornuate uterus include:

Low birth weight of the baby (due to the smaller uterine cavity)

Arterial hypertension during pregnancy

Vaginal bleeding during pregnancy

Postpartum hemorrhage

DIAGNOSIS

The diagnosis can be made with an ultrasound. 3D ultrasound is considered to provide 99% specificity in the diagnosis of a bicornuate uterus. Other tests that may be recommended to you are MRI, laparoscopy and hysteroscopy. It is recommended to have your  urinary system (kidneys, ureters, bladder) checked out as well, because in rare cases concomitant abnormalities are possible.

TREATMENT

Treatment is not required except in cases of recurrent miscarriages. Surgical correction of the uterus aims to remove the tissue forming the two horns, and the operation is laparoscopic.

Despite its challenges, a bicornuate uterus doesn’t necessarily mean the end of motherhood dreams. With advances in medical technology and personalized care, many women with this condition can carry out successful pregnancies. Regular monitoring and close collaboration with obstetricians greatly helps to mitigate potential risks and ensure the best possible outcome for both mother and baby.

WHAT CAUSES INFERTILITY IN WOMEN?

HYPERTENSION DURING PREGNANCY

Breastfeeding has been considered the best source of nutrients for the newborn.

Do I have enough breast milk?

This is the main question that every mother asks herself from the moment the baby is first put to the breast.

Does he or she have enough milk – is everything okay…?

In the first days after birth, the amount of colostrum that your breasts produce is completely sufficient for the nutritional needs of the baby. In the next few weeks after birth, the babies need to nurse very often because their stomach is small, they get tired quickly and cannot take large amounts of breast milk to satisfy their needs for long periods of time.

In the beginning, it can be difficult to know if the food is enough for the baby. The simplest rule to help you is to keep track of diapers. During the first month of a child’s life, stools are an extremely sensitive indicator and can guide you when everything is fine and when you need to seek for help. It is known that sometimes bottle feeding can cause the baby to wean, and nursing mothers are often warned against using bottles.

But there are situations when complementary feeding is expected to be a long-term and essential part of the feeding plan, or the baby is in a more serious condition that requires feeding to take a minimum of effort, then parents choose the bottles. However, since bottle feeding does carry a risk to breastfeeding success, it is important to do it in a way that closely resembles and preserves breast feeding skills.

We will focus on several important points when choosing a bottle and teat:

The bottle – The only important thing when choosing a bottle is the material from which it is made. Because of serious doubts about the health risks of BPA, it is preferable to choose plastic bottles that have been proven to be free of BPA – or glass bottles.

The teat – The success of combining breast and bottle depends to a large extent on two things: The strength of the stream and the speed with which the milk is poured into the mouth. How similar the position of the baby’s lips and tongue on the teat is to the breastfeeding position.

Carefully monitor your baby’s pacifier for the following: How big an angle is achieved in the corner between the baby’s lips – sharp or obtuse?

When breastfeeding, we aim for the lips to be wide open with an angle of more than 120 degrees, and it is important that the same happens on the bottle. How do the lips lie on the teat – are any of them pressed and sucked in? Are there holes in the corners of the mouth where milk leaks out? The answers to these questions will guide you to what extent the pacifier you use allows you to mimic breastfeeding as well as possible.

The goal is for the baby’s lips to be wide open, without being tense and without the upper one being bitten inward.

The vacuum they create around the teat should be good and there should be no leakage of milk from the sides. Rubber or silicone? It’s a matter of personal preference. Rubber teats made of natural material are softer and may be more comfortable for a newborn baby. Their disadvantage is that they wear out quickly. Silicone is a harder and fully synthetic material, but it is significantly more resistant, which – combined with its attractive transparency – makes it a favorite of most mothers.

BREASTFEEDING: WHY IS IT GOOD FOR BOTH YOU AND YOUR CHILD?

Summer is in full swing, and high temperatures are a fact.

How to protect the baby from the heat?

– is a question every mother asks herself.

What we should keep in mind and what to watch out for – you can read in the following lines.

During the first months of the newborn, his thermoregulation is still imperfect.

It is unable to respond adequately to sudden temperature changes occurring in its surroundings. Because of these physiological features, babies in the first months are more susceptible to both cooling and overheating. Overheating, especially in the summer months, often affects older children as well, but overheating in childhood can be the result of many factors – climate, inappropriate clothing, high temperature in the children’s room, thick blankets, etc. The sweat glands are not yet functional during the first months after birth, and this is also the reason why the body cannot cool itself by sweating.

In the following lines, we will pay attention to several signs that are associated with overheating and for which we should be careful:

• Increased body temperature and manifestations of drowsiness

• Rapid breathing

• Redness of the face or other parts of the body

• Sweating in the head or forehead area

• State of nervousness

• Nausea or vomiting

• A rash characterized by small red pimples on the face, neck, the abdomen, back, chest, groin and other parts of the body.

How to avoid overheating the baby?

1. The room temperature should be in the healthy range of up to 24 degrees

2. Avoid exposing the baby to direct sunlight, especially in noon, when the sun is at its strongest.

3. Do not dress the child in more layers of clothing than you wear yourself in the moment – if possible, the clothes should be made of natural material.

4. Never leave your baby unattended in your vehicle.

5. During the summer months, after a bath, avoid applying creams and lotions to the baby or oils.

The mild rash, which appears as a rash, does not have serious consequences for the child’s health, it is just a temporary discomfort.

However, overheating in a higher degree can lead to vomiting, pressure of the electrolyte balance, dehydration and other more serious problems. What to do if this still happens:

-as quickly as possible, provide a cool room to put the child in

– provide wet towels with lukewarm, but not cold water and apply to the skin – if possible give frequent small sips of water

– measure the temperature and if it does not fall below 39 degrees – contact your doctor

In conclusion, it is clear that with proper behavior in different seasons and avoiding the causes leading to overheating during the hot summer months, we could save ourselves unpleasant experiences, both for the baby and for the whole family.

SOURCE: APTEKI ZAPAD

GENTLE CARE – ADVICES FOR LITTLE ONES