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Questions and Answers

How widespread is infertility and what is the reason for the rise in infertility in recent decades?

Infertility, defined as the inability to conceive or carry a pregnancy to term, is a common problem. In Bulgaria its prevalence is about 1 in 7 couples, which is close to 15 per cent.
Probably the most important reason the rise in infertility observed in recent years is the increase in maternal age, both for first and second time mothers. While it is well documented that female fertility undergoes a sharp decline after the age of 35, nowadays more and more women delay motherhood until after that cutoff age. Even though it is less pronounced male fertility decreases with age as well. Another important reason is the higher rate of STD infections, which can contribute to infertility in both men and women. The 3rd major reason for the rise in infertility is the unhealthy lifestyle which many people have adopted.

What kind of diagnostic tests does the female patient need to undergo before going to IVF?

It is very important to know the cause of infertility before proceeding to any kind of assisted reproductive treatment. Depending on the type of infertility, your gynecologist will recommend the assisted reproductive procedure which gives you the best chance of achieving a successful pregnancy.
Investigative process in the female partner includes:
-Medical history
-Ultrasound of the uterus and ovaries
-Physical examination
-Lab tests to evaluate the hormone profile
-Lab tests to evaluate general health status as well as the function of other body systems
Depending on your physician’s recommendations a hysterosalpingogram (HSG) and/or a diagnostic hysteroscopy can also be conducted as well as other tests if necessary.

What kind of diagnostic tests does the male patient need to undergo before going to IVF?

It is very important to know the cause of infertility before proceeding to any kind of assisted reproductive treatment. Depending on the type of infertility, you will be referred to the most suitable treatment option.
Investigative process in the male partner
-Medical history
-Sperm analysis and if necessary hormone evaluation
-Physical examination
-Lab tests to evaluate general health status as well as the function of other body systems
In case there is a deviation from normal sperm parameters (concentration, motility and morphology of sperm cells) and if the treating urologist recommends it, imaging of the testis such as ultrasonography or testicular mapping should also be performed.

What guidelines do I need to follow before coming in for semen analysis?

There are a few guidelines that you as a patient are advised to follow before coming in for semen analysis in order for the results of the test to be representative.
First and foremost, it is important to abstain from ejaculation (through sexual intercourse or masturbation) for 2 to 5 days before the test. In case you get sick and especially if you need to take antibiotics, you need to consult the doctor who referred you for the test. The reason is that antibiotics are known to have a strong negative impact on spermatogenesis and depending on the type of antibiotics, you may have to postpone the test for more than 2 weeks. It is also advisable to wash the external genitalia before giving the semen sample for the test.

Is it possible to bring the semen sample from home?

Even though it is not advisable due to the lack of controlled conditions outside the clinic, it is permissible to bring the semen sample from home provided that it is brought to the clinic within 20 minutes. Temperature fluctuations during the transportation of the sample to the clinic should be avoided.
If you would like to bring your sample from home, please come by the clinic to collect your sterile semen container!

Is it possible for a couple to undergo an IVF treatment if the male partner is diagnosed with azoospermia?

In azoospermia cases (complete lack of sperm cells in the ejaculate after centrifugation) there are two options. The first one is for the male partner to undergo testicular biopsy (e.g. TESE or TEFNA) whereby a biopsy of testicular tissue is taken from the testes in search for the presence of sperm cells. The chances of finding sperm cells after such a procedure are different in different cases and depend on a number of factors (e.g. cause of the azoospermia, hormonal profile). If sperm cells are found, they can be used for ICSI fertilization (an IVF technique, whereby a single sperm cell is injected in a single egg cell). The other option is to use donor sperm.

Do you offer assisted reproductive procedures with donor material?

Yes, New Life Specialized Medical Center of Gynecology has its own in-house donor bank of tested and quarantined Bulgarian donors. The center also has a contract with Nordic Cryobank, Denmark, which offers a diverse selection of tested and quarantined donors from various ethnic backgrounds.
If you are considering the option of using donor eggs, please speak to our patient relations coordinator!

Who can apply for funding by the Bulgarian Center for Assisted Reproduction (CAR)?

Any woman who-is below the age of 43
-is a Bulgarian citizen or permanent resident
-fulfills the requirements for financing according to the medical indications posted on the Center for Assisted Reproduction website
-has a male partnerThe center only finances patients with infertility treatable by the methods of ART (assisted reproductive technology) – conventional in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Therefore, the patient’s diagnosis needs to be within the medical indications, posted on the CAR website. The center does not finance donor procedures and that is why the woman needs to have a male partner.

How can I apply for funding by the Center for Assisted Reproduction (CAR)?

If you would like to apply for funding by CAR, you need to let our patient coordinator know, so she can start preparing your documents. She will also explain to you what additional tests need to be performed and sent along with the other documents. After the full package of documents and required tests has been prepared, a member of our staff will sent those to the Center for Assisted Reproduction.

How long do I have to wait to get approved?

Your application for funding has to be reviewed by the expert commission, appointed by the Center for Assisted Reproduction (CAR), which normally takes several months. The official approval letter is given to the patient/patients by the director of CAR in person according to a specially appointed schedule. This can also take a few months. The timeframe of the whole procedure varies from year to year but in general a timeframe of 8 months to a year is to be expected.

If I am already approved, can I change my fertility center?

Once you are approved, the name of your fertility center of choice is written on the official approval letter (ordinance). In order to change your center of choice, you would have to go through the following steps:1. You should bring your official approval letter to your NEW fertility center of choice.2. The patient coordinator at the new center will issue an official request form, signed and stamped by the medical director of the center. The request form will state that you wish to change the fertility center where your IVF procedure will be conducted and, therefore, request the name of the center to be changed on your official approval letter.3. Then, you should take the request form to the Center for Assisted Reproduction in order to receive an amended approval letter with the name of your new fertility center.

Are children born after IVF or ICSI at higher risk of suffering from congenital abnormalities and genetic diseases?

According to the European Society of Human Reproduction and Embryology (ESHRE) position paper on birth defects in children born after IVF/ICSI, those children do have a higher risk of suffering from birth defects compared to children in the general population. However, that risk is not statistically different from the risk for children of subfertile parents who conceived naturally. Therefore, “this increased risk seems to be mainly due to parental characteristics from the infertility status and not to the treatment given.”

How soon after an unsuccessful cycle can I go in for another one?

It very much depends on your circumstances, so the best thing to do would be to consult with the gynecologist who treated you throughout you previous IVF cycle. In general, it is recommended to wait for at least 3 months before your next hormonal stimulation, although the exact period of time is to be determined by your gynecologist depending on factors like your hormonal profile, whether you have a history of ovarian hyperstimulation syndrome and others.