Category Archives: Полезные статьи

HOW TO DETERMINE THE FIRST DAY OF YOUR MENSTRUAL CYCLE?

Menstrual irregularities are common and are usually a symptom of a variety of gynecological problems. Therefore, menstrual cycle tracking is extremely important for every woman, regardless of her reproductive plans, and nowadays modern technology makes it easier than ever.

THE NORMAL MENSTRUAL CYCLE

By «menstrual cycle» we mean the period from the beginning of one menstrual bleeding to the beginning of the next. Normally its duration is 21-35 days (average 28 days).

Day 1 of your cycle is the first day of your period, which means the first day of red bloody discharge (spotting does not count). During this time, the uterus sheds the surface layer of its lining. Between days 1-5 of your cycle, new follicles (fluid sacks containing eggs) begin to develop in the ovaries.

Between days 5 and 12, one follicle grows significantly larger than the others and is referred to as dominant. It begins to secrete estrogen, which in turn increases the thickness of the lining of the uterus, preparing it for pregnancy.

Around day 12-16, the mature egg is released (ovulation). In women with a longer menstrual cycle, ovulation can occur around day 21. The egg is viable for fertilization up to 24 hours after ovulation. Sperm can survive in the female reproductive tract for up to 5 days. Therefore, regular sexual intercourse a few days before ovulation increases the chances of getting pregnant.

In the place where the egg was released, corpus luteum is formed, which produces progesterone and estrogen and prepares the lining of the uterus for embryo implantation. If pregnancy has not occurred, around day 28  corpus luteum degenerates, stops secreting hormones and menstruation occurs.

WHY IS IT IMPORTANT TO KNOW THE FIRST DAY OF MY MENSTRUAL CYCLE?

Knowing which is the first day of your menstrual cycle, you can easily calculate the approximate date of ovulation (day 12-16), therefore the most appropriate days for conception. This is more difficult in women with large variations in the length of the menstrual cycle. Today, there are home ovulation tests that make it much easier for couples who are trying to have a baby.

Some hormonal tests are done on a specific day of the menstrual cycle. For example, estradiol, prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels are tested on day 3 and progesterone on days 19-23.

Some drugs are taken at a specific stage of the menstrual cycle. For example, taking oral contraceptives starts on the first day of the menstrual cycle, and some women need to use progesterone from the 14th day.

HOW TO TRACK MY MENSTRUAL CYCLE?

Nowadays, there are various apps that completely replace the standard menstrual calendars. Most applications are free and have many benefits — adding input for other symptoms (headache, breast tenderness, etc.), a better description of your current period (amount of blood, pain), a reminder to take medication and even the option to share the information with a doctor or partner.

Every woman’s menstrual cycle is unique. However, significant fluctuations in the duration, frequency and amount of blood loss during your period should be discussed with your obstetrician-gynecologist.

Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, coming from a common progenitor. NK cells are best known for killing virally infected cells, and detecting and controlling early signs of cancer. As well as protecting against disease, specialized NK cells are also found in the placenta and may play an important role in pregnancy.

NK CELLS AND FERTILITY

NK cells are the major lymphocyte population (up to 70%) in the lining of the uterus during implantation and during early pregnancy. They are the major population, a source of immunoregulatory cytokines and play an important role in the regulation of the maternal immune response to fetal allograft, implantation and maintenance of pregnancy.

NK cell dysfunction leads to both problems with conception and some complications of pregnancy. Infertility caused by NK-cell activity can be manifest as failed embryo transfers or lack of spontaneous pregnancy after at least 1 year of attempts to conceive. Some scientists even suggest that abnormalities in NK cell function play an important role in the development of preeclampsia.

DIAGNOSTIC TESTS

NK cell testing is not routinely used in infertility diagnosis. It can be performed when standard tests (hormonal, imaging, etc.) cannot explain the cause of infertility.

It is advisable to administer immunological tests (including NK cell activity testing) in:

1. Women with a history of consecutive miscarriages and stillbirths.
2. Women with bleeding during the current pregnancy and a history of a previous miscarriage.
3. Women with preeclampsia in previous or current pregnancies.
4. Intrauterine growth restriction of the fetus in a previous or current pregnancy. This is a condition in which the fetus lags behind in growth compared to the norm for its gestational age.

INCREASED NK CELL ACTIVITY — IS THERE A TREATMENT?

There are several options for treating increased NK cell activity. One of them is the infusion of intravenous IgG immunoglobulins. These are antibodies obtained from of donor plasma, which have a beneficial effect on infertility caused by immunological problems.

HYPERTENSION DURING PREGNANCY

Interview with Dr. Milen Karageorgiev

What made you become part of the New Life team?

New Life attracted me in the first place with the team of specialists working in the clinic. I know each of my colleagues personally, long before I became part of the New Life family. I admire the professionalism and desire of the team and their dedication of achieving every patient`s dream of having a child.  Obstetrics and gynecology is my vocation and I think I can be extremely helpful to many women and couples with pregnancy monitoring, treatment or when there are problems with conceiving. I am more than happy to be part of this modern structure with first-class equipment and the soul that the team brings. Last but not least is the feeling that this is my place. The clinic prvides my patients everything I think they would need. We work with the National Health Insurance Fund, monitor pregnancies, conduct treatments of infertility, in vitro procedures and pay special attention to one recently discussed topic — egg donation. The clinic is an outstanding innovator in this area and I think that the donation program without the need of waiting to find a suitable donor is something we all needed — we as doctors and on the other hand the patients. For all of us, time is precious and we should not waste it in waiting.

Tell us something more about your interest in the field of reproductive medicine. How it all started?

I was raised to respect, appreciate and love the family institution. And yes, I call it an institution because for me it is the driving factor in the life of every person — from early childhood to old age. We are designed to rely on each other, to support and love one another. In recent years, in my practice as an obstetrician-gynecologist, I have observed more and more young people and families having problems with conceiving. This is what made me turn to reproductive medicine. I love working and communicating with young people — I accept them not only as patients but also as friends. As a result of lifestyle, work, school, stress and emotions, first Health problems appear at a very early age. I believe that a young person and a specialist like me can be in help of many patients thanks to my professional attitude, easy communication and the needed attention paid to all those who trust me.

What advice would you give to young people with reproductive problems?

In the first place do not to give up. The path is not easy and requires a lot of trust and support from the partner, family and doctor. As banal as it sounds, there is a solution to every problem. In the clinic we start by diagnosing the problem itself and with the help of medicine and technology we find the right solution. At the first consultation, I always advise my patients to calm down as a beginning. In life, not everything goes according our plan or when we want. Sometimes success requires a little help and personal effort. The first step is to become aware of the problem, followed by a consultation with a specialist who will suggest an appropriate solution. As my advice to all of you is – Dear Friends, don’t wait for too long.

How do you deal with the constant stress? Getting up in the late hours of the night when you are called from the hospital and generally the work as an obstetrician-gynecologist, which definitely keeps your mind awake even when you sleep?

This vocation and moral duty does not weigh on me at this stage. I’m used to live like this, that at any moment the phone can ring and I have to go to the hospital. I am extremely grateful to my family for understanding all that because they are the ones who suffer the most from my lack of holidays, dinners or occasions that I should attend. I used to get up in the middle of dinner or when I have to leave a restaurant as soon as I ordered. These situations are a lot, but I have never regretted even for a moment about my choice of profession. The key is in planning. When I need a break, I plan at least six months ahead and for no longer than a week. My job is extremely responsible and many people rely on me.

What about the postpartum depression? How does a woman recover after a natural birth? Are there any problems in sexual life after birth?

We always advise our patients not to accept the new member of the family as the most important unit, but as an addition to the family, without forgetting the people around them and the normal way of life. This is the key to avoid depression. When the intimate emotions between the partners are back, they should not have any sexual problems after the birth, especially when everything went normal. If there is a depression or any other problem of which the woman is aware of, a talk to a specialist is needed. Here is a piece of advice to the male half, too — Men, observe your wives, if you notice a change in their behavior or feel that something is wrong, please support them and seek adequate help to cope together.

WHAT IS THE DNA FRAGMENTATION TEST AND FOR WHO IS RECCOMENDED?

In our previous article, «Male Abstinence and Pregnancy,» we talked about the fact that long-term abstinence in men is associated with increased percentage of sperm with fragmented DNA.

But what does DNA fragmentation actually mean? Which men should do a DNA fragmentation test?

The standard semen analysis provides information on the three main parameters measuring a man’s fertility — concentration, motility and morphology of sperm. However, the spermogram does not provide information on the percentage of sperm with fragmented DNA in the man’s semen. The integrity of the genetic material (DNA) of sperm can be disrupted due to the action of chemicals, smoking, high fever, free radicals released during normal metabolism, and others. High rates of DNA fragmentation (≥ 30%) are associated with poorer embryo quality and miscarriages.

Indications for research

The DNA fragmentation test is recommended for patients with normal spermogram parameters who, together with their partner are with uncleared infertility factor or have undergone multiple failed assisted reproductive procedures.

The test can also be performed on patients with abnormalities in the basic parameters examined in the spermogram. Although the cause of infertility in men described as a male factor is considered to be known, a DNA fragmentation test may be ordered at the discretion of the treating physician. This usually happens when there are more than 3 failed in vitro procedures or several miscarriages. The test is also recommended in case of preconditions in the men`s working environment such as exposure to chemicals, fever and examples.

In such cases, the detection of an increased percentage of sperm with fragmented DNA means that a change in lifestyle is needed. This includes not only avoiding working environment risk, but also leading a healthier lifestyle and consuming much more foods rich in antioxidants.

A test for DNA fragmentation of sperm is done with a pre-arranged appointment at the clinic, as the result is ready on the next day.

Gestational diabetes is a diabetes that has occurred during pregnancy. As with other types of diabetes, the ability of glucose to enter the cells is impaired, which means that it can’t be converted into energy. These changes lead to an increase in blood sugar — a deviation that has a negative effect on the mother and baby. Although potentially dangerous, gestational diabetes can be controlled and complications  can be prevented.

WHAT ARE THE RISK FACTORS?

Although the mechanisms by which gestational diabetes occurs are not yet fully understood, some risk factors are known. These include being overweight, polycystic ovarian syndrome and genetic predisposition (relatives with diabetes).

At the first visit, your obstetrician-gynecologist will assess whether you fall into any of the risk groups for gestational diabetes. You will be given blood and urine tests according to the current Maternal Health program.

If you do not have risk factors, you will be offered a prophylactic test for diabetes in the second trimester of pregnancy — between the 24th and 28th week of gestation.

WHAT ARE THE SYMPTOMS OF GESTATIONAL DIABETES?

Diabetes is often asymptomatic for a long time. Gestational diabetes usually occurs around the second or third trimester. The symptoms are non-specific — thirst, fatigue, dry mouth, frequent urination — all unpleasant sensations that happen in a normal pregnancy.

WHAT ARE THE RISKS FOR MY BABY?

The most common risks are:

1. Large fetus (fetal macrosomia) — due to high blood sugar levels and insulin resistance in pregnant women with gestational diabetes, more blood sugar passes through the placenta and stimulates the baby’s pancreas to produce more insulin. As a result of the altered balance, the baby gains more muscle mass, subcutaneous fat and larger internal organs. In turn, this leads to birth traumas.
2. Hypoglycemia (low blood sugar) of the newborn
3. Premature birth
4. Prolonged jaundice
5. Risk of developing type 2 diabetes in the future.

DIABETES CONTROL

To minimize the risks, it is extremely important to start treatment immediately after the diagnosis of gestational diabetes. You will be prescribed a diet and a medication that controls your blood sugar levels — tablets or an insulin pen. You will also need to measure your blood sugar regularly with a glucometer.

Daily walks and light workouts help to normalize blood sugar, and also have other positive effects — improve mood and self-esteem and are associated with easier recovery after birth.

PROGNOSIS

Women with gestational diabetes usually normalize their blood sugar levels 6-12 weeks after giving birth. They are more likely to develop gestational diabetes again during a second pregnancy. They are also prone to developing type 2 diabetes in the future, so it is highly recommended that you get tested (oral glucose tolerance test) every 2 years.

In early diagnosed gestational diabetes, the prognosis for mother and baby is really positive. Share with your supervising obstetrician-gynecologist your complaints, no matter how minimal they may seem to you — timely measures are always preferable to treating the consequences.

OVER-EATING DURING PREGNANCY

WHAT IS HYSTEROSALPINGOGRAPHY?

Hysterosalpingography (HSG)  is a type of X-ray of the female reproductive system. For this purpose, a contrast medium is used  which helps visualize the uterine cavity and the fallopian tubes. This procedure is extremely important for reproductive medicine because it helps gynecologists to find the cause of infertility in many patients.

INDICATIONS

Hysterosalpingography is performed to establish:

1. Presence of adhesions inside the fallopian tubes
2. Shape and size of the uterine cavity
3. Congenital anomalies of the uterus and fallopian tubes

The test is not performed when we suspect pregnancy, pelvic inflammatory disease, allergy to the contrast medium, severe heart or kidney disease, vaginal bleeding.

PREPARATION FOR THE TEST

A few weeks before HSG, you will be tested for vaginal infections. If one is found, you will receive treatment.

Hysterosalpingography is performed between the 8th and 12th day of the menstrual cycle. It is important that you abstain from sexual intercourse after the beginning of that menstrual cycle.

On the day of the test or the day before, you will have blood drawn for a complete blood count (CBC) and erythrocyte sedimentation rate (ESR) to rule out infection. If you feel unwell (eg fever, diarrhea, burning when urinating, etc.), be sure to tell your obstetrician-gynecologist.

WHAT TO EXPECT DURING THE TEST?

The contrast agent is injected through the cervical canal with a soft, thin catheter into the uterine cavity and fallopian tubes. This is when the X-ray is taken. If the fallopian tubes are intact, the contrast medium flows into the abdominal cavity and is absorbed. In the presence of adhesions, the contrast matter stops at the level of adhesion, which is shown on the X-ray.

Hysterosalpingography can cause some discomfort or pain that resembles menstrual cramps. If necessary, intravenous anesthesia could be used. You will be advised to abstain from sexual intercourse for a week after the procedure.

Your gynecologist will interpret your test results and together you will discuss the most suitable methods for you to achieve a successful pregnancy.

Infertility Consultation, Tests & Evaluation

Fruits are not only an important element of a healthy diet, but also the best alternative to refined sugar. In summer, the abundance of fresh fruit suggests more frequent consumption. However, one should always be careful since sometimes fruit can be a source of allergies that we may not be aware of.

WHAT IS A FOOD ALLERGY?

Food allergy occurs when a person’s immune system reacts inadequately to proteins in food. The first stage of the process is called sensitization — when the «memory» of the immune system registers food as a possible threat. Antibodies are produced to this food, and in a subsequent encounter, these antibodies can bind to the protein of the food and cause the release of certain substances in the body, such as histamine. This leads to an allergic reaction. However, some people are sensitive to a food but never have an allergic reaction to it.

SYMPTOMS

People suffering from hay fever are most at risk of developing fruit allergies. This is due to the fact that some fruits contain proteins similar to those of pollen. A cross-reaction occurs — the immune system recognizes the fruit as allergens, which leads to the familiar symptoms of many:

1. Redness, swelling of the lips, tongue and palate;
2. Feeling of itching in the throat and eyes;
3. Abdominal pain, nausea;
4. Rarely, a severe allergic reaction may occur — anaphylaxis, leading to difficulty breathing, low blood pressure, changes in consciousness. In this case, immediate medical attention is required.

MOST COMMON FRUIT ALLERGIES

Any fruit can cause an allergic reaction. The most common «culprits» for food allergies are: peaches, apricots, citrus fruits, bananas, kiwis, raspberries, strawberries, tomatoes, pears, melons.

An interesting fact is that people with such allergies can usually consume the fruit if it has been cooked (jams or various desserts). Another option is to eat the fruit peeled whenever possible.

In most people, the symptoms remain limited within the mouth, are not serious and do not lead to severe complications. As a result, many do not even realize that they are allergic. However, to save yourself the discomfort, we recommend that you visit an allergologist. They will prescribe treatment and a proper diet. Depending on the success of the therapy, it is quite possible that one day you will eat your favorite fruits again.

VITAMIN DEFICIENCIES

We usually associate summer with rest, fun and the seaside. For couples in need of assisted reproduction, summer can acquire a new meaning, namely one of the most suitable moments for in vitro fertilization.

Numerous studies have shown that the changes that occur in a woman’s body during summer increase fertility and therefore make pregnancy (naturally or through ART) easier.

WHAT ARE THE BENEFITS OF SUMMER?

Not surprisingly, some physiological processes happen slightly differently depending on the season. The length of the day and the strength of the sun’s rays in the summer help in the synthesis of vitamin D, which we need not only for bone metabolism and a strong immune system, but also is associated with higher success of in vitro procedures.

Changes in our mood during summer should not be underestimated. Usually then we feel happier and less likely to get depressed. As it is well known, not only physical health but also a proper state of mind is important when trying to conceive.

The balance between your job and frequent visits to the doctor related to in vitro fertilization can be challenging. In this context, the holiday season has a special advantage – your summer vacation could transform into the perfect time for you to start an in vitro cycle. Last but not least, the extra time spent with your partner or loved ones will bring you the support you need in this difficult period of your life.

Let’s not forget that one of the most important factors for the success of in vitro fertilization is the age of the woman — the best results are achieved in patients who are up to 35 years old. We advise you not to postpone your in vitro procedure in case it does not coincide with the summer season.

OUR WORKING HOURS

New Life Clinic is going to be open for patients during the summer months. If you have questions or want to schedule an appointment with us, you can find our contact information here.

Contact Us

Every pregnant woman has found herself on the receiving end of all sorts of advice: don’t eat this, don’t do that and so on. Surely some well-meaning neighbor has (or will) warn you that you must not set foot in the sea at least until your child is 3 years old.

In fact, you probably won’t need to give up the warm sand and sea waves, as long as your activities are tailored to your pregnancy.

THE MOST IMPORTANT OPINION

Before booking your dream vacation, be sure to discuss your plans with your obstetrician-gynecologist. They will decide if it is safe to travel at the current stage of your pregnancy. If everything goes according to plan and you are not too close to term, expect to be given the green light to travel.

SEA SAFETY TIPS

1. Select a suitable location. Even if your pregnancy is going well, it is advisable to spend your summer relatively close to a big city with a hospital. We do not aim to scare you, just in case.
2. Plan a rather chill vacation. Instead of surfing or diving, we recommend swimming and walking on the beach. You can include light yoga or water gymnastics. Water is especially good for the joints, soothes pain and will protect you from overheating.
3. Beware of the sun. If you have hyperpigmentation (melasma), ultraviolet light can exacerbate it. Use sunscreen with a factor of at least 30 and stay in the shade. Relax in an air-conditioned room in the afternoon and moisturize your skin after coming back from the beach.
4. Drink plenty of fluids, preferably water. Juices and sweetened drinks contain plenty of «hidden calories», so they should be avoided. Bring well-washed fruits and vegetables, nuts, packaged foods to the beach. If you go to a restaurant, choose a reputable and hygienic place.

BONUS TIP

Be proud of your body! You are not too fat and your belly is not too big to rock a swimsuit. You’re growing a new life and this can make you nothing but more beautiful!

SUNLIGHT EXPOSURE AND PREGNANCY – Dos AND DON’Ts

Couples with infertility endure many anxieties, uncertainties, feelings of helplessness, and fears about the future — and now, there’s the COVID-19 pandemic on top of it all. At a time when the rules are constantly changing, starting a family may sound scary, but in fact it is far from impossible.

IS IT TIME FOR IN VITRO FERTILIZATION?

COVID-19 certainly took away many of our joys — travel, concerts, even until recently, going to a restaurant. At the same time, however, we were given more time with our loved ones and we learned to value our health.

In some patients, in vitro procedures (or other forms of assisted reproduction) cannot be delayed. These are women who are about to undergo cancer treatment and want to freeze their eggs, as well as those at risk of prematurely depleted ovarian reserve.

If you do not fall into these categories, the best time to start your in vitro cycle is entirely up to you! The most important thing in this case is for you to feel good — both physically and emotionally.

Given the complex epidemiological situation with COVID-19 in Bulgaria and other European countries, New Life Clinic continues to work and take care of your health and that of its team with increased attention to safety, complying with all requirements of the Ministry of Health.

CORONAVIRUS AND PREGNANCY — WHAT DO WE KNOW SO FAR

According to observations from The Royal College of Obstetricians and Gynaecologists (RCOG):

1. Pregnant women are not more susceptible to coronavirus infection than others. The course of coronavirus infection is not more severe in pregnant women. The majority experience mild to moderate symptoms.
2. Although the virus is new and still being studied, there is no evidence that coronavirus infection increases the risk of miscarriage or other complications during pregnancy.
3. Although rare, transmission of the infection from the mother to the fetus is possible, but there is no evidence that this leads to birth defects.

Keep in mind that information about this virus is very dynamic. If you are planning to become pregnant, whether naturally or through assisted reproductive techniques, do not hesitate to contact your obstetrician-gynecologist. It will give you the most up-to-date and exhaustive information about pregnancy during this pandemic.

PREMATURE OVARIAN FAILURE