Dr. Maya Vasileva about IN VTRO as a solution to resolve reproductive problems of couples in Bulgaria

The advanced age, at which the families decide to have babies, the series of co-lesions in women and men, the dynamics of time in which we live… all this bears its consequences and regretfully it results in big number of couples with reproductive difficulties, which increases still more.

To reply the multiple questions in this trend, we asked Dr. Maya Vasileva from IN VITRO Center of MBAL “Vita” in Sofia.

1. Which is the leading reason in your opinion about the reproductive problems among the couples in Bulgaria? Are the difficulties more in women or in men?

Bulgaria is one of the countries with significant negative population growth, and according to the statistics, now we are on the last place in Europe by the index “population growth”. The number of sterile couples is already 250 thousand approximately.
Impassibility of fallopian tubes is one of the leading medical reasons for sterility. Most often it is caused by infection – chlamydia, mycoplasma, ureaplasma, gonorrhea, bacterial vaginosis, etc.  They cause appearance of the so called pelvic inflammatory disease, in which the fallopian tubes at the final stage are obstructed thus leading to sterility.
Pelvic tumors are the other reason for tubes impassibility, which compress them in the immediate vicinity, as well as endometriosis, inborn abnormalities or extrauterine pregnancy.

The lack of ovulation and hormonal disorders in women are often the reason for sterility, which is due to various reasons like polycystic ovary syndrome, advanced age and exhausted ovarian reserve. In 50 % of sterility cases, the problem is in the aggravated quality of seminal fluid in men.

2. Polycystic ovaries are one of the frequent reasons for reproductive difficulties. Would you explain why and respectively what could be recommended to ladies with irregular cycle, suffering from this problem?

Polycystic ovary syndrome affects 10 % of the women with reproductive problem. The absence of ovulation or hormonal disorders are specific for it, leading to irregular cycle, to insulin resistance and risk of diabetes in later age, obesity, pilosity in the area of chest, face, head, breech.

The reason for appearance of polycystic ovary syndrome is not clear yet. What we do IN VITRO Center of VITA is to make hormonal tests in the range of the 2nd to 5th day of the cycle and depending on the result to recommend the relevant therapy, resulting in elimination of the problem.

3. Other hormonal problems also have attitude to conception and it is especially strong evident in patients with Hashimoto’s thyroiditis. Which is the problem there and what should be undertaken in order to shorten the time for unsuccessful conception trials?

In patients with infertility, it is obligatory necessary to test thyroid-stimulating hormone (TSH) and prolactin, because these hormones affect ovary function. Lack of ovulation is probable in case of elevated values, and respectively there are difficulties in conception and if there is a realized pregnancy, then there is a risk of spontaneous abortion or disturbed development of the CNS of fetus.

In such a case, therapy with hormones of thyroid gland or prolactin inhibitors is prescribed.

4. To what degree endometrial cyst may affect conception and respectively is there any danger for the successive pregnancy. What is the practice for the solution of this complex diagnosis and what are the steps afterwards for successful reproduction?

Endometriosis is a chronic disease with still unclear etiology, the so called “chocolate cysts” are formed in it, which gradually destroy the normal ovary tissue, lead to formation of mass adhesions between the small pelvis organs – uterine, fallopian tubes, ovaries, large intestine, urinary bladder. The clinical picture is manifested by pain, related to the cycle. Laparoscopy is the method – golden standard, in diagnostics and treatment of endometriosis. After its histological approval, the further treatment depends on the desire of the patient to become pregnant. If there is such a wish, then active experiments for baby are recommended, and in absence of such, six-month injection treatment is carried out by preparations which block the menstruation (GNRH agonists).

5. How much time after unsuccessful trials for conception is right to seek specialized aid?

The term depends directly on the age of the patient and may vary between six months and one year lack of pregnancy in spite of the active monthly trials of the couple.

6.  Very often the women themselves initiate tests for passability of fallopian tubes, the so called “colour picture”. Please tell us the nature of this procedure, what does it aim, what are the results and respectively what is done. It is clear that the practice in the various hospitals is different, because the readers often ask if anesthesia is to be applied, how long is hospitalization, etc. (Tell the situation in your department)

Histerosalpingography is a method to check passability of fallopian tubes, or “colour picture ”as is its popular name, is the first invasive examination, carried out in the first clear days after the end of the cycle, but not later than 12-13 days i.e. – prior to ovulation. It is necessary to carry out in advance cytosmera, test of vaginal secret, cervical secret for chlamydia, mycoplasma and in case of positive test - to carry out the relevant antibiotic therapy. The “colour picture” is made at the X-ray consulting room. Local anesthesia is applied by spraying the uterine neck by Lidocain. More rare and in case of declared wish on behalf of the patient, short intravenous anesthesia may be used too, but then the communication of physician-patient is lost and no back response may be obtained from the patients about the pain strength during the test. Menstrual-like pain is felt like in the first days of the cycle. After the end of the test, we recommend the patient to restrain from physical efforts and sexual contacts within a day of two. No hospitalization is necessary.

7.  Although each one of the examinations has strict designation and is compulsory to be prescribed by an expert physician in this sphere, could you explain which are some of the most freuently applied examinations for sterility!

Spermogram is a method to evaluate the fertilization ability of man. Minimum three days of sexual restrain should pass prior to the examination. The man should not use alcohol or drugs, to be not ill or to be febtile. Receipt is done by masturbation, best done at the department of sterility, but the material may be obtained also at home and brought here within an hour time.
Embryologist evaluates the qualitative and quantitative characteristics of ejaculate – volume, viscosity, liquefaction time, spermatozoa count in 1 ml, percentage of mobile spermatozoa, morphology. In case of deviations, the patient is directed for consultation with urologist-andrologist.

Examination of ovarian reserve is done by examination of Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH). Best it should be done between the 2nd and 5th days of the cycle. Reduction of AMH and increase of FSH is noticed with advancing of woman’s age, which correlates with fertility reduction i.e. the ability to become pregnant is reduced.

8.  Nutrition, avoiding harmful habits, motor activity, dietary supplements – are all of them placed in one and the same desirable category or each one is exceptionally important itself?

All they are included in the recommendations of the specialists of healthy mode of life. Administration of fruits and vegetables, proten-rich foods, limitation of sugar and fats leads to reduction of body weight, which in case of obesity is directly related to infertility. Increased physical activity also leads to body weight reduction and improves the chances of spontaneous conception.
It is especially important to stop smoking by both partners – this will improve significantly the quality of ovules and ejaculate. Prescription of additional administration of vitamins and minerals also assists the elimination of certain deviations in the indices of man. It regulates also the ovarian function of woman.

9.  Although improvement of APT technologies is outstanding recently, still there are non-ended examinations and clarified moments. Is this the reason that many people consider that psycho-emotional side is very important too. Disposition, positive adjustment, attitude, calm. Or the relation is completely logic – psycho-somatic?

Stress is abundant in our hurried and intense trivial round. It leads to neuro-mental overstress, high blood pressure, depression, obesity. All they on their behalf lead to infertility in man as well as in woman. Stress reduction leads to conception of women who have had many unsuccessful trials before. When a couple feels calm and happy, the conception chance increases rapidly. It indicates that brain and body are inextricable bound up. All negative emotions affect destructively the functions of human organs, sexual included. Many surveys indicate that yogi practice, relaxing massage, therapy with acupuncture and needle therapy increase significantly the conception chance. It is good to carry out consultation of the couple with psychologist, to discuss the problems and troubles they have.

It is not coincident that there is a folk proverb “Healthy spirit in healthy body”!

The process of establishing sterility reasons is complex and long one. Several months are necessary, sometimes one year. Therefore achieving pregnancy is happiness not only for the patients but also for the whole team of our Vita IN VITRO Center.
More information may be obtained by tel: 02 45 22 141 and 02 45 22 142.
Address: Sofia, Filip Kutev str. No. 10 (MBAL Vita)
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Vita Hospital (Second Building) - № 10 "Filip Kutev" Str.,
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