Plastic Surgery
	Invitro
	Dentist
	Vein Treatment
	Contacts
	Links
КРЕДИТИРАНЕ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contacts

7 "Radko Dimitriev" str.
Varna 9000; Bulgaria
Tel.: 00359 52 632 247
Tel.: 00359 52 620 351
Tel./fax: 00359 52 603 084
E-mail:office@bulmedicine.com

Skype:

TREATMENT

The basic indication for treatment by in vitro fertilization (IVF) is disturbed function of the uterine tubes. Our concept is that in case of bilateral hydrosalpinx, resulting from continuous and aggressive infection, the uterine tubes must be surgically removed prior to commencing the treatment. In case of treatment with 3-6 unsuccessful intrauterine insemination (IUI), (which necessarily requires passable uterine tubes), then the IVF method is a choice with very good results. The reason for infertility here is of no importance. In this group we usually find patients with infertility of unclear origin or women with PCOS (policystic ovary syndrome).

Another reason for infertility is endometriosis, an immunogenic hormonal disturbance. In the beginning it is usually presented by the so-called LUF syndrome (luteinizing unruptured follicle). This problem usually leads IVF, after several unsuccessful conventional ovary stimulations. It requires down regulation (suppressing the ovary function) for a few months, which leads to very good results.

Male infertility can be successfully treated with IUI, at specific values of the semen analysis. Specific treatment of the semen sample in the IVF laboratory is required, according to each separate case. In case this treatment doesn't give satisfactory result after several consecutive attempts, the best choice is to proceed to IVF.

EXAMINATIONS PRIOR TO IVF

Male: Diagnostic investigation of the semen. In case the results show poor quality of the sperm without an acceptable reason in the case history, ultrasound test and even possibly biopsy of the testicles is recommended. If the hormonal research shows high FSH values, chromosome analysis is recommended. If no spermatozoa are present in the semen sample (azoospermia), genetic analysis is needed for suspected cystic fibrosis of the spermatic ducts.

Female: Always starting with routine gynecological examination. The PAP (cytological smear for prophylaxis of uterine neck cancer) and Chlamidia trachomatis (bacterial) tests must be negative. The transvaginal US examination must show normal findings.

Very important is the FSH hormonal test in the early follicular phase of the monthly period. Its values are prognostic for the success of the treatment, especially with patients over 38 years. The FSH values must be no more than 15 IU/L, preferably below 10 IU/L.

PRICIPLES OF TREATMENT, STIMULATION PROTOCOLS

For a successful treatment a large number of oocytes are necessary to be fertilized in vitro. That is why stimulation of the ovaries is performed per various schemes and protocols, according to each individual case. During this treatment the production of women's own (endogenic) sexual hormones is temporary stopped. The growth of follicles in the ovaries and the maturing of the oocytes in them is controlled with exogenic FSH preparations. The temporary inactivity of the FSH-producing pituitary gland is obtained by various hormonal preparations: agonists (Synarel, Decapeptyl, Zoladex) and antagonists (Orgalutran).

The controlled stimulation of the ovaries is obtained with other preparations – exogenic FSH and LH (Humegon, Metrodin, Metrodin HP, Puregon). Depending on the protocol, the treatment starts about 1 week before the beginning of the monthly period, or at its very beginning. The stimulation effect is monitored by regular transvaginal sonography. When the growth of follicles in the ovaries and endometrium is found sufficient, hormonal induction is effected by a HCG injection (Profasi, Pregnyl).

Side effects:

The side effects are in general rare and discrete. Serious complication, the so called Hyperstimulation syndrome, appears very rarely in our practice, in less then 1% of all cases.

Oocyte retrieval, Ova pick up (OPU)

This procedure is performed transvaginally, under ultrasound guidance. We practice local anesthesia, muscular premedication and general anesthesia via intravenous injection. The punction of the ovaries is performed under surveillance of experienced anesthesiologists. The patient remains in the clinic for monitoring about 1-2 hours after the procedure. To fertilize the so obtained oocytes, we use semen, taken about this time. After the fertilization we follow-up the development of the embryos in the incubator, and about 48-72 hours thereafter, we transfer some of the best ones into the uterus.

Embryo TRANSFER:

A maximum of 2 or 3 embryos are transferred to the uterus through the cervix, using a small, soft catheter. This manipulation is absolutely painless. After embryo transfer the patient rests in the clinic for approximately 1 hour.

IVF- In vitro fertilization

After ova pick-up and oocyte retrieval, refined spermatozoa (treated by swim-up method in the laboratory) are added to each oocyte. The number of spermatozoa added depends on quality of the semen in each individual case.

On the first day after OPU the oocytes are checked for generation of pronuclei - sign of fertilization.

On the second day they are checked for cleavage - proof of developing embryos. We choose the best quality embryos and transfer 2 or 3 of them in the uterus on the second or third day

Embryo quality: The cleaving oocyte, called embryo, is inspected for the number of internal cells (blastomers) and their type. The number and type of the blastomers, different for each day of their development, are suggestive for the so-called individual uppraisal of the embryo. The higher the uppraisal, the higher is the success rate upon the transfer of the embryo into the uterus.

SUCCESS RATE

The rate of success is closely dependant on woman's age. The average pregnancy rate sharply drops after 40. Pregnancy is detected with urine test after delay of the menstruation, usually about 20 days after embryo transfer. It is evidenced by a positive biochemical HCG (choriogonadotropin) reaction.

Please note: Some clinics, mostly in the USA, transfer 10 or more embryos at a time, trying to increase the pregnancy rate. This leads to multiple pregnancies- tweens, triplets etc. In such cases the chance of healthy and on term delivered babies significantly drops. That is why we transfer no more than three embryos, as is the practice of all European clinics, for achieving higher number of full-term carried, healthy born children. We would rather increase the "take home a baby" rate than the number of biochemical pregnancies.

Success rate: 25-30 %

 

TREATMENT WITH IUI (INTRAUTERAL INSEMINATION)

This is only possible with passable and sound uterine tubes. Patency of the tubes is obligatory to prove. This is done by hysterosalpingography (HSG) - radiography with contrast matter or by hydrotubation under ultrasound control (HUSC), which has a more limited value as proof, but is better tolerated by the patients .

The purified and specially treated in IVF laboratory semen sample is introduced in the uterus at a time, when a dominant follicle is evident in one of the ovaries. Dominant follicle is a one with a mature oocyte. This may be done during the natural cycle, or the patient can be treated by stimulation for multiple oocytes development in the ovaries.

The manipulation is performed via a thin catheter and does not need any medication for pain relief. It is simple, precise and does not lead to any discomfort. The patient can leave the clinic about 20 min. later.

Compared to IVF, IUI has a lower rate-of success - about 10 % . Usually the three to six inseminations are effected. In case no pregnancy is obtained, we recommend IVF.

- The pregnancy rate with donor insemination is about 10-12 % per cycle

- When using the husband's semen, the rate is about 8 %, depending on the stimulation applied and the age of the woman.

- IUI is not used for treatment of impaired tubal function.

- IUI is not used with poor quality semen

- IUI with husband's semen is always used in combination with a light hyperstimulation of the ovaries.

OOCYTES DONORSHIP

The current Bulgarian medical legislation allows only limited application of donored oocytes.