Frequently Asked Questions (FAQ)

Frequently Asked Questions (FAQ)

You will find brief answers to some of the most frequently asked questions.

What percentage of couples in Bulgaria suffer from infertility, and what are the reasons for the increase in their number over the past decades?

Infertility, defined as the inability to conceive, carry, and deliver a viable child, is a common issue. In Bulgaria, approximately 1 in every 7 couples experiences reproductive problems.

One of the main reasons for the growing number of couples facing fertility challenges is the increasing average age at childbirth — both for women having their first child and for those giving birth for the second or subsequent time. Although it is well known that female fertility declines sharply after the age of 35, more and more women are choosing to postpone starting a family beyond this age. Male fertility also decreases with age, although the decline is generally less pronounced than in women.

Another significant factor is the higher incidence of sexually transmitted infections, which can lead to infertility in both men and women. A third major reason is that an increasing number of men and women of reproductive age are leading unhealthy lifestyles, which negatively impacts their reproductive health.

What diagnostic tests should a woman undergo before proceeding with in vitro fertilization (IVF)?

Before undergoing any type of assisted reproduction, it is essential to determine the cause of infertility in you and/or your partner. Depending on the cause, your obstetrician-gynecologist, who specializes in fertility treatment, will recommend the assisted reproductive procedure that offers you the highest chance of achieving a successful pregnancy and birth.

The standard diagnostic process for women typically includes:

If necessary, additional tests may be performed, such as a hysterosalpingogram (HSG) to check the fallopian tubes, diagnostic hysteroscopy, and other evaluations as recommended by your gynecologist.

What diagnostic tests should a man undergo before proceeding with in vitro fertilization (IVF)?

Before proceeding with any type of assisted reproduction, it is important to determine the cause of infertility in you and/or your partner. Depending on the cause, you will be directed to the most appropriate treatment for your situation.

The standard diagnostic process for men includes:

If abnormalities are detected in the sperm analysis parameters (concentration, motility, and morphology of sperm in the semen) and based on the urologist’s assessment, imaging diagnostics of the testes (ultrasound or mapping) may also be performed.

Are there any special instructions I should follow before coming for a semen analysis (spermogram)?

Yes, there are some instructions you should follow before coming for a semen analysis to ensure the results are as accurate and representative as possible.

First, you should maintain sexual abstinence (no sexual intercourse or masturbation) for 2 to 5 days before the test. It is also important that you have not been ill for at least one week prior to the semen analysis. If you do become ill, especially if you need to take antibiotics, please consult the doctor who ordered the test. It is well known that antibiotics can negatively affect spermatogenesis, so depending on the type of antibiotic taken, the test may need to be postponed for more than 2 weeks.

Additionally, it is recommended to wash the external genitalia before providing the semen sample.

Am I allowed to bring the semen sample from home?

Although it is not recommended due to the lack of controlled conditions outside the clinic, it is allowed to bring a semen sample from home if it is delivered within 20 minutes after collection. The sample should be kept close to the body during transportation to the clinic to avoid temperature changes.

If you prefer to bring your semen sample from home, please visit New Life to receive your sterile container!

Is it possible for a woman to attempt pregnancy through in vitro fertilization (IVF) if her partner has been diagnosed with azoospermia?

In patients with azoospermia (complete absence of sperm in the ejaculate after centrifugation), there are two possible options. The first is for the patient to undergo a testicular biopsy (e.g., TEFNA), aimed at finding sperm in the biopsied tissue. The chances of finding sperm in this procedure strongly depend on factors such as the cause and type of azoospermia (obstructive or non-obstructive). If sperm are found, they are used for ICSI fertilization — a technique of in vitro fertilization where a single sperm is injected directly into an egg using a fine needle and a device called a micromanipulator.

The second option is to use donor sperm, whose physical characteristics and education level can be selected to closely match those of the partner.

Do you offer assisted reproductive procedures using donor gametes?

Yes, New Life Specialized Medical Center for Gynecology has its own donor bank with tested donors who have undergone a 6-month quarantine. The center also has a contract with Nordic Cryobank, Denmark, a donor sperm bank offering a selection of tested donors from diverse ethnic and national backgrounds, all having completed quarantine.

If you are considering using donor eggs, please contact the administrative staff at New Life!

Who is eligible for funding from the Assisted Reproduction Center (ARC)?

Any woman who:
– is under 43 years of age
– is a Bulgarian citizen or holds permanent residence status in Bulgaria
– meets the medical criteria for receiving financial assistance

The Assisted Reproduction Center (ARC) funds only patients suffering from infertility that can be treated with assisted reproduction methods — conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

How can I apply for funding from the Assisted Reproduction Center (ARC)?

If you wish to apply for funding from the ARC, please notify our Client Relations Manager, who will prepare your documents. She will also provide you with detailed information about the tests you need to undergo and the documents that must be included with your application for financial and organizational assistance. Once the complete package of documents is prepared, it will be submitted to the ARC for review by a clinic staff member.

How long does it take for the Assisted Reproduction Center (ARC) to review the documents?

Your funding application is reviewed by a competent committee appointed by the Assisted Reproduction Center (ARC), which usually takes several months. The official funding approval is handed personally to the patient/couple by the director of the ARC according to a pre-established schedule. This procedure can also take several months. The overall duration of the process varies depending on the number of applicants in a given year, but it typically ranges from 8 months to 1 year.

If I already have an issued funding approval, can I change the IVF center where the procedure will be performed?

If you have already been approved for funding and have an issued order, the name of the IVF center where your documents were originally submitted is listed on the order. To change the center where your procedure will be performed, you need to take the following steps:

Are children conceived through IVF or ICSI at a higher risk of congenital anomalies and genetic disorders compared to children conceived naturally?

The official position of the European Society of Human Reproduction and Embryology (ESHRE) is that children born through IVF or ICSI are at an increased risk of congenital anomalies, but this risk is attributed to the subfertility of their parents rather than the assisted reproductive procedures themselves. This position is based on a meta-analysis of multiple studies, which found no statistically significant difference in the rate of congenital anomalies between children conceived through IVF/ICSI and those conceived naturally by subfertile parents.

How long after a previous unsuccessful IVF cycle can I start a new one?

The answer to this question largely depends on your specific case, so the best thing you can do is to consult with the obstetrician-gynecologist who treated you during your previous IVF cycle. Generally, it is recommended to wait at least 3 months after the previous stimulation before starting a new one. The exact waiting period in your case will be determined by your treating doctor based on factors such as your hormonal profile, medical history, and others.

If you have frozen embryos from a previous IVF cycle, a frozen embryo transfer (FET) can be performed earlier than 3 months after hormonal stimulation. In some cases, FET may even be done during the next menstrual cycle. The exact timing of the frozen embryo transfer should again be determined by your treating obstetrician-gynecologist.