1. Infertility - IVF

WHY INFERTILITY TREATMENT in BULGARIA?
WHY CHOOSE MEDSPA and NADEZHDA CLINIC?

• High success rate
• Competitive prices
• No waiting list
• Treatment of challenging infertility cases
• Individual approach to every patient
• High age limit for women undergoing IVF (51 years both for non-donor and donor-egg IVF)
• Fertility treatment available for single women and female couples
• IVF treatment for overweight patients
• Bulgaria within reach from any major European airport
• No restrictions on fertility treatments:
  • IVF including with donor sperm and donor eggs; ICSI/IMSI, assisted hatching and blastocyst embryo transfer; frozen embryo transfer
  • Intrauterine insemination (IUI) − stimulated or unstimulated, including with donor sperm
  • Immune and anti-coagulant therapy;
  • Surgical sperm retrieval (PESA; TESA; MESA);
  • Preimplantation genetic diagnosis (PGD); Preimplantation genetic screening (PGS); Comparative genomic hybridisation (CGH)
• English speaking doctors & nurses
• Low complication rate
• Acupuncture to increase success rate
• Counselling service in English
• 7-day-a-week service
• 24-hour nurse on-call service

• Personal coordinatior
• Analysis of medical records & individual consultancy
• All paperwork
• Traveler's information
• Meeting at airport & transfer to hotel
• Transportation & accompanying to the appointments at the clinic & back to the hotel
• Cell phone with BG SIM
• Drop off at the airport
• Treatment follow-up

ADDITIONAL SERVICES

• Translation & interpreting
• Trips to local attractions
• Individual IVF support SPA program

YOUR IVF PROGRAM IN BULGARIA

When traveling for IVF treatment, it is important to work with a reputable company, one who is able to provide a reliable calendar far in advance. Here at MEDSPA, we understand that you have a busy life and that international travel takes time. We make sure to provide all of our clients with important dates as soon as we can. We will not waste your time…or your money.

MEDSPA works with one of the best fertility clinics in Bulgaria - NADEZHDA. As MEDSPA is their preferred partner, our patients receive a priority attention at the clinic. With practically no waiting time, you can be in Sofia for your initial consultation with a doctor and first visit to the assisted reproduction unit just within a few-hour flight from anywhere in Europe. Visits during the weekend could also be arranged. As soon as all medical tests are made, based on your preferences and the type of your IVF treatment, you can plan either for a 10 to 14-day stay in case of a non-donor IVF or a donor sperm IVF treatment, or a 5-day stay in case of a donor egg or donor embryo IVF treatment. If your male partner is restricted from traveling due to occupational obligations, he may just come for one day only to provide the sperm necessary for the fertilization process. Furthermore, we will be glad to pamper you with a number of SPA options during your stay in Bulgaria that may help you feel more relaxed, optimistic and self-confident before, during and after your IVF treatment as well as arrange inspiring one-day trips to interesting landmarks during your IVF vacation in Bulgaria.

IVF STEP by STEP GUIDE

1. Contact MEDSPA and briefly describe your infertility case using our enquiry form. Ask any questions relevant to your potential IVF treatment or stay in Bulgaria.

2. Complete a medical questionnaire we are going to send you, covering your and your partner's medical/fertility history and send scanned copies of any fertility medical reports or results of relevant blood tests or spermograms.

3. Get a free quote from MEDSPA case manager.

4. Ask any further questions relevant to you potential IVF treatment or stay in Bulgaria and receive our prompt reply.

5. Receive our IVF treatment contract and review it.

6. Sign the IVF treatment contract and return it via fax or scanned via e-mail.

7. Schedule with MEDSPA your initial consultation visit to the clinic and receive options for your travel plan, including accommodation.

8. Arrive in Sofia. Your MEDSPA case manager will meet you at the airport, bring you to the hotel and accompany you to the clinic and at your initial consultation. You will receive a mobile phone with no limit for local calls to help you communicate freely with your doctor at NADEZHDA or MEDSPA case manager while in Bulgaria.

9. Initial consultation with your doctor and first visit to the assisted reproduction unit at NADEZHDA. At this point you will meet NADEZHDA physician, who has already reviewed your medical & fertility history. The doctor may ask you questions about your couple history as well as about your lifestyle. He/she will check the results of any additional previous tests that you have brought. You are also free to ask any questions about the clinic and your chances to conceive a baby through an assisted reproduction there. The doctor will perform a transvaginal ultrasound scan of the lady to assess her uterus, ovaries and pelvis. You will receive a list of all tests that need to be done in your case in order to find the best solution for your infertility problem.

10 Do all tests relevant to your specific medical case. If your health insurance covers the routine lab work needed in the preliminary stages before IVF, you can conduct these tests at home, and the specialists at NADEZHDA clinic will assess the results that you will send. If your insurance does not cover any or all of the tests, you can make the tests needed at the serology and immunology lab of NADEZHDA clinic (In Bulgaria prices of all such tests are quite competitive compared to the rest of Europe.)

If you proceed to a non-donor IVF treatment
or a donor sperm IVF treatment:

11. Based on the results and the final evaluation of your doctor at NADEZHDA clinic, you will receive a treatment plan and your IVF program will be explained to you. Then you sign an informed consent form.

12. In case of a long stimulation protocol (based on all tests and exams, the type of your ovaries and infertility factor, your doctor at NADEZHDA will decide if long or short stimulation protocol should be applied in your case), at around day 20 of your menstrual cycle, you pass an ultrasound scan at you local Ob/Gyn to confirm that there is no follicle left over from the previous cycle. Only if this is confirmed, you go ahead with a blocking injection that will temporarily suppress your ovaries. You will have received detailed instructions from NADEZHDA on how to give yourself the injection. You may also ask your local GP or practice nurse to administer this. If for some reason you are not sure about the ultrasound scan result, please, email it to MEDSPA at and you will timely receive a reply from NADEZHDA clinic.

13. In about 2 weeks you have an ultrasound scan at you local Ob/Gyn and your estradiol (E2) level is measured through a blood test to give a baseline about the first doses of follicle-stimulating hormones needed. Please, email the results to MEDSPA at to receive instructions from NADEZHDA.

14. In order to save time, your ovarian stimulation may start at home (the first 4-5 days). This could be coordinated between NADEZHDA clinic and your local Ob/Gyn (please, have in mind that prices of fertility medications are more or less at the same level in all EU countries. Please, check if your health insurance covers the fertility medications prescribed by your doctor). Usually patients take the ovarian stimulation medications from NADEZHDA clinic. The nurse provides them with a detailed explanation on how to store the medications and administer them. Patients receive a small cooling bag for medications that need to be kept at fridge temperature. If your health insurance covers the prescribed stimulation medications, you can buy them when you return home. In that case you will also receive a cooling bag together with instructions on how to administer the medications and safely bring the remaining doses on your next visit to NADEZHDA clinic.

15. Arrange your travel plan with MEDSPA, so as to visit your doctor at NADEZHDA clinic on the 5th day of your stimulation at the latest.

16. Within about a week, starting from the 5th day of your stimulation, you will pass several ultrasound scans at NADEZHDA clinic to monitor the development of your follicles and blood tests to measure your estradiol and progesterone levels that will help adjust the doses of your stimulation medications.

17. If short stimulation protocol is applied, no blocking injection is used. Stimulation starts on the 2-3 day of the menstrual cycle after a baseline ultrasound scan and a blood test to measure FSH, E2, and progesterone levels. Following no more than 3 days of stimulation, an ultrasound scan will be performed and the levels of your Е2, LH and progesterone will be checked again to adjust the doses of your stimulation medications, if needed. From then on, every other day you will have ultrasound scan & blood test to monitor the development of your follicles and the levels of your hormones.

18. When your doctor decides that the number and size of your follicles, as well as the levels of your hormones are optimal, you will be given an HCG (human chorionic gonadotrophin) injection that will induce the maturation of your eggs.

19. Your eggs will be retrieved in the morning of the 2nd day or 36 to 38 hours following the HCG injection. Egg removal takes around 10 minutes and is made under short intravenous anesthesia. Then you will have some rest while at the laboratory of NADEZHDA your partner provides sperm necessary for the fertilization process. Your doctor will prescribe you medications that you have to administer before the embryo transfer - usually Utrogestan, Estrofem and folic acid.

20. For a donor sperm IVF treatment only: NADEZHDA clinic has its own sperm bank. On your request, we can also arrange for a frozen sperm specimen to be shipped to NADEZHDA clinic from any sperm bank of your choice.

21. On the same day your eggs will be fertilized by the sperm through IVF/ICSI.

22. On the next day you will be advised about the number of the fertilized eggs and the way they develop. On the following day you will receive information about the cell division of your embryos and at the discretion of your doctor, the embryo transfer may take place in the afternoon of the same day.

23. Embryos could be cultured for several more days until they reach the stage of blastocyst culture on day 5 after egg fertilisation. At that stage they are quite strong and stable. Also day 5 is most suitable for embryo transfer as usually at this time the embryo normally reaches the uterus and is ready to implant. You will be informed on daily basis about the development of your embryos. Please, have in mind that not all embryos are viable to reach the stage of blastocyst in a laboratory, so the embryo transfer may be carried out on day 2 or day 3 after fertilization.

24. The number of embryos to be transferred is recommended individually depending mainly on the quality of the embryos, patient’s age, treatment and obstetric history. Embryos with the best potential to implant in the uterus are chosen for the transfer. Having been advised of the chances and potential risks, you will have the opportunity to give an informed opinion about the number of embryos that you would like transferred.

25. Shortly before the transfer, the embryos selected will also pass assisted hatching (a standard procedure at NADEZHDA) in order to improve their chances for implantation.

26. PGD (preimplantation genetic diagnosis also referred to as preimplantation testing) is usually performed on day 3 of embryo development. This procedure could be recommended by a geneticist, after examination of karyotype of your blood cell. If mosaic cells or chromosomal translocations have been found, it is strongly recommended to perform PGD, because of a higher chance of aneuploidy. PGD is also recommended for couples who are at risk for passing on to their offspring inherited genetic disease such as monogenic disorders, autosomal recessive andautosomal dominantdisorders or X-linked disorders.PGD with FISH (fluorescent in-situ hybridization) is performed by taking 1 cell from the embryo. The cell is hybridized with special probe for the specific region from selected chromosome. Results are ready late at day 4, so the transfer could be done at day 4 or 5. However, PGD could not give information about all the chromosomes.

27. A new method applied at NADEZHDA is CGH (comparative genomic hybridisation) that allowstesting of all 24 chromosomes in an embryo. The genetic material from the eggs/embryos contains small regions from all chromosomes. It is hybridised in a chip and analyzed with a computer. So, information about the structure of all 24 chromosomes is received to select the most viable eggs/embryos and increase the chances for IVF success. This method is more informative but more expensive.

28. The appropriate number of embryos is transferred to your uterus using ultrasound guidance for best placement. The procedure is painless and is carried out with great care while you are listening to some pleasant and relaxing music.

29. After the transfer you are allowed to lay down for some 20-30 minutes listening to the music. Try to achieve physical and mental rest thus to improve the chances of your embryos to implant.

30. Following the embryo transfer, you will be prescribed a number of medications (usually No-Spa, Medrol, Aspirin or Fraxiparin) which, together with the medications prescribed after the egg retrieval, you have to administer for 17 days by the time of your pregnancy test.

31. Leave Bulgaria on the 14th day of your arrival at the latest and travel safely back to your country or spend a few more relaxing days with sightseeing and SPA in Bulgaria before going home.

32. Check if you are pregnant on the 15-17th day following the embryo transfer. The most reliable way is through BHCG blood test. If the test is positive, call your doctor at NADEZHDA to share the good news and you will be reminded in detail about the medications you should continue to administer.

33. Make an appointment for an early pregnancy scan in 7-10 days. If your pregnancy is confirmed, please, call again your doctor at NADEZHDA and receive again instructions about the medications you have to administer.

34. After confirmation of a pregnancy, your home clinic assumes responsibility for pregnancy follow up, although MEDSPA provides any support during the first trimester.

35. If you are not pregnant, stop the medications (Medrol is stopped by gradually decreasing the doses) and make an appointment for an exam and consultation after your next menstrual cycle.

36. If there are frozen embryos left from this cycle at NADEZHDA, they can be used for a subsequent cycle at NADEZHDA or they can be shipped to another clinic for future IVF treatments.

Non-donor IVF treatment and services cost

For more details, pls., read the information about MEDSPA services as well as the website of NADEZHDA clinic http://www.invitro-bg.com.

12. If you need donor sperm as well, NADEZHDA clinic has its own sperm bank. On your request, we can arrange for a frozen sperm specimen to be shipped to the clinic from any sperm bank of your choice.

13. Each recipient requires individual medications. Usually, for a recipient with regular periods, the treatment starts with a blocking injection to temporarily block the release of your normal hormones. The injection is administered at around day 20 of the beginning of your menstrual cycle. You will have received detailed instructions from NADEZHDA on how to give yourself the injection or you may ask your local GP or practice nurse to administer it. If you are a recipient with no menstrual period, you have to take first Duphaston and Estrofem to induce your period. Within about two weeks (if blocking injection has been applied) or on day 1 of your menstrual cycle (if no blocking was used), synthetic estrogen in the form of tablets, injections or patches (usually Estrofem) is administered for about 14 days followed by an ultrasound scan by your local Ob/Gyn to measure the thickness of your uterine lining. Send the result of your ultrasound scan to MEDSPA and you will receive a reply from your doctor at NADEZHDA if it is necessary to adjust your estrogen dosage to ensure that at the end of your mock cycle (up to 3 weeks) your uterine is prepared for the embryos to implant. You will be advised in time about the date planned for the donor's egg retrieval (in some cases the donor may hyperstimulate, or fail to stimulate, and the treatment may have to be cancelled). On that day you have to start administering progesterone (usually vaginal Utrogestan) and folic acid.

14. Arrange with MEDSPA your trip to Bulgaria, so as to be at NADEZHDA clinic on the day of the donor’s oocyte pick up or the next day at the latest. From then on, while waiting for the embryo transfer, you will receive information on daily basis about the embryo development.

15. Embryos with the best potential to implant in the uterus are chosen for the transfer which is usually performed 2-3 days after the day of oocyte pick up. Shortly before that, the embryos selected will pass assisted hatching (a standard procedure at NADEZHDA) in order to improve their chances for implantation. At this stage PGD (pre-implantation genetic diagnostics) with FISH or CGH (comparative genomic hybridisation) of the embryos could also be performed at patient’s request.

16. The appropriate number of embryos is transferred to your uterus using ultrasound guidance for best placement. The procedure is painless and is carried out with great care while you are listening to some pleasant and relaxing music.

17. After the transfer you are allowed to lay down for some 20-30 minutes listening to the music. Try to achieve physical and mental rest thus to improve the chances of your embryos to implant.

18. Following the embryo transfer, you will be prescribed a number of medications which you have to administer for 17 days by the time of your pregnancy test.

19. Embryo transfer is usually done in the afternoon, so it’s appropriate to go home not earlier than the day after the ET. You may also spend a few more relaxing days with sightseeing and SPA in Bulgaria.

20. Check if you are pregnant on the 15-17th day following the embryo transfer. The most reliable way is through bHCG blood test. If the test is positive, call your doctor at NADEZHDA to share the good news and you will be reminded in detail about the medications you should continue to administer - folic acid by the 12-13th week, Estrofem - by the 6-7th week and Aspirin in some cases.

21. Make an appointment for an early pregnancy scan in 7-10 days. If the scan confirms your pregnancy, please, call again your doctor at NADEZHDA clinic.

22. After confirmation of a pregnancy, your home clinic assumes responsibility for pregnancy follow up, although MEDSPA provides any support during the first trimester.

22. If you are not pregnant, stop the medications and make an appointment for an exam and consultation after your next menstrual cycle.

24. If there are frozen embryos left from this cycle at NADEZHDA, they can be used for a subsequent cycle at NADEZHDA or they can be shipped to another clinic for future IVF treatments.

Details on your donor IVF treatment in Bulgaria

The Bulgarian legislation allows for donor eggs, donor sperm and donor embryos.

Donation of eggs, sperm and embryos is anonymous. You will not be able to see pictures of donors. However, NADEZHDA clinic keeps a registry of approved sperm donors from which you can choose based on their ethnic group, blood type, physical characteristics such as height, weight, hair, eye and skin colour as well as on their education and personal interests. For egg donors, we will ask you to provide a description based on the same abovementioned characteristics, so as for NADEZHDA clinic to be able to offer you the best match available. You can also provide a picture of yourself for NADEZHDA to match the donor more closely to your looks.

All donors (of eggs or sperm) approved at NADEZHDA clinic meet strict requirements:

1. Sperm donors:

• are over 18 years of age;
• are not from HIV/AIDS risk groups;
• are with a good family medical history that does not indicate the likelihood of any hereditary conditions;
• are physically and mentally healthy and have never had any serious illness or surgery;
• have a normal semen analysis allowing freezing and successful thawing;
• have serologic testing for HIV, HBV & HCV, Syphilis and Chlamydia trachomatis;
• have testing for Thalassemia and Mucoviscidose.

2. Egg donors:

• are between 18 and 34 years of age;
• are nonsmokers or rarely smoke;
• are of normal weight;
• have strong physical and mental health;
• have serologic testing for HIV, HBV & HCV, Syphilis, Herpes, Cytomegalovirus, Chlamydia trachomatis and all other sexually transmitted diseases;
• have had a complete gynaecological examination;
• are with a good family medical history that does not indicate the likelihood of any hereditary conditions;
• have a good social status;
• are not from HIV/AIDS risk groups;
• have already had a child.

Donor-egg IVF treatment and services cost

For more details, pls., read the information about MEDSPA services as well as the website of NADEZHDA clinic http://www.invitro-bg.com.

Click here if you would like to combine your IVF vacation with a dental treatment.

TESTS REQUIRED FOR IVF TREATMENT

A. Non-donor IVF

Usual tests:

• Both partners: Blood test for Hepatitis B & C, HIV 1 & 2 and Syphilis less than 3 months old, complete blood count - less than 1 month old;
• Female partner: Transvaginal ultrasound measuring the thickness of the endometrium and checking the uterine cavity for abnormalities 12-14 days from the beginning of the cycle; Blood test for FSH, LH, FT3, FT4, E2 and Prolactin done within the first three days of a menstrual cycle, less than 3 months old; FSH and LH levels are usually measured on the 3rd day of the menstrual period. Please, consider this when arranging your trip to Bulgaria.
• Male partner: sperm analysis. The male partner will be asked for a semen sample to be analyzed by the sperm lab at NADEZHDA clinic. The analysis takes about an hour. If your sperm is within normal values, the semen samples could be cryopreserved for future IVF treatment in case you don’t have opportunity to travel again. The cryo sperm bank is in NADEZHDA clinic.

Specific tests required in some cases: immunoassays, Anti-Müllerian hormone test, Inhibin B test.

B. Donor egg IVF

Usual tests:

• Both partners: Blood test for Hepatitis B & C, HIV 1 & 2 and Syphilis less than 3 months old, complete blood count - less than 1 month old;
• Female partner: Transvaginal ultrasound measuring the thickness of the endometrium and checking the uterine cavity for abnormalities 12-14 days from the beginning of the cycle (1st cycle day = 1st day of a menstrual bleed); Women who have an irregular cycle or no longer have a cycle should have an ultrasound scan after 14 days of using estrogen supplements.
• Male partner: sperm analysis. The male partner will be asked for a semen sample to be analyzed by the sperm lab at NADEZHDA clinic. The analysis takes about an hour. If your sperm is within normal values, the semen samples could be cryopreserved for future IVF treatment in case you don’t have opportunity to travel again. The cryo sperm bank is in the clinic.

ACUPUNCTURE TO INCREASE YOUR CHANCES TO GET PREGNANT

In order to improve your chances to conceive, you could take advantage of the acupuncture offered at NADEZHDA clinic. The purpose of acupuncture during IVF treatment is to lower your adrenaline level and increase the endorphins, balance your sex hormones, soothe the micro-contractions of the cervical muscles and improve the blood flow of the uterine lining. The program includes 4 acupuncture procedures, 30 minutes each, 3 of them during the hormonal stimulation period and the last one − right after the embryo transfer. Based on their 3-year experience with acupuncture treatment, NADEZHDA clinic reports 14% increased chances of getting pregnant.