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IVF/ICSI in Nadezhda Women’s Health Hospital

International patients applying for the package IVF/ICSI program at Nadezhda Women’s Health Hospital are taken care of personally by Dr Georgi Stamenov, head of the fertility team. This includes all consultations and ultrasound scans, assigning and monitoring your stimulation, egg retrieval and embryo transfer.

Usually you have short- or long-protocol IVF program. For a short protocol there are two options to start:

• To come on day 2-3 of your period – for hormone testing, ultrasound scan and administering the first injections. In total you stay around 16-17 days in Sofia, Bulgaria.
• If at the initial consultation you have been given injections for the first 4 days of stimulation, you have to come for first monitoring on day 5 of your stimulation. In this case you stay around 11-13 days in Sofia.

In case of a long-protocol IVF you’ll be given a blocking injection around day 20 of your previous cycle. You can receive the blocking injection from Nadezhda Hospital or buy it in your country. In both cases you’ll receive a prescription and instructions on doing the injection. You’ll be advised when exactly to come for stimulation start-up. Please, plan around 16-17 days stay in Sofia.

On day 5-6 of your stimulation you will pass an ultrasound scan, your hormones will be tested and injections for 2 days will be prescribed. 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 and further medicines will be adjusted accordingly. The whole stimulation usually takes around 10 days.

Your eggs will be retrieved in the morning of the 2nd day following an HCG injection. Egg retrieval takes around 15 minutes and is done under short intravenous anesthesia. Then you will have some rest while your partner provides sperm necessary for the fertilization process.

In most cases egg fertilization in Nadezhda is done with ICSI to maximize success rate. If there are serious issues with your partner’s sperm, like low motility, poor morphology, high DNA fragmentation and low count, he may be advised to consider some further sperm selection procedures like sperm enrichment, magnetic activated cell sorting (MACS) and IMSI.

If you need donor sperm, you can easily choose an anonymous donor from Nadezhda Hospital’s sperm bank. Alternatively, on your request, it can be arranged for a frozen sperm specimen to be shipped to Nadezhda Hospital from a European sperm bank of your choice. Nadezhda works on a regular basis with Cryos.

Your doctor will prescribe you medications that you have to administer before the embryo transfer - usually progesterone, estradiol and folic acid.

Your embryos will be cultured in an EmbryScope by the time of your embryo transfer (usually on day 3 or day 5 after egg retrieval).

You will be informed daily about the development of your embryos. Usually in Nadezhda they try to culture your embryos by day 5 when the most viable of them reach blastocyst stage. Blastocysts 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. Please, have in mind that not all embryos are considered capable of reaching blastocyst stage, so your embryo transfer may be carried out also on day 2, 3 or 4 after fertilization.

The number of embryos to be transferred is recommended individually depending mainly on the quality of the embryos, patient’s age, previous IVF fails. 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 to be transferred.

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

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.

After embryo transfer you’ll be recommended two days bed rest to facilitate embryo implantation. Then you can travel back home.

Following the embryo transfer, you may be prescribed further medications for post IVF luteal phase support. You will receive a detailed e-mail by MEDSPA on how to administer all the medicines and the duration of intake for each of them. You can buy all the medicines in Bulgaria or purchase an initial quantity by the time you pregnancy is confirmed, and then supply the rest of the medicines with prescription by your GP or gynecologist in charge.

If there are embryos left after your transfer, they can be vitrified and used in a frozen embryo transfer.

For more details, please, visit https://www.nadezhda.bg/

To apply for fertility treatment or ask any questions, please contact:

Mrs Iva Stoykova, Fertility Case Coordinator at phone: +359 885 272738, +359 889 340686 e-mail: fertility@medspa.bg

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