Frequently Asked Questions

LUF syndrome means that the follicle matures and even goes into the luteal phase (corpus luteum), but does not rupture and does not release an egg. This creates the illusion that ovulation has occurred, but in reality it has not occurred. LUF can be detected by serial ultrasound in an ovulation window and is a possible cause of unexplained infertility. Treatment involves stimulation with gonadotropins and/or administration of hCG to induce rupture of the follicle.

Ovulation induction is a medical procedure in which, with the help of hormonal medications, the ovaries are stimulated to induce or regulate ovulation. It is used in women with: lack of ovulation (anovulation), irregular cycle, polycystic ovary syndrome (PCOS), either in preparation for insemination, or in vitro. Medications such as clomiphene citrate, letrozole or gonadotropins are most commonly used. The process is tracked by ultrasound and hormonal studies.

A healthy lifestyle increases the chances of conception. It is recommended to eat a balanced diet, regular activity, normalize weight and avoid harmful habits.

Laparoscopy is a minimally invasive surgical procedure used to diagnose and treat endometriosis, fibroids, adhesions and others.

With bilateral obstruction of the tubes - a natural pregnancy is impossible. In vitro fertilization is the method of choice.

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Both substances can reduce ovarian reserve, disrupt hormonal balance and increase the risk of miscarriage.

These therapies can damage the ovarian reserve and even lead to premature ovarian failure. It is recommended to freeze eggs or embryos before treatment.

Early menopause is the depletion of the ovarian reserve before the age of 40. The chance of a natural pregnancy is greatly reduced.

Ja. Maladies such as lupus, autoimmune thyroiditis, and celiac disease can affect fertility through inflammation, hormonal disruption, or a direct impact on ovarian function.

This is a condition in which a woman's immune system creates antibodies against sperm, attacking them and interfering with fertilization.

Disorders in the thyroid gland can lead to irregular ovulation, an increased risk of miscarriage, and problems getting pregnant.

Infertility secondarily means the inability to become pregnant after a previous successful pregnancy. Causes may include age, hormonal disorders, adhesions, and others

Treatment depends on the cause and age: stimulation of ovulation, insemination, in vitro or ICSI, surgical treatment for endometriosis, fibroids, adhesions, donor egg.

Yes. Both conditions can disrupt hormonal balance, ovulation, and the menstrual cycle.

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus — along ovaries, tubes, peritoneum. It can lead to adhesions, blockage of tubes and disruption of ovulation.

The ovulation problem means that the ovaries do not release an egg every month. Causes: PCOS, hormonal imbalance, stress, weight, thyroid problems.

Treatment: stimulation of ovulation with medication, lifestyle change, hormonal control.

Stress itself is rarely the only cause of infertility, but it can negatively affect hormonal balance, ovulation and the menstrual cycle.

With age, the chances of getting pregnant naturally decrease, especially after the age of 35. The quality and number of eggs decreases, the risk of genetic abnormalities increases, and the likelihood of miscarriage increases.

This means that the number and/or quality of eggs in the ovaries is lower than expected for age. It is measured by: AMH (Anti-Muller Hormone) and the number of antral follicles (AFC) on ultrasound.

Diagnosis includes: detailed anamnesis and gynecological examination, hormonal tests (FSH, LH, AMH, TSH, prolactin, etc.), ultrasound examination of ovaries and uterus, check of patency of the fallopian tubes (HSG or hydrosonography), if necessary — laparoscopy or hysteroscopy.

The most common causes include: hormonal disorders - polycystic ovary syndrome (PCOS, ovulation problems), clogged fallopian tubes, endometriosis, uterine abnormalities (fibroids, polyps, septa), decreased ovarian reserve, autoimmune and genetic factors.

Female infertility is a condition in which a woman cannot become pregnant after 12 months of regular, unprotected sex life (or 6 months in women over 35).

In many cases of azoospermia, getting pregnant is possible, thanks to advances in modern reproductive medicine. Studies have shown that after successful testicular sperm extraction and ICSI, the chances of successful fertilization can reach up to 70%, regardless of whether it is a non-obstructive or obstructive form. The success rate of ICSI after testicular extraction is slightly higher in cases of obstructive azoospermia. Despite concerns about lower embryo quality in non-obstructive form, this was not observed in studies.

Azoospermia is not a “sentence”. The condition is subject to treatment, which in some cases can be very effective. It is important not to postpone the consultation of a good specialist so as not to waste precious time.

Obstructive azoospermia occurs in a smaller percentage of cases. In it, no sperm are found in the ejaculate, despite normal spermatogenesis. The reason is the presence of obstruction in the sperm pathway. It can be at different levels in the urogenital system — e.g. at the level of the seminiferous tubules or vas deferens.

Obstructive azoospermia may be due to obstruction due to trauma, surgical interventions, infections, congenital defects of the vas deferens or genetic causes (cystic fibrosis or cystic fibrosis), retrograde ejaculation.

Non-obstructive (secretory) form is the most common and difficult to treat. About 70% of cases are like that. It is a consequence of congenital or acquired conditions that lead to impaired testicular function, impaired spermatogenesis and sterility. Non-obstructive azoospermia:

• may be due to pretesticular disorders associated with: hormonal disruptions — low plasma concentration of FSH(follicle-stimulating hormone), leading to weak stimulation of the testicles and suppressed sperm production; disorders in the function of the pituitary gland (hypopituitarism), suppression of FSH secretion by external import of testosterone into the body. Chemotherapy can also suppress spermatogenesis.
• It can be of testicular origin. In this case (49-93% of cases), the testicles are of an abnormal structure, atrophic or absent. Sperm production is greatly reduced or absent. The causes of non-obstructive azoospermia of testicular origin are mostly chromosomal defects and gene mutations — Klinefelter syndrome, cryptorchidism, Sertoli cell syndrome. Non-genetic causes of testicular failure are varicocele, infections (orchitis), surgical interventions performed (tumors, trauma), radiation, etc.

Azoospermia is the term that is used when there is a complete absence of sperm in the ejaculate. Most patients assume that this diagnosis would rule out the possibility of a man becoming a biological parent. However, reality shows that the absence of sperm in the ejaculate does not exclude the possibility of sperm production. Azoospermia affects 1 in every 100 males in the general population. In about 10-15% of cases of men with infertility, the cause is precisely the lack of sperm in the ejaculate. The diagnosis of azoospermia is made, if at 2 consecutive spermogramssettle down complete lack of sperm.

A number of factors can lead to the appearance of azoospermia. They either cause a violation in the production of sperm, or cause blockage of the male reproductive tract. Sometimes the lack of sperm may be due to the simultaneous combination of 2 or more factors.

According to the leading cause of its occurrence, azoospermia can be of two types: non-obstructive (secretory) or obstructive.

Treatment of male infertility varies depending on the causes. Treatment can be by:

• Medications to improve sperm production, correct hormonal imbalances or treat infections that affect spermatogenesis;
• Surgical interventions to remove anatomical barriers that block the production, maturation or ejaculation of sperm;
• Assisted reproductive technologies — various methods of processing and selection of sperm (Swim-up, Gradient centrifugation, PICSI, ZyMOT), as well as fertilization techniques (IMSI, ICSI).

YES! Steroids taken orally or injected can stop the production of hormones needed to carry out spermatogenesis.

Smoking reduces the quality of sperm, which is expressed in a lower number and worse sperm movement. Smoking can cause damage to sperm DNA, which is associated with an increased risk of miscarriage.

It's not mandatory. For the majority of couples seeking treatment for infertility, the risk of conceiving a child with a birth defect is the same as in the general population. However, some diseases (especially genetic diseases) that cause infertility can also cause an increased risk of conceiving a child with birth defects. For this reason, couples need thorough evaluation and counseling before proceeding with some forms of assisted reproductive techniques.

• Azoospermia — lack of sperm in the ejaculate
• Asthenozoospermia — decreased sperm motility;
• Olygozoospemia — reduced sperm count;
• Normozoospermia — all indicators of seminal fluid are normal;
• Teratozoospermia — deteriorated morphology of spermatozoa.

Yes! Basic requirements are:

• Sexual abstinence from 3 to 5 days;
• Without taking antibiotics in the last 2 weeks;
• No intake of alcohol and narcotic substances at least on the days of abstinence;
• Pre-recorded time to conduct the study.

It is advisable to separate the sample on the spot, in the clinic, in specially adapted boxes. The sample is excreted by masturbation. In the event that this is not possible, the study material can be delivered to the laboratory up to 30 minutes after ejaculation. It is necessary to inform the person conducting the study about all drugs and dietary supplements that the patient is taking, as well as in the event that the entire amount of ejaculate has not got into the sterile container. Loss of quantity can affect the reliability of the results.

The main parameters to be studied are:

• Ejaculate volume in milliliters, pH and viscosity;
• Sperm concentration — this is the amount of sperm in
  one milliliter;
• Total sperm count in the entire ejaculate;
• Sperm motility in%, divided into several categories;
• Morphology of spermatozoa in%, that is, how many of them are of the correct shape.

The study is called a spermogram and includes many indicators, not always a deviation from a given parameter is a sign of a disease. Only a comprehensive assessment of all parameters and their dynamics over time, from the obtained data, allows to make a reliable qualitative assessment of the male's fertility capacity.If the results of the study are not good and there are deviations from the norm, a re-examination should be done after a certain period of time to confirm or rule out poor results. It is possible that this is a temporary condition. Spermogram varies within certain limits. Sometimes the cause is an unclarified side factor that temporarily negatively affects the study.

• Disorders in the production and functional fitness of sperm: hypogonadism, cryptorchidism, varicocele, infections, antisperm antibodies, testicular torsion, etc. ;
• Disorders in the delivery of sperm: erectile dysfunction, retrograde ejaculation, congenital absence of vas deferens, operations on the prostate gland, injuries in the testicle area, etc.
• Genetic disorders: Klinefelter syndrome, Superman syndrome, Cushing's syndrome, Y chromosome microdeletions, etc.
• Harmful influence of profession and environment: occupational hazards, stress, pesticides, chemicals, radiation;
• General health problems and lifestyle: diabetes, kidney and liver diseases, hypertension, cancers of the testicle and organs of the male genital system, chemotherapy, hypovitaminosis, obesity, smoking, alcohol abuse, drugs, etc.

In 60% of all couples who suffer from infertility, a male factor is present, with 40% of these couples having a male factor of infertility, and in an additional 20% a combination of male and female factors is present. Therefore, when a couple has problems with conception, the first examination that needs to be done is a spermogram.

Sex selection is not permitted for ethical and legal reasons, except in the case of a proven hereditary disease associated with a particular sex (e.g. X-linked diseases). In these cases, preimplantation genetic diagnosis (PGT) is performed.

Medical — there is no strict limitation, but evaluation is recommended after each unsuccessful attempt. Practically, the number of attempts depends on: age, ovarian reserve, emotional and physical readiness, available embryos (frozen).

If pregnancy does not occur, the entire cycle is analyzed - from stimulation to embryo development. Next steps are discussed: retrying, changing the protocol, further research or methods. The approach is always individual and coordinated with the patient.

The number depends on age and medical indicators:

• In women up to 35 years of age, 1 embryo is usually returned (selective transfer);
• At an older age or unsuccessful attempts — up to 2 embryos.

The goal is to minimize the risk of multiple pregnancies.

Yes. Excess quality embryos can be frozen by vitrification, and the recommended storage period is for a period of up to 5 years (with the possibility of extension according to regulations). They can be used in a subsequent cycle without the need for repeated puncture.

With unexplained sterility, all standard studies are normal, but pregnancy does not occur. In such cases apply:

• stimulation with insemination;
• in vitro or ICSI;
• additional genetic and immunological studies as needed.

The approach is individual according to the age and history of the couple.

Risks are rare, but possible. The most common are: hyperstimulation syndrome, complications of puncture or transfer, multiple pregnancy. All procedures are carried out under strict medical supervision in order to minimize risks.

Factors that influence are: the woman's age, ovarian reserve, hormonal balance, sperm quality, lifestyle (weight, smoking, stress), medical conditions available (endometriosis, autoimmune diseases, etc.)

Success rate depends on reproductive age, ovarian reserve, health status and other factors. At a woman's age up to 35 years, the chance of pregnancy is about 50%, and after 40 years — less than 20%. The results vary according to the specific case and the treatment methods used.

• Age over 35 years;
• Repeated unsuccessful embryo transfers;
• Repeated miscarriages;
• Known genetic disease in the family;
• Previous child with a chromosomal abnormality.

PGT is a method in which genetic analysis of embryos is performed before transfer to the uterus. The goal is to select only genetically healthy embryos, which increases the chance of implantation and a healthy baby.

Types of PGT:

• PGT-A (anaplodias): to exclude chromosomal abnormalities, such as Down syndrome;
• PGT-M (monogenic diseases): in the presence of a carrier or the presence of a specific hereditary disease;
• PGT-SR (structural chromosome rearrangements): in balanced translocations and inversions.

• Karyotype (chromosome analysis) — in both partners;
• Microdeletions of the Y-chromosome — in severe male factor;
• Mutations in the fibrosis gene (CFTR) — in azoospermia;
• Panel for hereditary diseases (carrier screening) — to exclude carrier;
• PGT (pre-implantation genetic diagnosis) — in embryos, if indicated.

Genetic testing is not mandatory for every couple, but in certain cases it can be key, to establish the cause, for sterility or recurrent reproductive failures. They are recommended in the following situations:

• Repeated miscarriages;
• Severe deviations in the spermogram (azoospermia, teratozoospermia, etc.) ;
• Depleted ovarian reserve in young women (<35 years) ;
• Unsuccessful attempts with high-quality embryos;
• Family history of genetic diseases;
• Early menopause or ovarian failure;
• Existence of kinship ties between partners;
• Presence of children with genetic abnormalities in the genus.

Success rate depends on age, ovarian reserve, health status and other factors. By the age of 35, the chance of pregnancy is about 40— 50%, after the age of 40 — less than 20%. The results vary according to the specific case and the methods used.

The separation of eggs between classical in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is done in order to achieve the maximum good result with the available eggs and sperm, using an individual and balanced approach to each pair. Indications:

• Sperm has borderline indicators - when the ejaculate indicators are not categorically good, but not severely damaged, a combined approach is applied - part of the eggs are fertilized naturally (IVF), and another part with ICSI. This increases the likelihood of successful fertilization.
• Previous unsuccessful attempt with a classic invitro. If a lack of fertilization was observed in a previous procedure, separate the eggs to avoid repeated failure.
• Diagnostic approach to the fertilizing capacity of spermatozoa. Separation allows to assess the ability of sperm to fertilize eggs on their own. This helps to choose the most appropriate method in future attempts.

IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) is an advanced variant of ICSI, in which sperm are selected under a very large magnification (6000—7000 times) using a special microscopic technique. IMSI is recommended in cases such as:

• Repeated unsuccessful attempts with ICSI;

• Repeated miscarriages;

• Severe deviations in the morphology of spermatozoa;

• The presence of high DNA fragmentation in sperm;

• Unclear male factor at otherwise normal values from the spermogram.

ICSI is a method in which a single sperm is injected directly into the cytoplasm of an egg. It is used in:

• Severe male sterility;
• Poor sperm quality;
• Limited number of eggs;
• Previous unsuccessful fertilizations with a standard in vitro procedure.

Necessary research includes:

• Spermogram of the partner and, if necessary, supplement specialized tests;
• Hormonal profile;
• Examination for ovarian reserve;
• Examination for infections;
• Genetic studies (if there are indications);
• Blood count, biochemistry, etc.

The in vitro procedure is not considered painful. Hormonal stimulation can cause temporary discomfort, and the puncture of the follicles is performed under venous anesthesia. Most patients tolerate it well.

No, but hormone treatment significantly improves the chances of achieving pregnancy. IVF can be performed on a “spontaneous cycle”, that is, a woman's own cycle. In the spontaneous cycle, there is a certain risk of not extracting an egg, or it not being fertilized or dividing. With hormone therapy, there is a greater chance of aspirating an optimal number of eggs suitable for fertilization and the formation of healthy embryos.

The entire process — from preparation for the procedure to embryo transfer usually takes between 4 and 6 weeks. It includes hormonal stimulation, puncture of the follicles for aspiration of eggs, fertilization in the laboratory and the return of embryos.

In vitro fertilization is recommended for:

• Obstructed fallopian tubes;
• Male factor of infertility;
• Endometriosis;
• Advanced reproductive age;
• Unexplained sterility;
• Unsuccessful attempts with other methods (e.g. insemination).

Intrauterine insemination is a milder procedure in which pre-treated sperm, using a thin catheter, is introduced directly into the uterus, during ovulation. In vitro fertilization involves hormonal stimulation, the removal of eggs, their fertilization in the laboratory and the return of embryos to the woman's uterus.

Yes. Stress can affect hormonal balance, sleep, and immune response. Emotional support increases the couple's chances of success and resilience.

ERA (Endometrial Receptivity Analysis) is a test that determines the exact window of implantation in a woman. It is applied in case of repeated failures with good embryos in order to make a transfer at the most appropriate time.

When there is no pregnancy after 2 or more transfers with quality embryos, we speak of repeated implantation failure. This requires a more thorough search for causes.

Usually, an analysis of the entire cycle is made and additional studies are discussed: hormonal profile, embryological analysis, PGT, ERA test, immunological and microbiological tests. Then a new approach is planned.

Causes may include insufficiently good embryo quality, poor endometrial receptivity, immunological factors, uterine abnormalities, coagulation problems, incorrect hormonal profile, or chronic inflammation of the endometrium.

FET stands for Transfer of Pre-Frozen Embryos. It is performed on a natural or hormonally controlled cycle and has a similar or higher success rate than “fresh” transfers.

It depends on the quality of the embryo, the age of the patient and the condition of the endometrium. On average, 40— 50% success rate of blastocyst transfer in women under the age of 35

A blood test (β-hCG) is done 7 to 10 days after the transfer, depending on the day of the embryo (day 5 or day 3).

Rest in the first hours is advisable. Avoid heavy physical exertion, stress and warm procedures. Follow the instructions for taking medication given by your doctor.

A full bladder, comfortable clothes, avoiding perfumes and complete calm are recommended. The procedure is short and non-invasive.

Embryo transfer is usually done on day 3 (6—8 cell embryo) or day 5 (blastocyst), depending on the number and quality of embryos and the individual protocol.

The selection is made by the embryologist, based on quality, stage of development, morphology and results of preimplantation diagnosis (PGT), if made.

The number depends on age and medical history. Usually 1 embryo in women under 35 years of age and up to 2 embryos at an older age or unsuccessful previous attempts.

The procedure is painless and does not require anesthesia. It is performed with a thin catheter under ultrasound control. Some women feel a slight discomfort, similar to a gynecological examination.

Embryo transfer is the final stage of the in vitro procedure, in which one or two fertilized and developed embryos are placed in the uterine cavity for implantation and the onset of pregnancy.

The use of donor material raises important ethical questions: awareness and consent, donor anonymity, the child's right to know his or her biological origin, equality and access to treatment. Invitro Clinic “Sofia” follows clear rules to ensure ethical and responsible treatment.

Under Bulgarian law, donors are usually women between the ages of 18 and 38. Recipients can be women up to 50 years, according to the individual judgment of the medical team and the general state of health.

No. Due to anonymity, patients do not receive information about the number of families or children conceived by the respective donor. In Bulgaria, there are restrictions on the number of uses by the same donor in order to avoid a biological connection between unknown children.

Although there is no genetic link, carrying a pregnancy has an epigenetic influence on the development of the embryo. Many women describe a strong emotional connection with the child and do not feel a lack of a “biological connection” with him.

Patients sign: informed consent to the use of donor material, a statement of awareness about rights and obligations, a medical protocol and consent to transfer.

Yes. Increasingly, already frozen donor eggs or embryos are used, which facilitates synchronization and shortens the preparation time. The success rate is comparable to that of “fresh” eggs.

Yes. Donation of eggs, sperm and embryos is regulated by Bulgarian legislation. It is carried out according to the Ordinance №N-2/12.07.2023 of the Ministry of Internal Affairs. All procedures are under the supervision of the Executive Agency “Medical Supervision”.

Preparation and synchronization takes about 3—4 weeks. The transfer is carried out after reaching the optimal state of the uterine mucosa. When using frozen donor eggs or embryos, the procedure may be shorter.

Donated embryos are used when both partners cannot provide genetic material. These are embryos donated by couples who have already achieved the desired pregnancy and have given consent to donation.

The success rate is very high — on average 60— 70% per transfer, as eggs from young, healthy women are used. The factors that influence are the condition of the uterus, endometrium and the overall health of the patient.

The donor goes through stimulation and the eggs are collected. For fertilization, the partner's sperm is used. Embryos are developed in a laboratory and transferred to the recipient's uterus. Excess embryos can be frozen.

Yes, the donor is selected in such a way as to maximally match the physical and ethnic characteristics of the patient: height, eye color, hair, blood type, etc. There is no possibility of personal selection of a specific donor by name or photo.

Yes, in Bulgaria donation is anonymous by law. Neither the donor nor the recipient can know the identity of the other. Exceptions are made only with serious medical indications and with the permission of the relevant institutions.

Donors undergo a strict selection, including: medical examination, psychological evaluation, genetic screening and tests for infections (HIV, hepatitis, syphilis, chlamydia, etc.). They are selected by age, good health and lack of family burdens.

Donor sperm is recommended for: lack of sperm (azoospermia), severe genetic diseases in a man, unsuccessful attempts with partner sperm, single women.

It is used for: depleted ovarian reserve or early menopause, genetic diseases in a woman, repeated unsuccessful in vitro attempts, poor egg quality, absence of ovaries (congenital or after surgery).

Донорската програма е възможност за двойки с репродуктивни затруднения да използват дарени яйцеклетки, сперматозоиди или ембриони в лечението си. Това е надеждна алтернатива при тежки форми на инфертилитет.