In vitro

FAQ

What is the success rate of the in vitro proceedure?
The percentage of achieved clinical pregnancy in our laboratory is 45-50%, where in the cases of a 5th day (blastocyst stage) embryo-transfer this number goes up to 75%.. The percentage of missed abortions after positive pregnancy is lowered down to 5%.

What are the tests, which needs to be done by the patient and her partner?

The following tests are preferable:

  • The patient: whole gynecological state, ultrasound examination, examination of the fallopian tubes, series of clinical tests (hormones, blood tests etc.).
  • The partner: sperm analysis and additional tests, determined by the medical staff.
  • Both should be tested for: HIV (Anti-HIV-1, 2); hepatitis B; hepatitis С; syphilis.

How to know which medicine to use and when?
During the consultations the medical staff will discuss the best possible treatments and will prescribe the most appropriate medications for each individual case.

How long does the procedure take?
The approximate time of the follicular puncture itself is 10-15 minutes, however it is recommended that the patient stays in the hospital at least 3 hours for observation.

Is the procedure painful?
The follicular puncture is done under general anesthesia. There is no pain whatsoever.

Are all ova cells fertilized?
Normally around 65% of the cells are fertilized. In some patient that percentage is much higher, and in some considerably lowers.

How many embryos will be transferred?
Depending on the quality of the embryos, the type of infertility, patient’s age, as well as other factors, 1 to 3 embryos are being transferred. The chances of achieved pregnancy are higher when more, high quality embryos are transferred, on the other hand that may lead to multiple pregnancy. The multiple pregnancy can be dangerous for the health and condition of both the fetus and the mother, including risk for their life. This is the main reason why the medical staff is searching for balance when transferring embryos – on one side to increase the chances of successful pregnancy, and on the other to limit the chances of multiple pregnancies.

What happens to the rest of the embryos after the transfer?
Not all embryos continue their development through cellular division. Only the highest quality ones are chosen for the transfer, while the rest of the potential ones can be cryopreserved. The ones, proven to be unsuitable for transfer, are being disposed of.

When can the patient return to the normal daily activities such as driving, going to work etc?
24 hours after the embryo-transfer, the patient can go back to her normal daily routine. However it is highly recommended to avoid stress and strains on the body.

How long after the transfer can the patient have normal sexual relations?
24 hours after the transfer.

What can the patient do if she doesn’t have a partner or appropriate sperm donor?
The patient should consult with the medical staff about different donor programs.

Why choose “St. Lazar” hospital?
We provide the full range of services in regards to assisted reproduction, monitoring of the pregnancy and delivery of the child:

  • All methods of in vitro
  • Monitoring the development of the pregnancy throughout its stages
  • Providing access to “future parents school” program
  • Providing the facilities and accommodation for delivery of the child
  • Stem cells cryopreservation, ensuring the health of your child and family
  • The care for the newborn can be made considerably easier when assisted by highly professional teams

Preliminary studies

Saint Lazar Hospital offers a package price for all preliminary tests prior IVF treatment:

  • gynecological examination
  • ultrasound scan
  • blood and microbiology tests
  • cervix probing
  • semen analysis

Package price 350 EU.

Inter-uterus insemination (IUI)

The IUI is a procedure, where the spermatozoids are treated and injected directly into the patient’s uterus. While in natural sexual intercourse only parts of them can reach the uterus, by using IUI their amount is highly increased, which in turn increases the chances for fertilization. The most appropriate time for IUI is determined by the patient’s ovulation.

 

 

 

Classical in vitro

The in vitro insemination is a method, in which the mature ova cells of the patient are combines with the spermatozoids of her partner (or donor). In the classical in vitro (IVF) selected spermatozoids are combined with the ova cells and are placed in в CO2 incubator with constant temperature of 37оC for 6 to 18 hours.

On the 18th hour are done series of tests for signs of insemination.
This method is mostly used when the fallopian tube is partially or completely blocked or surgically removed.

 

 

 

ICSI (Intra Cytoplasmic Sperm Injection)

ICSI (Intra Cytoplasmic Sperm Injection) – The injection of single spermatozoid in the ova cell under microscope control and using specially developed for the purpose technology.

This method is used when the reason for the infertility is the male factor; there are immunological reasons for infertility, or the classical IVF method doesn’t yield results.

 

 

 

IMSI

Sperm morphology has been proven to be the best indicator in assessing male fertility potential. The ICSI procedure was developed for cases involving male infertility. The accuracy with which the morphological changes of spermatozoa are evaluated depends on the resolution and the zoom options in the optical system used.

The high optical magnification allows for the detection of sperm anomalies - intravascular vacuoles, which could not be demonstrated by conventional methods. Microinjection of a normal-looking sperm, but with large vacuoles, reduces the incidence of pregnancies and increases early abortion.

The results of a number of studies have shown that the degree of DNA fragmentation is significantly higher in sperm with large vacuoles, and damage to sperm DNA is detrimental to the reproductive outcome. Indications for IMSI administration:

  • Heavy Male Factor / Heavy Oligoasthenozoospermia or Kruger Morphology Less than 4%;
  • High degree of sperm DNA fragmentation;  
  • Embryos with poor morphological characteristics established in previous IVF / ICSI procedures;
  • Spontaneous abortions in the first trimester of pregnancy;
  • A series of failed in vitro procedures;  
  • Sterility of unexplained origin;

Laser-assisted hatching

The advent of the laser has allowed the development of precision techniques to manipulate embryos for enhanced fertility. Laser-assisted hatching can turn around a history of failure for embryos to implant themselves in the uterine wall.

Assisted hatching is used to help the embryo hatch from its protective outer shell, the zona pellucida, and promote implantation in the uterine wall after embryo transfer.

Laser-assisted hatching requires less handling of the embryo than these other assisted hatching methods. Also, laser-assisted hatching is faster than the other methods and, therefore, the embryo spends less time outside the incubator.

Indications for LAH concern women with an elevated baseline level of FSH, women with poor prognosis embryos, including conditions such as a thick zona pellucida, slow cell division rate, or high cell fragmentation and women using frozen/thawed embryos, which may have hardened zona pellucida

Vitrifiсation

The high quality embryos, which are not transferred, can be cryopreserved. The vitrification is the most commonly used method, in which the embryos are processed with high-density cryoprotectors, and then placed in liquid nitrogen.

The embryos can be cryopreserved for unlimited time and that allows their usage in another cycle, or if the first transfer is unsuccessful.

Donor programs

Having a baby using a donor sperm, egg or both gives hope to many people who thought they could never become parents. Our ART Lab is fully certified and has it's own cryo bank for donor sperm, egg and embryos. We can safely say that we can meet any patient's needs. We also have an active contract with an international cryo bank as we aim to offer our patients the best possible service.

Donated eggs may be offered to women suffering premature menopause, whose eggs will not fertilize, whose ovaries have been removed, women with a genetic disorder that may be passed on or, older women.

Some men may have a very low sperm count or no sperm for a variety of reasons. In these cases, donor sperm insemination may be an appropriate treatment option. A couple may choose to use donor sperm if the male partner has a genetic disorder that might be passed on. Single women and same sex couples may also choose to use our sperm donor insemination program.

In our laboratory we can use both fresh and frozen eggs depending on the needs and want of the patients. 

The patient has the right to chose the donor/s according to phenotype signs only. This way the anonymity of the donors is guaranteed as regulated by the Ministry of Health.

An Egg donor can become any woman between the age of 18-34 meeting the following criteria:

  • At least one child of her own
  • Lacking anamnesis for family diseases
  • Negative testing for HIV HBV, HBC and Syphilis
  • Notary signed written consent for donation

The donation of eggs is an act for free in Bulgaria, but some expenses are paid to the donor, such as: transportation, hotel accommodation, absence from work, lost benefits.

If you wish to become a donor please do not hesitate to contact us. You will be directed to the Hospital Manager Mrs Gabriela Georgieva or to our IVF specialist Dr. Valentin Lachev, MD 

Prices

 

Service PRICE  EU
Analysis and handling of semen samples
Semen analysis 45
Full semen analysis 200
DNA fragmentation 75
ТЕSE 450 
PESA 400 
Microbiology test of a semen sample 30 
Assisted reproductive technologies
Partner IUI 1+2 600
Donor IUI 1+2 1200
Donor sperm usage for  IUI,IVF,ICSI 400
Preliminary testing package 350
IVF - with stimulation 1890
IVF - spontaneous  
ICSI - with stimulation 2300
ICSI  - Spontaneous  
Laser Assisted hatching 360
IMSI /morphology selection of sperm cells/ 290
Repro-abrasion 205
Cultivating Endometrium cells 300
Cultivationg embryos along with endometrium cells 200
Punction / oocyte extraction 850
Freezing and storage of reproductive cells  
Sperm freezing per year 280
Ebryo freezing per one/per year 150/per 1
Donor Program  
Donor egg and donor embryo program to 7500
Medication  
Medical stimulation 1600-1950 

 

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