IVF - confidential and personal

Dr Lachev, there are around 32 IVF laboratories in the country. How should we choose the right one?

Large laboratories usually work on conveyer. In our laboratory, based on a daily ultrasound examination, hormone tests, Doppler and other specific tests, I measure very strictly the dosage of the medication. But, of course that is only possible when I have 4-5 families per day, not 30-40 instead. When we first started with our laboratory in “Saint Lazar”, 8 years ago, the average age of the patients was 32 years. Nowadays, is 38. We have two pregnant patients, at the age of 44 and 45 years old, at the moment. Our success rate in embryo transfers is 38,5%.Some laboratories claim to have a success rate of 70%. This is a statistical equilibrium. When a woman gets pregnant in a natural way, the percentage of this happening is less than 30. Well then, how IVF can have a success rate of 70%?

What do you do to women with reduced egg reserve, in order to expect positive results?

We have already introduced several methods in this direction. Physiotherapeutic and laser procedures, for instance, before actually starting the In Vitro manipulations. Then, we conduct Doppler, hormone, ultrasound and other examinations in order to see whether the methods have proven effective. And finally, we apply more complex, more expensive and more difficult to implement schemes of procedures. Even though this hampers our work financially, we do not allow any price increase of IVF procedures.

There are constantly new methodologies being introduced in the field of In vitro worldwide. How do you decide, which ones exactly to be implemented in your practice?

In practice turns out, that only 2-3 out of 10 new methodologies actually work out. So, our goal is quickly to implement the method that has already proven itself successful and has established itself in the leading laboratories around the world.  Because, to people, the result is what really matters. When we first started freezing embryos, 7 years ago,we bought an expensive freezer, but soon it turned out that it is much better to apply the method of vitrification – a quick freeze procedure, which does not require equipment, and the results are far better. The freezer is now being used in the freezing stem cells, where it is really necessary and applicable. Of course, we have also been applying the method of “bonding” the egg cell to the uterine wall, for quite long time now, or growing the embryo in endometrial nest created by the cells of the of a female’s endometrium.

I have read that freezing an egg cell and an embryo and defrosting alive is really difficult and precise. What are your results in this direction?

This is a worldwide problem, for 90% of the egg cells’ content is water, and after being defrosted, not all of them survive. This also applies to embryos. The survival rate of our embryos is almost 100%, as we only freeze the qualitative ones, where we have achieved excellent result in the preliminary growing. Respectively, over 70% success ratewith the egg cells. We are soon to purchase equipment which will allow us to monitor the parameters in the incubator, where the embryos and egg cells “sleep”. This way, if there is any change, we will be able to act on time.

Please, give a few examples, why people choose to freeze genetic material.

For example if a woman knows that her ovaries have to be removed or a man has to go through radiotherapy, which leads to loss of reproductive ability. Another example. 30 years old women, who still have very good reproductive function, but, due to very active professional way of living cannot afford to give birth at the moment. We are about to create a bank for egg cells and sperm donors. This will help women, whose egg cells reserve is effete.

Is there a chance for less successful in vitro procedure when using frozen genetic material?

With us, the chance for getting pregnant from frozen embryos is almost equal to the chance from fresh ones. First, because we have embryos, which after defrosting do not really differ from the fresh ones, second – because we can transfer the defrosted ones a little bit later. We have established that this way is better.

So, the higher the age of a woman, the more often it leads to in vitro procedures based on a spontaneous cycle.

Of course, there are also younger women who prefer this method. The spontaneous cycle has its pluses and minuses. On the plus side, the female is not stimulated medically and when we get a qualitative embryo, the chance to remain embedded is higher. On the other hand, only one egg cell can be extracted. That is why, some women freeze 2-3 egg cells and later use them on a natural cycle along with the fresh one.

In case of infertility, does the solution always have to be in vitro?

Very often the problems of couplesconcern endocrinology, including with men, and these problems can be solved in another way. Unfortunately, gynecologists-endocrinologists can be counted only on fingers of my both hands.