The decision has been made – you want to have a child. For some people the next steps to achieving the result will pass unnoticed, but for others the road is full of problems such as infertility, difficult pregnancy, worries about the baby.
Contemporary medicine is able to solve most of your dilemmas, with growing success. Technology is developing so quickly that it is possible you are simply not aware of the newest methods in use. Before trying a procedure, it is good to have the independent opinion of a specialist – not only on the matter whether it is suitable for you and your health condition, but also what the chances of success are and if you need this treatment in particular.
One of the areas with incredible improvement is treatment of fertility problems. Things that were impossible to achieve technologically years ago – for example precise selection of a sperm to inject into the ova – are now a regular procedure. In men and women reasons for lower fertility or sterility can be very different, therefore it is important to do precise tests. Pay attention to the certificates of the laboratory which you will be using. Exact apparatus helps to get the picture of the particular organism in order to select the best genetic material for the procedures of artificial insemination of ova.
Before you go for in vitro, check if you can use some easier methods such as medication therapy without surgical intervention. In order to have the ova retrieval and subsequent injection go as pain-free as possible, pick good specialists with long-term experience in the in vitro fertilisation and using proven technologies. Harvesting and freezing some of the ova retrieved for possible further use is by now a standard practice – this way you can ensure yourself any future pregnancies or just slow down your biological clock, if you are not planning to get pregnant yet.
The success of the in vitro procedure varies according to your age and many other factors – so do not necessarily expect results from the first try.
"Each couple that is about to undergo an in vitro procedure must first be loaded with lots of patience and love. It is important to know that in natural conditions, the chances of achieving a pregnancy with couples who have no problems in conceiving a child are the same as with the chances of in vitro fertilisation – approximately 35 percent, " says Dr Daniela Savova, gynaecologist and specialist in reproductive medicine, Dr Shterev Hospital. "This means that the application of an in vitro procedure, although it is assisted by us, the specialists in reproductive medicine, does not always guarantees 100 percent success."
The couple should start preparing at least three months before procedure. "To a great extent, the success of a procedure depends on the quality of the oocytes and the embryos with a definite potential for implantation", Dr Savova explains. "The follicles, in which the oocytes are developed, have been recruited around 90 days before that. So, smoking should be quit, alcohol and coffee intake should be reduced. It is advisable for obese patients to lose some weight."
Typically the embryos injected are two or more, which increases the possibility for successful development of at least one of them. But be prepared to possibly make a decision to remove some other embryos in order to lower the risk of miscarriage.
"Although rare, there are cases when patients could suffer the so called ovarian hyperstimulation syndrome," Dr Savova says. "Another risk is the lack of ovarian response to the stimulation that could lead to a premature termination of the whole procedure. A common complication is the multiple pregnancy which poses serious risks for both the mother and the proper development of the foetuses, their survival and delivery of healthy babies. All these risks could be avoided if the procedure is applied by an experienced and qualified specialist."
Pregnancy comes with additional worries on the health of the baby and the proper development of the embryo. You certainly know that pregnancy after 35 years of age poses risks for genetic defects. On the other hand the diagnostics is not so easy.
"No woman is safe from having a pregnancy with a Down syndrome or other chromosome abnormality," says Dr Maria Yankova, an obstetrician at Sveta Petka Medical Centre. "Prenatal diagnostics discovers abnormal pregnancies and gives the parents a chance to abort it, if they want, in an early stage. In twin pregnancies where risk of chromosome abnormality is twice bigger, it is possible to stop the development of the "ill" twin and the healthy one to be born." Statistically, on every 100,000 pregnancies, there are 200 with Dawn syndrome and other 200 with different abnormalities. "The Dawn syndrome screening and foetal morphology are tests aimed at detecting a significant number of chromosome conditions, genetic disorders and structural anomalies," says Dr Yankova.
The main methods for diagnosis of embryos are taking some of the amniotic fluid, or amniocentesis, and the chronologically earlier chorionic villus sampling, which means taking samples of the structure that later evolves into placenta. Both carry some risks for the embryo, since they are invasive to the gestational sac, but they give reliable information on the development of the organs of the embryo, the number of chromosomes and their structure.
The earliest period in which chorionic villus sampling can be performed is 10th gestational week. In Bulgaria there are already available non-invasive prenatal tests, in which blood from the pregnant woman is enough to receive very reliable results on the most frequent chromosome defects as early as 9th gestational week.
One such is the Free Cell DNA test. "It examines the mother's blood, where the embryo DNA is stored," says Dr Yankova. "We apply it on pregnancies where invasive diagnostics such as amniocentesis and chorionic biopsy are not suitable due to higher risk of abortion. The Free Cell DNA test can define which pregnancies are indeed with abnormalities and which are normal, although risky. Thus, we decrease the use of invasive diagnostics and save more pregnancies."
In many medical centres and offices you can get 4D diagnostics of the embryo, which in combination with the other tests can give you precise information on the development of the organs. Through an ultrasound image the movements of the embryo can be traced and a number of anomalies of the spine development can be excluded. The test is not obligatory, but besides peace of mind, this kind of diagnostics will also bring you the first complete image of your child – unforgettable emotion, which stays as a memory for your whole life.