Dr. Stella Chapanova graduated from the Faculty of Medicine at Trakia University – Stara Zagora in 2015. The same year, she became part of the team of “Nadezhda” Medical Center, where she also completed her specialization. She acquired a specialty in “Obstetrics and Gynecology” in 2020. She completed courses in the field of assisted reproduction and minimally invasive gynecology in Barcelona, Lisbon and Dubai. He is a member of the Bulgarian Medical Union and ESHRE.
On October 16 and 17, 2021, the team of “Nadezhda” Medical Center, headed by Dr. Stella Chapanova, took part in the first ever Swiss forum for patients with reproductive difficulties – Kinderwunsch InfoWeekend, which was held in “Technopark-Zurich” . In the seminar part of the event, Dr. Chapanova, a specialist obstetrician-gynecologist from the “Reproductive Medicine” Sector, talked about the modern approaches and therapies in the treatment of difficult cases of infertility, for which “Nadezhda” Hospital is known abroad.
– Dr. Chapanova, tell us about your participation in the Swiss forum for patients with reproductive difficulties?
– This is the first such forum to be held in Switzerland dedicated to reproductive health and couples with infertility. Clinics from Spain, Italy, Greece, Russia and Turkey were invited. Nadezhda Hospital was the only representative from Bulgaria, which is a great honor for us.
We were also the only center among the participants, offering complex diagnosis and treatment of problem pregnancy, including in relation to immunological and genetic problems, as well as opportunities for modern minimally invasive reproductive surgery. At the forum, I presented different approaches to treating patients with infertility, based on our experience and specific examples from our practice.
The event was held in a hybrid format – online for the seminar program and in person under strict anti-epidemic measures. In addition to the lecture part, we also participated in the event with consultations of couples with reproductive problems. Dozens of families from Switzerland visited the forum and took advantage of the opportunity to meet specialists from all over Europe.
– What are the innovations in the treatment of difficult cases of infertility that you apply?
– In the hospital, we have a huge team of specialists in various medical fields, which gives us the opportunity to do a wide range of research and manipulations when solving individual cases. We introduce and apply world achievements in the field of assisted reproduction, ensuring this with the necessary highly specialized medical equipment.
For example, one of the achievements of modern medicine that we successfully apply in the hospital is the pre-implantation genetic test of embryos (PGT). This is a method for early genetic diagnosis of in vitro embryos, before their transfer to the uterus. We are also the first invitro center in Bulgaria, which introduced them 13 years ago. During this period, thousands of embryos were examined and a huge amount of experience was gained.
Another direction in which we are actively developing is reproductive surgery – diagnostic and operative hysteroscopy, laparoscopic operations for various pathologies. I should note here that the hospital introduced an innovative method of laparoscopy with a diode laser into its practice. Laser interventions are extremely precise and gentle, and this is essential for the patient, who has a shorter stay under anesthesia, minimal tissue damage and reduced blood loss – a guarantee of a quick recovery.
In the diagnosis and treatment of reproductive difficulties, we also apply a set of immunological tests that are tailored to the individual case of each couple. One such test is IMPO, a diagnostic method developed in our hospital to determine the implantation window. The aim is to determine when is the best time for embryo transfer and whether there is a risk of complications afterwards (implantation failure, abortion).
In addition, the hospital also performs immunological, microbiological and virological biopsies of the endometrium. With their help, recurrent miscarriages and implantation failures, which many couples face, are overcome.
Dr. Stella Chapanova
– What are the main difficulties you face in treating such cases?
– The most complicated are those cases in which we have to compete with time – in advanced reproductive age and in women with prematurely reduced ovarian reserve. We have different strategies that we try to help restore ovarian function and improve egg quality, but the road is long and full of challenges.
Other complex cases are patients with severe uterine anomalies unresponsive to correction, as well as those who have undergone operations with resection of ovarian tissue or removal of ovaries. We must not miss the cases related to the male factor – patients in whom there are single spermatozoa or no sperm at all, even with the application of invasive procedures, such as TESE/PESA (testicular biopsy/epididymal puncture).
In addition, difficulties in treatment may also be caused by the patients’ previous experience. We have such couples who have suffered multiple setbacks and wandered between different diagnoses and centers. Then we need to differentiate the main problem and focus our efforts on solving it. The psychological aspects of reproductive problems are also a challenge in our work – the couple’s belief in the success of our common struggle. Patients who have undergone many procedures are extremely vulnerable and should be approached with special care.
– What are the main causes leading to infertility? In which gender are they more common?
– We cannot attribute the reasons solely to women or men. Very often there is a problem with both partners. In men, changes may be related to sperm count, motility or morphology. The presence of antisperm antibodies or DNA fragmentation of the spermatozoa are also not excluded.
In women, the problems may be related to the patency of the tubes, features of the uterus, endometriosis, adenomyosis, immunological factor, lack of ovulation, etc.
– What kind of prevention is good to apply to prevent such problems?
– Reproductive problems and their causes are different and there is no exact “recipe” for prevention. But what every woman can do for herself is not to miss her regular preventive examinations at the gynecologist, and in case of complaints, not to delay treatment. If there are plans for a baby, but they are not on the agenda, we recommend that the ovarian reserve be examined at least once a year. This is a blood test for Antimuller hormone, E2, LH and FSH on the second-third day of the monthly cycle, combined with a gynecological examination with ultrasound.
It is important for a woman’s overall good physical condition to lead a healthy lifestyle – to eat a balanced diet, not to overdo it with smoking and alcohol, and to do sports.
Men can check their reproductive status through an easy and affordable basic test – a spermogram. The recommendation for a healthy and active lifestyle also applies to them.
It is important to say that any couple who are trying for a baby, but are unsuccessful, should consult a reproductive specialist in a timely manner and not delay. If the woman in the couple is under 35 years old, the visit to the doctor should take place up to a year after the first attempts for a baby. If the woman is over this age – after 6 months of unsuccessful attempts, it is appropriate to visit a specialized center for reproductive health.
Women who do not have plans to get pregnant or a suitable partner at the moment can consider the option of freezing their eggs – a direction in which our hospital is actively working and has accumulated experience.
– To what extent does genetics predispose to infertility?
– The reasons for infertility in couples are different and often complex. Some of them may be genetic. We are talking about a genetic factor in patients with translocations, inversions, microdeletions, Turner syndrome, Kallman syndrome, various structural autosomal aberrations, etc. Prematurely exhausted ovarian reserve may also be an expression of a genetic abnormality.
Other conditions associated with a genetic factor are poor ovarian response to stimulation, various cases of hypogonadism, and even diagnoses such as polycystic syndrome and fibroid uterus.
In men, genetics can be an explanation for a severely deteriorated sperm count.