The very in depth details they sent me can be seen below.

Contact details and more information on Nadezhda clinic, Sofia, Bulgaria can be found at:
http://www.medspa.bg/en/view-treatment-and-rehabilitation/1/infertility-ivf.html
http://www.medspa.bg/en/view-hospital/3/nadejda-fertility-clinic.html

The response to my questions were:

1. What is the current success rate for your clinic? (preferably by age as I know that the success rate will be much lower for somebody of my age)

Success rate of NADEZHDA clinic, 2010

Clinical pregnancy rate for controlled ovarian stimulation cycles at NADEZHDA clinic:

Age                 Success rate
below 30         55.32%
30 − 35           43.9%
36 − 39            32.84%
39 and above   18.4%

Clinical pregnancy rate for patients that had low response to stimulation (up to 4 eggs retrieved): 25.33%

Live births rate as per cent of treatment cycles (controlled ovarian stimulation cycles): 39%

2. How many cycles do you perform per year at the clinic?

About 1900 stimulations, 700 natural cycles and 2289 embryo transfers − fresh and frozen-thawed cycles. Data year 2010.

3. What is the maximum age that you treat?

51 years, both for non-donor and donor-egg IVF.

4. Are there any fertility conditions that you will not treat?

NADEZHDA has gained an excellent reputation both in Bulgaria and abroad. It is well known for dealing with complicated cases. The clinic has achieved good results in cases of poor ovarian response, unexplained infertility and recurrent ART failure.

5. What is your embryo transfer policy? How many embryos will you replace at one time?

The number of embryos to be transferred is recommended individually depending mainly on the quality of the embryos, patient’s age, treatment and obstetric history. Embryos with the best potential to implant in the uterus are chosen for the transfer.  Having been advised of the chances and potential risks, the patient will have the opportunity to give an informed opinion about the number of embryos that she would like to be transferred.

6. What is the basic cost of the IVF treatment?

EUR 2600 non-donor IVF treatment cost, including:

1. NADEZHDA clinic services: medical/fertility history review, initial consultation, follow-up consultations, incl. prescribing proper doses of stimulation medications, ultrasound scans, blood tests, IVF treatment plan estabilishment, IVF program clarification and medical administration guidance, egg retrieval incl. anaesthesia and anesthesiologist, sperm collection and preparation for egg fertilization (preparation of donor sperm), fertilization with ICSI, extended cultivation over 48 hours / blastocyst culture, everyday information on the embryos development, assisted hatching, embryo transfer, final report on the cost of medications and procedures;
2. MEDSPA services (treatment abroad facilitating agency): all coordination between you and the IVF clinic, in your country and in Bulgaria, assistance with IVF vacation travel arrangements, meeting you at the airport, transportation to your hotel, transportation to all appointments at the IVF clinic and back to the hotel, assistance with currency exchange in Bulgaria, cell phone with your doctor’s cell phone number and other important numbers pre-programmed, traveler’s information and advice on cultural differences, savings, SPA treatments, sightseeing, dining, movies, concerts, wine tasting, day trips to historical, cultural or natural landmarks and shopping, drive back to the airport.

EUR 4800 donor-egg IVF treatment cost, including:

1. NADEZHDA clinic services: medical/fertility history review, initial consultation, follow-up consultations, egg donor matching, ultrasound scans, blood tests, IVF treatment plan estabilishment, IVF program clarification and medical administration guidance, synchronising your cycle with the egg donor’s cycle, stimulation medications for the egg donor and donor compenstaion, prescribing proper medications to improve your endometrial receptivity, donor egg retrieval incl. anaesthesia and anesthesiologist, sperm collection and preparation for egg fertilization (preparation of donor sperm), fertilization with ICSI, extended cultivation over 48 hours / blastocyst culture (if applicable), everyday information on the embryos development, assisted hatching, embryo transfer, final report on the cost of medications and procedures, including medications used for the stimulation of the egg donor, procedures for the donor and donor compensations;
2. MEDSPA services (treatment abroad facilitating agency): all coordination between you and the IVF clinic, in your country and in Bulgaria, assistance with IVF vacation travel arrangements, meeting you at the airport, transportation to your hotel, transportation to all appointments at the IVF clinic and back to the hotel, assistance with currency exchange in Bulgaria, cell phone with your doctor’s cell phone number and other important numbers pre-programmed, traveler’s information and advice on cultural differences, savings, SPA treatments, sightseeing, dining, movies, concerts, wine tasting, day trips to historical, cultural or natural landmarks and shopping, drive back to the airport.

7. What additional costs would / could be incurred?

The non-donor IVF treatment cost does not include: stimulation medications, sperm donor matching and sperm donor compensation (if applicable), fertilization with IMSI (if needed), preimplantation genetic diagnosis − PGD/CGH (on request, recommended by а geneticist), acupuncture (on request), sperm freezing and 1 year storage (on request), freezing of surplus embryos and 1 year storage (on request), psychological counseling (on request), accommodation in a hotel or an appartment house, interpreting services (on request), translation of documents (if needed), individual IVF support SPA program (on request).

The donor-egg IVF treatment cost does not include: blocking injection (if applicable) and hormone replacement medications for you, blocking injection (if applicable) and hormone replacement medications for you, sperm donor matching and sperm donor compensation (if applicable), fertilization with IMSI (if needed), preimplantation genetic diagnosis – PGD/CGH (on request, recommended by а geneticist), acupuncture (on request), sperm freezing and 1 year storage (on request), freezing of surplus embryos and 1 year storage (on request), psychological counseling (on request), accommodation in a hotel or an appartment house, interpreting services (on request), translation of documents (if needed), individual IVF support SPA program (on request).

8. What happens to the costs if the cycle has to be abandoned?

You receive a final report of the cost of the cycle up to the moment it has been cancelled. Money paid by for services not rendered could be either returned or left for another cycle.

9. How long would I need to be in Bulgaria for?

You have to stay 14 days for non-donor IVF and 5 days for donor-egg IVF.

10. Who deals with the logistics of flights and accommodation?

Our partner MEDSPA BG, a medical tourism facilitator, takes care of flight arrangements and accommodation.

11. How is the pre-treatment carried out?

1. Schedule with MEDSPA your initial consultation visit to the clinic and receive options for your travel plan, including accommodation.
2. Arrive in Sofia. Your MEDSPA case manager will meet you at the airport, bring you to the hotel and accompany you to the clinic and at your initial consultation. You will receive a mobile phone with no limit for local calls to help you communicate freely with your doctor at NADEZHDA or MEDSPA case manager while in Bulgaria.
3. Initial consultation with your doctor and first visit to the assisted reproduction unit at NADEZHDA. At this point you will meet NADEZHDA physician, who has already reviewed your medical & fertility history. The doctor may ask you questions about your couple history as well as about your lifestyle. He/she will check the results of any additional previous tests that you have brought. You are also free to ask any questions about the clinic and your chances to conceive a baby through an assisted reproduction there. The doctor will perform a transvaginal ultrasound scan of the lady to assess her uterus, ovaries and pelvis. You will receive a list of all tests that need to be done in your case in order to find the best solution for your infertility problem. Do all tests relevant to your specific medical case. If your health insurance covers the routine lab work needed in the preliminary stages before IVF, you can conduct these tests at home, and the specialists at NADEZHDA clinic will assess the results that you will send. If your insurance does not cover any or all of the tests, you can make the tests needed at the serology and immunology lab of NADEZHDA clinic ( In Bulgaria prices of all such tests are quite competitive compared to the rest of Europe.)
4. If you proceed to a non-donor IVF treatment, based on the results and the final evaluation of your doctor at NADEZHDA clinic, you will receive a treatment plan and your IVF program will be explained to you. Then you sign an informed consent form.
5. If you proceed to donor egg or donor embryo IVF treatment, you receive a treatment plan based on the results and the final evaluation of your doctor at NADEZHDA clinic. The purpose is to synchronize your cycle with the egg donor’s cycle and to prescribe you the most proper hormone replacement in order to prepare your uterus for the embryo implantation. You are encouraged to ask any questions about the steps of your protocol.  Sign an informed consent form.

12. How do I get medication?

In order to save time, your ovarian stimulation may start at home (the first 4-5 days). This could be coordinated between NADEZHDA clinic and your local Ob/Gyn.  Usually patients take the ovarian stimulation medications from NADEZHDA clinic. The nurse provides them with a detailed explanation on how to store the medications and administer them. Patients receive a small cooling bag for medications that need to be kept at fridge temperature. If your health insurance covers the prescribed stimulation medications, you can buy them when you return home. In that case you will also receive a cooling bag together with instructions on how to administer the medications and safely bring the remaining doses on your next visit to NADEZHDA clinic. Please, check if your health insurance covers the fertility medications prescribed by your doctor.

13. How will I be monitored?

Non-donor IVF treatment:
In case of a long stimulation protocol (Based on all tests and exams, the type of your ovaries and infertility factor, your doctor at NADEZHDA will decide if long or short stimulation protocol should be applied in your case), at around day 20 of your menstrual cycle, you pass an ultrasound scan at you local Ob/Gyn to confirm that there is no follicle left over from the previous cycle. Only if this is confirmed, you go ahead with a blocking injection that will temporarily suppress your ovaries. You will have received detailed instructions from NADEZHDA on how to give yourself the injection. You may also ask your local GP or practice nurse to administer this. If for some reason you are not sure about the ultrasound scan result, please, email it to MEDSPA at office@medspa.bg and you will timely receive a reply from NADEZHDA clinic.

In about 2 weeks you have an ultrasound scan at you local Ob/Gyn and your estradiol (E2) level is measured through a blood test to give a baseline about the first doses of follicle-stimulating hormones needed. Please, email the results to MEDSPA at office@medspa.bg to receive instructions from NADEZHDA.

In order to save time, your ovarian stimulation may start at home (the first 4-5 days). This could be coordinated between NADEZHDA clinic and your local Ob/Gyn.  Usually patients take the ovarian stimulation medications from NADEZHDA clinic. The nurse provides them with a detailed explanation on how to store the medications and administer them. Patients receive a small cooling bag for medications that need to be kept at fridge temperature. If your health insurance covers the prescribed stimulation medications, you can buy them when you return home. In that case you will also receive a cooling bag together with instructions on how to administer the medications and safely bring the remaining doses on your next visit to NADEZHDA clinic. (Please, have in mind that prices of fertility medications are more or less at the same level in all EU countries.)

Arrange your travel plan with MEDSPA, so as to visit your doctor at NADEZHDA clinic on the 5th day of your stimulation at the latest.  

Within about a week, starting from the 5th day of your stimulation, you will pass several ultrasound scans at NADEZHDA clinic to monitor the development of your follicles and blood tests to measure your estradiol and progesterone levels that will help adjust the doses of your stimulation medications.

If short stimulation protocol is applied, no blocking injection is used. Stimulation starts on the 2-3 day of the menstrual cycle after a baseline ultrasound scan and a blood test to measure FSH, E2, and progesterone levels. Following no more than 3 days of stimulation, an ultrasound scan will be performed and the levels of your Е2, LH and progesterone will be checked again to adjust the doses of your stimulation medications, if needed. From then on, every other day you will have ultrasound scan & blood test to monitor the development of your follicles and the levels of your hormones.

When your doctor decides that the number and size of your follicles, as well as the levels of your hormones are optimal, you will be given an HCG (human chorionic gonadotrophin) injection that will induce the maturation of your eggs.

Donor-egg IVF treatment:

Each recipient requires individual medications. Usually, for a recipient with regular periods, the treatment starts with a blocking injection to temporarily block the release of your normal hormones. The injection is administered at around day 20 of the beginning of your menstrual cycle. You will have received detailed instructions from NADEZHDA on how to give yourself the injection or you may ask your local GP or practice nurse to administer it. If you are a recipient with no menstrual period, you have to take first Duphaston and Estrofem to induce your period. Within about two weeks (if blocking injection has been applied) or on day 1 of your menstrual cycle (if no blocking was used), synthetic estrogen in the form of tablets, injections or patches (usually Estrofem) is administered for about 14 days followed by an ultrasound scan by your local Ob/Gyn to measure the thickness of your uterine lining. Send the result of your ultrasound scan to MEDSPA and you will receive a reply from your doctor at NADEZHDA if it is necessary to adjust your estrogen dosage to ensure that at the end of your mock cycle (up to 3 weeks) your uterine is prepared for the embryos to implant. You will be advised in time about the date planned for the donor’s egg retrieval. (In some cases the donor may hyperstimulate, or fail to stimulate, and the treatment may have to be cancelled.) On that day you have to start administering progesterone (usually vaginal Utrogestan) and folic acid.

14. How will I know that I am not being under / over stimulated?

This information is received from your blood tests and ultrasound scans at Nadezhda clinic.

15. If I have a problem whilst in the UK who would I go to?

Your local Ob/Gyn or GP. Unfortunately, Nadezhda clinic does not partner yet with a specific UK clinic.

16. Is the clinic registered with any regulatory body?

NADEZHDA clinic is certified as per the requirements of Ordinance 28 of the Bulgarian Ministry of Health for Assisted Reproduction Activities.

Technorati Tags: Bulgaria

The price seems pretty good considering it includes all the medication. It does, however require a fairly lengthy stay in Bulgaria of 30 days. The website is www.invitr.bg but unfortunately it is not in English.

Thank you for your interest in our clinic. First I want to tell you that we are a little IVF centre, not situated in a hospital.
Secondly, I tried to answear all the questions in your e-mail in short:
1. 1 patient (with no donor oocytes).
2. 130-150 cycles per year.
3. We offer donor oocytes to women over 42 years of age, but there is no problem whatsoever to try with your own oocytes (if you respond to the stimulation)
4. Yes, there are. According to the medical standarts.
5. Depending on the age of the patient and the quality of the embryos (in your case – probably all of them).
6. Approximately 3000 euro, (approx. US$4,080) including the medications (without donor oocytes).
7. Everything considering your accommodation in Sofia – transport, hotel prices etc.
8. You pay for the treatment, you have been subjected to – for example if your ovaries do not respond to the stimulation, you are obliged to pay only for the medications you have used so far and the examinations, but not for the IVF procedure itself.
9. Approximately 30 days.
10. Unfortunately, we are not able to provide you any help with this matter.
11. I am not sure I understand your question, please be more specific.
12. The price we give you (app. 3000 euro) includes the medications. If you have the possibility to obtain your own, there will be no problems, but you have to consult a doctor first.
13. Epicrisis, ultrasound examinations, hormone levels measurement, spermogramme.
14. You will be monitored personally by the doctor.
15. London Women’s Clinic, dr. Matey Andonov.
16. Yes, it is legal requirement.

Best regards
Plamen Todorov, PhD
Senior Clinical Embryologist

To save you having to jump between my letter and the answers these are the questions I asked:

1. What is the current success rate for your clinic? (preferably by age as I know that the success rate will be much lower for somebody of my age)
2. How many cycles do you perform per year at the clinic?
3. What is the maximum age that you treat?
4. Are there any fertility conditions that you will not treat?
5. What is your embryo transfer policy? How many embryos will you replace at one time?
6. What is the basic cost of the IVF treatment?
7. What additional costs would / could be incurred?
8. What happens to the costs if the cycle has to be abandoned?
   
9. How long would I need to be in ________ for?
   
10. Who deals with the logistics of flights and accommodation?
11. How is the pre-treatment carried out?
12. How do I get medication?
13. How will I be monitored?
14. How will I know that I am not being under / over stimulated?
15. If I have a problem whilst in the UK who would I go to?
16. Is the clinic registered with any regulatory body?

Technorati Tags: Bulgaria