Your professional scope in the field of gynaecology and obstetrics is really extensive. What attracted you to assisted reproduction, which you are now most involved in?
Since the beginning of my medical practice, I have been fascinated by couples’ desire for a child. As a young doctor, I worked for nine years at the University Hospital in the east of Slovakia, where until then there was no clinic for infertility treatment. I was lucky enough to know that in our gynaecology department there was a specialist who at that time was the only one in the region who dealt with infertile couples. I realized what an important role a doctor can play in this process. I was intrigued from the very beginning and was with him every free moment.The final decision to specialize in reproductive medicine and go to work in a fertility clinic came after successfully completing my specialization in Gynecology and Obstetrics in Bratislava. Almost immediately after the exam, I joined the division and devoted all my time preparing for the specialty attestation in Reproductive Medicine, which I — also successfully — passed in Bratislava. During my studies I understood more and more that infertility was a really big problem, couples with fertility defects were increasing rapidly and there were few clinics in Slovakia at that time that dealt with this issue. That is why I decided to co-found an assisted reproduction centre in Košice with a very experienced chief doctor from the Czech Republic, where in 8 years we have built a successful clinic that has helped many couples in Slovakia and all over the world to have the baby they longed for.
You are a specialist in artificial insemination. Are you more likely to be contacted by older couples, or is there a growing number of couples who seemingly should not have a problem with conception or natural pregnancy?
It is true that in the past it was more about older couples aged around forty years, because there was low awareness in society about the possibilities of infertility treatment. Mostly only women came to us, and one can say that they came late. As age is becoming more widely discussed as the biggest enemy of fertility, the average age of couples coming to us is decreasing, and it is now averaging 37 – 38 years. While this is a positive trend, it is important to remember that even this age is on the borderline of the optimal time period for conception. In fact, the quality of the eggs of women after the age of 37 decreases significantly, which affects the success of treatment.
Through the media, you also spread awareness of fertility disorders and assisted reproduction. What myths do you encounter most often in this area?
The most common myth is that age does not affect the success of assisted reproduction in the sense of “I don’t need to rush, I have time, we need to give nature a chance, we want a child naturally”. In a negative way, this myth is kept alive by tabloid articles and pictures of well-known celebrities who have been lucky enough to have a child in their 40s and beyond. Of course, what is missing from the article is the very important information that in most cases the child is conceived by IVF and even more often by using another woman’s donated eggs. From my point of view, it is ideal to start dealing with infertility before the age of 35, and even earlier if a woman experiences any gynaecological difficulties such as painful, irregular or heavy menstruation, frequent inflammation or painful intercourse. These symptoms may be associated with ovulation disorders and reduced fertility. If a woman knows that she does not want to become pregnant in the near future, it is advisable to consider social freezing — that is, freezing young, healthy eggs. This will ensure that she can use them in the future if natural conception is not possible. Another very common myth is that artificial insemination produces ‘disabled children’. Many expert scientific studies have repeatedly shown that children conceived by IVF have not been shown to have an increased risk of developmental defects or any other serious diseases. The risk of multiple pregnancies is also a myth. It is precisely by using IVF and transferring just one embryo into the woman’s uterus that we can reduce the risk of twins and triplets, even in couples who have relatives with multiple pregnancies in the family. By doing so, we protect the health of both mother and children, because multiple pregnancies are associated with a higher risk of complications such as high blood pressure, gestational diabetes and premature birth.
The IVF method helps to achieve the desired baby both in case of complications on the part of the woman and in case of difficulties on the part of the man. What kind of problem do couples usually come to you with?
In most cases, “healthy” couples come to us who have no difficulties, they are just unable to conceive a child. Only we usually tell them where the problem is and how we recommend to solve it. For women, it is most often irregular cycles with hormonal imbalances caused by polycystic ovary syndrome, endometriosis, or prematurely “aging” ovaries. In men, it is most often urological problems, surgeries, inflammation, or injuries to the testicles, which may have happened even in childhood, and which cause poor sperm production in adulthood, even often to the absence of sperm in the ejaculate. In the last 10 years, since the world has seen a significant increase in wireless technologies based on the principle of electromagnetic waves, the morphology of sperm, that is to say, the shape regularity, especially of the sperm heads, has deteriorated significantly. These are then unable to naturally fertilise the woman’s egg in the fallopian tube. For these couples, IVF is often the only option.
It is claimed that IVF can help up to 90% of couples experiencing fertility difficulties. Which method have you used the most in your practice so far?
This statement is true, but it can be understood in different ways, and that tends to be a problem. Often a couple in their 40s will come to us and, after the necessary examinations, will be horrified to hear that the chance of having a child after IVF from their own eggs and sperm is about 10 – 15 %. However, this is a percentage of the success rate of one IVF cycle — that is, the chance of getting pregnant after the eggs have been collected in one menstrual cycle and then fertilised with their own sperm. The success rate of such an IVF cycle in a young couple under 35 years of age increases to 80 – 85 % depending on the condition of the ovaries and sperm. Of course, even older couples can increase their chances to 90 % if they repeat the cycles several times or ask for fertilisation of the donated eggs with their own sperm. The success rate of getting pregnant is then about as high as it is at the age of the young donor. So, yes, it is true that we help 90 % of couples who do not give up and undergo more cycles as they grow older or reconcile using donated eggs. Unfortunately, about 1 in 10 couples have serious diagnoses or unexplained causes of infertility, where even reproductive medicine is clueless for now.
What exactly awaits the couple who come to you?
The ideal first visit is when both partners are ready. This means that they bring all available medical reports, test results and information about previous illnesses and surgeries. The rest of the information will be found out during the joint consultation, which lasts between 40 and 50 minutes. The female patient undergoes a vaginal ultrasound and her partner, if he is after 2 – 5 days of sexual abstinence, submits an ejaculate sample, where we evaluate the number, motility and shape of sperm. The collection is performed by the partner alone, or with the female partner, in an intimate collection room by masturbation. Initial examinations include blood draws on both partners to screen for infectious diseases and, in the case of the woman, to rule out hormonal and immunological causes of infertility. Based on these results and medical history, we can suggest further steps to achieve pregnancy at the first visit.
Is there any way to support the treatment? Is there anything a couple can do to increase the likelihood of a healthy pregnancy (perhaps diet, vitamins, nutrition, or something else)?
I recommend every couple, regardless of diagnosis and age, to work on improving their lifestyle — not smoking, limiting alcohol, doing more sports, eating healthy, i.e. eating less smoked and fried food and more antioxidants in the form of leafy greens. For a woman, there are freely available dietary supplements containing inositols, folic acid and vitamins needed in pregnancy. For guys, I also recommend inositols, amino acids, trace elements Se, Zn, antioxidants, or if they have lower testosterone, also an anchoress — tribulus terestris. Sufficiently long and regular sleep and stress reduction are also important. If a couple has been unable to conceive for a really long time, or if they have had unsuccessful treatment and are mentally exhausted, psychological counselling is also recommended.
Is it still possible to get pregnant naturally after having a baby from artificial insemination?
Yes, sometimes the pregnancy itself, or the stimulation of the ovaries before IVF, has a healing effect on a woman’s body. The ovaries “rest” during pregnancy, the hormonal system in the body stabilizes, which can lead to an increased chance of natural conception. Not to mention the positive effect of successful conception on the couple’s psyche. However, it always depends on the cause too — why the couple underwent artificial insemination. There are diagnoses that are definite and irreversible, then the chances of natural conception are minimal.
Do you have a professional dream that you want to fulfill?
My biggest professional dream was to find a field of medicine in which I could help people as much as possible and become a recognized professional. I found it in reproductive medicine. Running a successful clinic that has helped many couples was a nice cherry on top of the cake. Now I try to stay fit and healthy so that I can keep doing this work for as long as possible, and thus help as many infertile couples as possible. I also want to pass on my experience to younger colleagues who, like me, have become enthusiastic about this very interesting field of medicine. My vision is a world where every couple who wants a child has a chance to become parents.
