Specializări

Infertility is a heavy burden to couples who want to be parents. Assisted reproduction procedures, such as in vitro fertilization and intrauterine insemination, offer a chance to those who suffer from certain pathologies, or are simply diagnosed with infertility for unknown causes. Psychological counseling is a useful and necessary step that can help couples manage the emotional impact of the situation.

Infertility has a significant socio-economic impact; it is a fierce struggle and an emotional challenge. The role of the psychologist throughout the course of treatment is to complement drug and surgical treatments.

Although in vitro fertilization is not a challenging process, it may appear to be so because of the emotional charge involved. This is a fertility clinic, with integrated services and as such, we offer both members of the couple the opportunity to be counseled by our psychologist. Their skills include cognitive behavioral therapies, integrative psychotherapy and clinical psychology.

Couples benefit from the experience and skills of a psychologist who has an in-depth understanding of the IVF process. They work closely with the clinic’s medical staff, thus being qualified to “guide” patients throughout the entire process.

In addition to the feeling of inadequacy that arises when the infertility diagnosis has been ruled, the woman, in particular, must face a series of investigations that can add to that overwhelming sensation. At our clinic, we try to offer a relaxed, friendly environment to help patients in times of stress. Anxiety is a feeling that can occur time and again, but can be managed with the support of a psychologist.

When establishing the plan for the in vitro fertilization procedure, it is important for patients to be emotionally prepared. In this context, psychological counseling can play a very important role. Patients, especially women, can more easily cover all stages of the IVF process if there is a change in perspective. Somatization is a process recognized in the medical literature. Emotions can manifest physically as pain and discomfort, and these feelings can give a false sense of danger, of insecurity. The psychologist can help balance emotions, feelings, but more importantly, can play an important role in the emotional preparation of the couple for the procedures that follow.

Obstetrics involves monitoring and assisting woman during pregnancy, childbirth and postpartum. Gynecology is the branch of medicine that deals with the treatment of diseases of the female genital apparatus.

Obstetricians & gynecologists are doctors who specialize in women’s reproductive health and in the care of pregnancy and childbirth. They evaluate and treat a wide range of conditions such as: uterine fibroids, endometrial polyps, endometriosis, adenomyosis, cervical or endometrial cancer, urinary or genital tract infections, ovarian cysts, ectopic pregnancy, pelvic inflammatory disease, ovarian torsion.

Gynecologists can conduct a series of investigations and procedures, such as:

• Cervico-vaginal cytology (Papanicolau)
• Colposcopy
• Transvaginal ultrasound
• Hysteroscopy
• Laparoscopy
• Endometrial biopsy
• Biopsy and/or hemostatic curettage
• Amniocentesis
• Fetal morphological ultrasound
• Uterine devices fitting
• Myomectomy

The gynecologist who monitors the expectant woman throughout pregnancy, as well as during confinement, is in charge of the care, treatment and prevention of issues that can endanger the fetus and the mother. The obstetrician is familiar with the pathologies and complications that can occur during this demanding period for the future mother’s body. During pregnancy, the specialist would recommend a series of tests and medical checks to monitor the health of the pregnant woman and of the fetus. In addition to standard protocols, the doctor may prescribe any additional investigations, depending on the particularities and context of each case. Effective and constant communication between the obstetrician and the childbearing woman is essential for a seamless pregnancy. Therefore, the doctor-patient relationship needs to be based on trust. The gynecologist shall have a personalized approach, which they adapt along the way.

Pregnant women who opt for pregnancy monitoring in our clinic shall benefit from all specific investigations, from 1st – 2nd – 3rd trimester (single or multiple) pregnancy ultrasound, to 1st – 2nd – 3rd trimester (single or multiple pregnancy) fetal morphology, 2d, 3d, 4d ultrasound. Our laboratory is endowed with state-of-the-art equipment, which guarantees correct results.

Childbirth is one of the most important events in a woman’s life, as well as the beginning of a new stage. The process unfolds under the close supervision of the gynecologist. Patients can choose to give birth naturally, or by caesarean section.

Vaginal birth is a natural process through which certain physiological changes occur that allow the safe expulsion of the fetus. The process can be exhausting and traumatic, so the childbearing woman shall receive care and support from the medical team.

Although we encourage natural childbirth, there are medical situations in which this is not recommended, for reasons involving mother and/or baby health. The specialist doctor shall evaluate the case and shall also consider the preference of the future mother. Caesarean section is a surgical procedure that is performed with rachianaesthesia. The patient does not feel pain. The incision is made in the mother’s uterus, and the baby is born surgically. Our intervention rooms are at par with the highest quality standards in the industry, so that new mothers are completely safe when delivering their baby by caesarean section.

Gynecology is the medical specialty that deals with the prevention, diagnosis and treatment of conditions that can affect the external genitalia (vulva, vagina) or the internal one (uterus, ovaries, fallopian tubes) of women. Gynecology also deals with issues related to fertility, contraception, menopause and gynecological cancer. At Embryos, patients benefit from the experience of gynecologists and obstetricians, who offer solutions and treatments for a wide range of conditions.

Annual gynecological consultation is recommended and encouraged to monitor women’s health. The gynecologist specializes in diseases of the reproductive system, and can diagnose and establish the therapeutic conduct in case of a disease.

One of the strongest reasons for having an annual gynecological examination is screening for gynecological cancers. Detected in early stages, most gynecological cancers have high survival rates.

Maternal-fetal medicine aims at preventing and minimizing obstetric and perinatal complications, which can have serious consequences on the mother’s and child’ health. Maternal-fetal medicine involves a multidisciplinary approach, which is based on the collaboration between specialists in obstetrics-gynecology, neonatology, genetics, cardiology, pediatric surgery and other fields. The aim is to provide personalized and integrated care, also taking into account the needs and preferences of the mother and of the family.

Maternal-fetal medicine is a medical specialty that deals with the diagnosis, monitoring and treatment of conditions that may emerge in relation to the mother or to the fetus during pregnancy. It concerns all pregnant women, but especially those who are at high risk of complications during pregnancy. This risk may be triggered by the advanced maternal age (over 35), family history of genetic diseases or birth defects, multiple pregnancies (twins or more), history of gestational loss or premature births, chronic diseases of the mother or abnormalities detected on ultrasound.

Supra-specialized obstetricians identify risk factors that can have an impact on both the pregnant woman and the fetus. Specialists are competent in the treatment of pathologies that can upset the smooth running of a pregnancy. As the name suggests, the specialty considers either the health of the mother and the risk factors that can affect her (maternal medicine), or the health of the fetus and the risk factors that can impact it (fetal medicine).

Embryos specialists in maternal-fetal medicine are obstetricians in charge of the complex assessment of pregnancy. We have top-of-the-line ultrasounds which, used by our accomplished specialists, help evaluate and correctly diagnose children during intrauterine life.

Consultation with a specialist in maternal-fetal medicine is recommended to all pregnant women, but especially to those who face one or more of the following issues:

• At-risk pregnancies – are pregnancies that pose an increased risk of complications to the mother or fetus, because of factors such as advanced maternal age (over 35), multiple pregnancies (twins or more), history of gestational diabetes, preeclampsia, placenta previa, premature rupture of membranes, antepartum or postpartum hemorrhage, etc. These pregnancies require careful and frequent monitoring of the mother and fetus health, as well as proper birth planning.
• Pregnancy complications – are issues that occur during pregnancy and can affect its evolution or endanger the life of the mother or fetus. Among the most common complications are: miscarriage, premature birth, intrauterine growth restriction, intrauterine infections, congenital malformations of the fetus, chromosomal abnormalities of the fetus, intrauterine fetal death, etc. These complications require early and accurate diagnosis, as well as adequate and prompt treatment.
• History of gestational loss or premature birth – these are situations that indicate a vulnerability of the pregnancy and may increase the risk of recurrence in subsequent pregnancies. Gestational loss refers to any miscarriage before a 24-week gestation period, regardless of the cause. Preterm birth refers to any birth that occurs before a 37-week gestation period.
• Fetal abnormalities – are deviations from the fetus standard development, which can be detected by ultrasound or other prenatal diagnostic techniques. Fetal abnormalities can be structural (affecting the organs or physiological systems of the fetus) or chromosomal (affecting the number or structure of the fetus chromosomes). Fetal abnormalities can have genetic, infectious, drug, toxic or unknown causes.
• Medical conditions of the mother – are chronic or acute diseases that can affect the health of the mother and have repercussions on pregnancy or the fetus. Among the most common medical conditions of the mother are: diabetes, hypertension, heart disease, kidney disease, thyroid disease, autoimmune diseases, hematological diseases, infectious diseases, mental illnesses, etc.

Fetal medicine involves a series of investigations that allow early identification of abnormalities in the fetus, as well as maternal diseases that can affect the evolution of pregnancy or endanger the life of the fetus.

First trimester morphology consists of a detailed examination of fetal structures, that is conducted between 11 weeks and 6 days and 13 weeks and 6 days of gestation. At this stage, the development of fetal organs is systematically studied, which provides information about the exact age of pregnancy, the existence of certain abnormalities, the risk of developing genetic syndromes such as Down, Edwards and Patau. This risk is established by corroborating ultrasound results with serum testing.

Second trimester morphology consists of a detailed examination of fetal structures that is performed between 19 weeks and 23 weeks, and aims to examine in detail the anatomy and development of the fetus. This investigation can detect possible structural abnormalities of the fetus, such as malformations of the skull, face, missing limbs, kidney or heart abnormalities. Second trimester fetal morphology is important to check if the fetus is developing normally and to establish appropriate treatment if there are problems. At this stage, the fetus is sufficiently developed for the doctor to conduct a clear assessment of body structures. Tests shall be conducted to find whether fetal measurements are appropriate to the gestational age, and an analysis of all structures and organs shall be performed. Also, the risk of premature birth shall be calculated, by evaluating the cervix.

Fetal morphology ultrasound shall be performed starting with week 28 of pregnancy, the ideal period being weeks 30-33. During the investigation, head circumference, femur length, and body weight shall be measured. The indexes obtained shall be compared with standard values. Ultrasound can reveal whether there exist issues, such as growth restriction, functionality of the fetus organs, identification of possible malformations.

3-4D ultrasound is a type of obstetric ultrasound that allows visualization of the fetus in three dimensions and in real time. This type of ultrasound is mainly aimed at increasing the emotional bond between parents and baby, by providing realistic images of the face and movements of the fetus. Also, 3-4D ultrasound can be useful in some situations to better study the anatomy of the fetus and to detect possible malformations or abnormalities. It does not replace regular ultrasounds or fetal morphology, but it is an optional and additional examination.

Investigations performed by specialists in maternal-fetal medicine are essential in assessing the health of the mother and of the fetus. At Embryos, our specialist doctors perform the full range of ultrasounds required to monitor pregnancy.

High-performance equipment, endorsed by the experience of our gynecologists assure pregnant women that they are in good hands. In the first trimester of pregnancy, screening for chromosomal abnormalities is vital. Conditions such as Down syndrome (Trisomy 21), Patau syndrome (Trisomy 13), Edwards syndrome (Trisomy 18) can be identified at this stage. In the second trimester, screening for congenital anomalies can be performed. Birth defects may be less obvious at birth, but develop as the baby grows. They can cause mental or physical disability, from minor to very serious forms. The cause is abnormal embryonic development. When there is a suspicion or confirmation of genetic issues, maternal-fetal medicine specialists establish a pregnancy monitoring strategy, which they carefully direct, so that the pregnant woman can safely carry the pregnancy to term. Our specialists have a series of investigations available to monitor the mother and the fetus. In addition, when necessary, the gynecologist shall refer the pregnant woman to various related specialties, which contributes to maintaining them in good health.

Genetic diseases are conditions that occur as a result of changes in the hereditary material (DNA) in the cells of the body. These changes can be inherited from parents or occur spontaneously, during fetus development. Genetic diseases can affect various organs and systems of the body and trigger symptoms ranging from mild to severe.

The human karyotype is the graphic representation of the number and shape of chromosomes in human somatic cells. Chromosomes are structures made up of DNA and proteins, that contain the genetic information of the organism. The human karyotype is obtained by photographing, cutting and arranging chromosomes according to certain criteria, such as size, shape and position of the centromere (the region connecting the two chromatids of a chromosome).

Trisomy is a chromosomal abnormality, in which there are three copies of one of the chromosomes instead of two. Trisomy can affect various chromosomes and cause genetic syndromes having varying degrees of severity.

Trisomy 21 is the most common form of trisomy and is also known as Down syndrome. It causes mental retardation, distinctive facial features, heart conditions, and other physical abnormalities.

Trisomy 13 is a rare and severe form of trisomy and is also known as Patau syndrome. It causes significant mental retardation, malformations of the head, face, eyes, heart, kidneys and other organs.

Trisomy 16 is the most common form of trisomy that occurs at conception, but is incompatible with life. This causes miscarriage in the first trimester of pregnancy.

Trisomy 18 is a rare and severe form of trisomy and is also known as Edwards syndrome. It causes profound mental retardation, malformations of the skull, face, hands, feet, heart and other organs.

Genetic counseling is recommended to pregnant women when there are abnormal results of prenatal screening tests, a history of miscarriage, previous premature births, previous birth of a child with issues, exposure to external factors that can affect fetal development.

Infertility impacts on an average 4 out of 10 couples, while the number of those facing this issue increases every year. This is defined as the inability to conceive for 12 months, in the context of regular, unprotected sexual contact, under 35 years of age, or for 6 months, when over 35.

In vitro fertilization is a medically assisted reproduction procedure that consists of fertilizing the woman’s egg with the man’s sperm outside the body, in a specialized laboratory. The purpose of this procedure is to help couples who cannot conceive naturally because of fertility issues. The assisted human reproduction procedures that patients can benefit from in our clinic are in vitro fertilization or intrauterine insemination.

Intrauterine insemination and in vitro fertilization are two medically assisted reproduction procedures aimed at helping couples who cannot conceive naturally. Both procedures involve the introduction of sperm, or of already formed embryos in the uterus, but they differ in the way and place where fertilization takes place.

Intrauterine insemination (IUI) is a simpler and less expensive procedure, which consists of injecting a sperm concentrate directly into the woman’s uterus, around the ovulatory period. Sperm must swim to the fallopian tubes, where they can meet and fertilize an egg released from the ovary. Fertilization occurs naturally at the level of the fallopian tube and subsequently the zygote thus formed migrates for implantation in the uterus.

In vitro fertilization (IVF) is a more complex procedure, which consists in harvesting mature oocytes from the woman’s ovaries and combining them with sperm in a culture medium, outside the body, in a specialized laboratory. Fertilization occurs artificially, outside the woman’s body. The fertilized eggs become embryos and are transferred to the woman’s uterus after a few days of development. In vitro fertilization is recommended in cases of severe infertility or when intrauterine insemination has not worked.

In vitro fertilization is recommended when other methods of infertility treatment have not worked or when there is a severe or irreversible cause of infertility, such as:

• Blocked or absent fallopian tubes;
• Male infertility;
• Old age of the patient;
• Infertility caused by endometriosis, ovulation disorders, uterine fibroids or other gynecological conditions;
• Inherited genetic diseases;
• Premature ovarian failure;
• Unexplained infertility.

The IVF preparation stage involves several steps. The couple shall undergo an initial consultation with the assisted reproduction specialist. A detailed anamnesis shall be performed, then the patient shall be assessed from an ultrasound point of view. Subsequently, both partners shall undergo a series of medical tests, depending on their respective medical context and medical history. The couple shall adopt a healthy lifestyle prior to IVF, which includes a balanced diet, adequate hydration, avoiding smoking, alcohol and drugs, reducing stress and practicing moderate physical activity.

Ovarian stimulation is an essential step in the IVF process, since it is aimed at obtaining as many mature and quality oocytes as possible, which can be fertilized with sperm in the laboratory. The procedure is performed by administering hormonal drugs, under the supervision of a specialist in medically assisted human reproduction. Ovarian stimulation usually begins in the first few days of a woman’s menstrual cycle and lasts about 10-14 days. Depending on the type of protocol chosen, the process may involve the following steps:

• taking medicines that block the natural secretion of pituitary hormones (FSH and LH), which control ovulation. The drugs used are exogenous gonadotrophins (FSH, LH) and GnRH antagonists (gonadotrophin-releasing hormone) and shall be given as subcutaneous or intramuscular injections.
• administration of drugs that stimulate the growth and maturation of several ovarian follicles, which contain oocytes. The drugs used for follicular stimulation are gonadotrophins (FSH and LH) and shall be given subcutaneously. The dose and duration of follicular stimulation shall be determined individually, in relation to the ovarian response of each patient.
• giving a hCG (human chorionic gonadotropin) injection which mimics the action of natural LH and triggers ovulation. The purpose of this step is to induce the final maturation of oocytes and their release from follicles. The hCG injection shall be given at a precise time, established by the doctor, usually 35 hours before oocyte retrieval.

During stimulation, periodic ultrasound checks shall be performed to monitor the evolution.

Approximately 35 hours after the administration of medication to trigger ovulation, oocytes are harvested by ovarian puncture under ultrasound guidance. The procedure shall be performed under analgosedation and is painless for the patient. Under ultrasound guidance, the specialist punctures the ovaries and aspirates the follicular fluid containing the oocytes. This is immediately stored in sterile test tubes at human body temperature and handed over to the embryologist. The male genetic material shall be harvested at the same time interval and immediately transferred to the laboratory, to launch the fertilization process.

The process of laboratory fertilization is the stage during which harvested oocytes are combined with the sperm of the partner or of a donor, under controlled conditions, to obtain embryos. The laboratory fertilization process can involve two main techniques: standard IVF or ICSI.

After retrieval, oocytes shall be examined under a microscope to verify their maturity stage and integrity. Only mature oocytes (with two pronuclei) can be fertilized. Immature oocytes (with a single pronucleus) can be cultured to see if they reach maturity or can be removed. The harvested sperm is processed by various methods, to separate viable from dead or immobile sperm and other cells or substances. Sperm are selected according to motility and morphology and shall be kept in a culture medium until fertilization. Whenever IVF is used, each mature oocyte is placed in a drop of culture medium, along with a sufficient number of sperm (approximately 50,000-100,000). The droplets are coated with mineral oil to prevent evaporation and contamination and incubated at 37°C, for 16-18 hours. In ICSI, each mature oocyte is immobilized using a special pipette and injected with a single sperm, using a thin needle. The injected oocytes are then placed in a culture medium and incubated at 37°C, for 16-18 hours.

The embryo transfer procedure is the last stage of the in vitro fertilization process, which involves transferring the embryo(s) to the uterine cavity. It is a simple and painless procedure that does not require anesthesia and is more like a regular gynecological examination. It is recommended to transfer only one embryo and, in selected cases, 2 embryos at most.

In the period prior to the procedure, the preparation of the uterus shall be carried out, through hormonal treatment that stimulates the thickening of the endometrium or the thickening of the uterus naturally, without drug treatment. The best embryos shall be chosen for transfer, based on their quality and viability. The transfer to the uterus shall be performed through a thin and flexible catheter, which shall be inserted through the cervix to the level of the uterine cavity, where the doctor releases the contents.

In vitro fertilization is a process that can be demanding, both physically and emotionally. Preparation for IVF starts the moment of the initial consultation and ends with the embryo transfer. The couple shall adopt a healthy lifestyle and go through a series of medical tests required to assess their health.

The success rate of IVF procedures depends on several factors. The most relevant are the age of the woman and the number of oocytes harvested. But other factors can also influence the likelihood of success, such as sperm quality, couple’s lifestyle, certain associated medical conditions and the circumstances in the IVF laboratory where the procedure is performed.

The IVF treatment success rate is also influenced by the number of oocytes harvested from a woman in a cycle. The likelihood of obtaining quality embryos for transfer to the uterus increases with the number of eggs retrieved.

IVF procedures have higher chances of success if there are no associated pathologies and if the woman has a good ovarian reserve, if many oocytes are harvested and if there is a good quality endometrium. Sperm quality also makes a difference.

The success rate is higher the younger the woman is, while the absence of other pathologies that could prevent or hinder the process is of the essence. The decisions of the specialist doctor regarding the stimulation protocols are very important, but so is the laboratory where the fertilization procedure takes place. Note should be taken that it often takes several cycles of treatment to succeed.

Subsequent to the IVF procedure, after the embryo transfer, patients can resume their normal activity, with certain restrictions relating to excessive effort, extreme environmental conditions and exposure to stressful situations. There are a number of typical symptoms after IVF procedure, such as bloating, cramping, constipation, breast tenderness, etc. There are also situations that may require a specialist examination to rule out a possible infection, ovarian torsion, or ovarian hyperstimulation.

The in vitro fertilization process is not devoid of risks. It is important to inform patients of all the implications of the process. These are some of the most important risks involved by the IVF process:

• ovarian hyperstimulation syndrome;
• multiple pregnancy;
• ectopic pregnancy;
• infections;

Moreover, emotional issues are a part of the process that should not be ignored.

Medicine offers solutions that we make available to patients under the guise of the latest assisted human reproduction techniques. Each case is subjected to a thorough anamnesis. We attach great importance and embrace a holistic approach to the particularities of each person. Our clinic is endowed with state-of-the-art equipment. Our embryology and andrology laboratories are in the top tier in the country.

High-performance equipment helps us quickly and correctly identify the causes of infertility, and state-of-the-art fertilization techniques significantly contribute to increasing the prospects of pregnancy.

Endocrinology is that branch of medicine that diagnoses and treats hormonal conditions. Hormones play a central role in conceiving and carrying a pregnancy to term. Fertility issues can have hormonal causes. Similarly, maintaining a normal weight, as well as tight blood glucose control are essential to enhance pregnancy rates. Working with your diabetes doctor to make lifestyle changes is vital.

The thyroid gland is an endocrine gland responsible for regulating metabolism and other essential functions of the body. The thyroid gland functions undergo transformations during pregnancy, as a natural consequence of physiological and hormonal changes. The endocrinologist shall have to interpret the medical test results diverging from reference values, taking into account the background of pregnancy.

In the instance of an endocrine dysfunction, the woman may find herself unable to conceive. Disorders of the thyroid gland can cause a series of imbalances in the body. The endocrinologist guidance is paramount in restoring hormonal balance and creating an environment conducive to pregnancy.

Dysfunctions of the thyroid gland can be either hypothyroidism or hyperthyroidism. These may be pre-existing conditions that can negatively impact the pregnancy development, or occur by reason of it. These conditions can be autoimmune in nature and require close collaboration between the obstetrician and the endocrinologist.

Hypothyroidism is one of the main causes of female infertility. It is an endocrine disorder characterized by an insufficient production of thyroid hormones, which have an important role in regulating metabolism and the reproductive function. Hypothyroidism can affect fertility through several mechanisms, such as menstrual disorders, anovulation, hyperprolactinemia, or altered oocyte quality. Therefore, it is important to detect and treat hypothyroidism when you want to get pregnant. In order to diagnose the condition as a cause of infertility, the following investigations are required:

• Determining the level of thyroid-stimulating hormone (TSH) – this is a blood test that measures the amount of TSH secreted by the pituitary to stimulate the thyroid.
• Determining the level of free thyroid hormones (FT4 and FT3) – these are blood tests that measure the amount of thyroid hormones available for action at cellular level.
• Prolactin level determination (PRL) – this is a blood test that measures the amount of PRL secreted by the pituitary.
• Thyroid ultrasound – this is an imaging investigation that allows visualization of the structure and size of the thyroid, as well as possible nodules or cysts. Thyroid ultrasound can reveal any abnormalities in the gland.

In order for the fetus to properly develop its brain and nervous system, as well as to preserve harmony between mother and baby, an adequate amount of thyroid hormones is required. Hypothyroidism can cause the following issues during pregnancy:

• Miscarriage – the risk of miscarriage is increased in women with untreated hypothyroidism, especially in the first trimester of pregnancy. This is because excess thyroid hormones can affect the implantation of the embryo and cause an increase in prostaglandin levels, which can stimulate uterine contractions and lead to the expulsion of the product of conception.
• Preeclampsia –is a serious complication of pregnancy, characterized by increased blood pressure and the presence of protein in the urine after week 20 of pregnancy. Preeclampsia can affect both mother and fetus, causing edema, convulsions, kidney failure, coagulopathy, intrauterine growth retardation or fetal death. Hypothyroidism can promote preeclampsia by increasing heart rate, decreasing peripheral vascular resistance and altering endothelial function.
• Preterm birth – is defined as the birth occurring before week 37 of pregnancy. Premature birth can have negative consequences on the fetus, such as breathing difficulties, brain hemorrhage, infections or neurological sequelae. Hypothyroidism can cause premature birth by affecting the placenta or triggering preterm labor.
• Postpartum hemorrhage – is excessive blood loss after childbirth, which can endanger the mother’s life. Hypothyroidism may increase the risk of postpartum hemorrhage by rising uterine contractility or through clotting disorders.
• Congestive heart failure – is an impairment of the heart function, which involves accumulation of fluid in the lungs and other tissues of the body. Hypothyroidism can trigger congestive heart failure by increasing heart rate, decreasing peripheral vascular resistance, and altering the systolic function.

Hypothyroidism in pregnancy can have various manifestations and mimic the usual symptoms of pregnancy or depression. Here are some of the symptoms:

• Fatigue – a state of physical and mental weakness, which does not get better with rest. Expecting women with hypothyroidism may feel more exhausted than normal, even if they get enough sleep. Fatigue can affect the ability to manage daily activities.
• Cold intolerance – a high sensitivity to low temperatures, which causes chills, tremors or a freezing sensation. Pregnant women with hypothyroidism may perceive the environment colder, even if the temperature is adequate. Cold intolerance can affect the comfort and well-being of a pregnant woman.
• Weight gain – an excessive accumulation of body fat, which is not only due to the growth of the fetus. Expecting women with hypothyroidism may gain more weight than it is normal during pregnancy, even if they have a balanced diet and an adequate caloric intake. Weight gain can affect a pregnant woman’s health and self-image.
• Constipation – difficulty passing stools, which causes abdominal discomfort, bloating or pain. Childbearing women with hypothyroidism may experience constipation more frequently, even if they have an adequate fiber and fluids intake. Constipation can affect the quality of life and promote hemorrhoids.
• Dry skin – this is the dehydration of the superficial layer of skin, which causes a feeling of roughness, itching or cracking. Pregnant women with hypothyroidism may experience dry skin, even if they use moisturizers or oils.
• Friable hair and nails – this involves changes in the structure and strength of hair and nails, which cause hair loss, breakage of nails or the appearance of striations on their surface.

Hypothyroidism can have various causes, which can tell on both the thyroid gland and the pituitary gland or fetus. Among the most common causes are:

• Iodine deficiency – this is a common cause of hypothyroidism. Iodine is an essential element for the synthesis of thyroid hormones. During pregnancy, the need for iodine increases, as the fetus takes the mother’s reserves of iodine and thyroid hormones for its development. When iodine intake is insufficient, both mother and fetus may suffer from hypothyroidism.
• Autoimmune thyroiditis – this is a common condition in developed countries, especially in women with a family history of autoimmune thyroiditis or other autoimmune disorders. The disease is a chronic inflammation of the thyroid gland, triggered by an attack of the immune system on thyroid cells. This leads to progressive destruction of the thyroid and decreased production of thyroid hormones. Autoimmune thyroiditis can be triggered or aggravated by pregnancy.
• Disorders of the pituitary gland – these are rare causes of hypothyroidism, involving a dysfunction of the pituitary gland, located at the base of the brain. The pituitary gland produces the thyroid-stimulating hormone (TSH), which tells the thyroid how many hormones to produce. If the pituitary gland does not produce enough TSH or produces an abnormal TSH, the thyroid does not function properly and secretes fewer thyroid hormones. Disorders of the pituitary gland can be caused by tumors, radiation, surgery or autoimmune diseases.
• Congenital hypothyroidism – this is a rare cause of hypothyroidism in newborns, which can be genetically transmitted or can be triggered by environmental factors. Congenital hypothyroidism involves the absence, malformation or dysfunction of the thyroid gland in the fetus. This leads to a decrease in thyroid hormone levels in fetuses and newborns, with serious repercussion on the physical and mental development of the baby. Congenital hypothyroidism can be caused by the mother’s iodine deficiency during pregnancy, exposure to ionizing radiation, infectious or autoimmune diseases of the mother, or the negative impact of certain drugs or chemicals on the fetus.

Hyperthyroidism is the excess of thyroid hormones. The most serious consequence of this disorder is pre-eclampsia.

Here are some of the most common symptoms of hyperthyroidism:

• Heat intolerance – a decreased sensitivity to high temperatures, which induces excessive sweating, thirst or thermal discomfort.
• Fatigue – a state of persistent, chronic physical and mental weakness.
• Anxiety – a state of unease, worry or exaggerated fear that has no objective cause. Anxiety can affect your well-being and relationship with your partner or child. 
• Tachycardia – an increase in heart rate above 100 beats per minute, which is not explained by physical exertion or strong emotions. Women with hyperthyroidism may experience tachycardia more often than usual, even if they’re not performing strenuous activities or aren’t stressed. Tachycardia can affect cardiovascular health and increase the risk of heart complications.
• Nausea and severe vomiting – persistent nausea and severe vomiting, even in the absence of heavy or spoiled foods intake. The expectant woman may have nutrition and hydration problems because of severe nausea and vomiting, which can be a sign of a serious toxicosis called hyperemesis gravidarum.
• Weight loss – a reduction in body mass, which is not solely due to loss of water or adipose tissue. Women with hyperthyroidism may lose more weight than normal during pregnancy, even if they have a normal or even increased appetite. Weight loss can affect fetal health and development.

Hyperthyroidism can have various causes, which affect both the thyroid gland and the pituitary gland or fetus. Here are some of the most common causes:

• Graves’ disease – an autoimmune disease, in which the immune system attacks the thyroid gland and causes it to produce more thyroid hormones than needed. It is the most common cause of hyperthyroidism in pregnancy, especially in young women or women with a family history of the disease. Graves’ disease can be triggered or aggravated by pregnancy.
• Gestational hyperthyroidism – a mild and temporary form of hyperthyroidism that occurs in some women in the first trimester of pregnancy. It is caused by increased levels of pregnancy hormones, such as estrogen and human chorionic gonadotropin (hCG), which stimulate thyroid hormone production. It usually does not require treatment and resolves spontaneously after birth.
• Thyroiditis – an inflammation of the thyroid gland, which can have infectious, autoimmune or postpartum causes. Thyroiditis can cause an initial phase of hyperthyroidism, followed by a phase of hypothyroidism.

The endocrinologist shall prescribe the appropriate treatment during pregnancy. However, the treatment shall be adapted to the nature of the condition, namely whether it is a pre-existing condition or a condition developed during pregnancy.

A healthy diet and a normal weight are beneficial both for conceiving and for the healthy development of the fetus. Patients can benefit from consultation with the specialist in diabetes and nutritional disorders, in order to establish a nutrition plan appropriate to each case.

Male infertility is as common a condition as female infertility. Consequently, our clinic has a dedicated andrology laboratory. State-of-the-art equipment helps us make a correct and quick diagnosis, and decide together with patients the steps to follow.

Infertility is a complex issue that often involves both members of the couple. Andrology is the branch of medicine that studies the male reproductive system. Andrologists deal with the diagnosis, prevention and treatment of diseases of the male sexual organs. A number of pathologies and male sexual problems can be treated by the andrologist: infertility, erectile dysfunction, prostate problems, onco-andrological pathologies, sexually transmitted diseases. The diagnosis of male infertility can be made after a series of investigations. The causes can be multiple and multifactorial: infections, varicocele, chromosomal defects, environmental factors, endocrine disorders, genetic disorders, etc. The andrologist shall perform a comprehensive anamnesis, guide the patient and recommend all necessary medical tests. Our clinic offers a wide range of investigations, such as: clinical examination, transrectal prostate ultrasound, testicular ultrasound, semen analysis, hormonal tests.

Urology is the specialty that brings together medical approach and surgical treatment to correct congenital anomalies. The urologist is the one who performs surgery to treat male infertility. One of the most revolutionary investigations is the testicular biopsy, MicroTESE. During this revolutionary procedure, the urologist surgeon uses microsurgical instruments and a surgical microscope that magnifies 20 times or more, to carefully search inside the testicle for areas containing sperm. The procedure is minimally invasive, with multiple advantages for men experiencing total sperm absence. It allows semen to be collected directly from the testicular tubules. These structures are similar to “ducts” inside the testicles, which produce sperm. In the absence of such a procedure, the couple experiencing this type of infertility would normally resort to insemination or fertilization with donated semen. Our specialist doctors, assisted by state-of-the-art medical equipment, help couples fulfill their dream. Male infertility is no longer an obstacle to in vitro fertilization or to intrauterine insemination procedures.