Dr. Mariela Daskalova is a doctor with 25 years of academic practice in the Department of Anatomy, Histology and Embryology of the Medical University – Plovdiv and has the same specialty. She has completed a number of international postgraduate courses in anatomy, histology and cytology, embryology, maternal-fetal medicine, ultrasound embryology and fetal anatomy, reproductive medicine, infertility diagnosis and treatment, etc. He has several years of experience as an embryologist in in vitro centers, and since 2012 he has been working as a doctor at the “Dr. Vasil Daskalov” Center for Reproductive Health in Plovdiv. USBALAG “Selena” medical consultant for male fertility. Co-founder and permanent medical consultant of the “Conception” association – the first patient organization, which since 2004 has been protecting the rights of patients with reproductive problems in Bulgaria. – Dr. Daskalova, every year in the month of November, the global health community conducts a number of initiatives regarding men’s health, we have also seen such initiatives in our country in recent years. Do you think there is any benefit to them? There is a benefit to any information campaign that is carried out with care and with a responsible attitude. Did you know that sometimes I get calls from people who have read something I wrote 10 years ago or more. And that has helped them. Any credible information arms people with knowledge, and knowledge is power. An informed person does not wander, but knows who to turn to, what to do and what decisions to take. This saves him time, nerves and money. – Why are we focusing on men’s health? Men’s health is a focus in men’s health campaigns because men live an average of 5 years less than women. Shortening their life expectancy is often due to preventable diseases, both physical and mental. And this is the goal of the November campaign, and it is, of course, year-round and permanent – to extend life and improve the health of men. – What does reproductive health prevention and care include? Reproductive health is part of a person’s overall health. Reproductive health means that people are able to have responsible, satisfying and safe sex lives, and that they have the ability to reproduce (have children) and the freedom to decide whether, when and how often to do so. A healthy man is not the one who does not go to the doctor, but the one who regularly visits a health specialist and takes preventive measures. Modern medicine does not wait for diseases to develop, but tries to detect predispositions early and take preventive measures in time. The lack of campaigns for prevention and funding of basic research is a major problem of our health policy. For which I have been blaming the state for 20 years and insisting that this change. And I will continue to do so. – As a specialist in this particular field, has the awareness of men regarding reproductive health increased? There is much more information now than years ago,but there are also many false things written on the net. And people can hardly sift the wheat from the chaff by themselves. That’s why I always advise people to have media hygiene. Just as we have physical hygiene and wash the fruits before eating them, so it is good to have media hygiene and not read from unreliable, mean and misinforming sites. And there are plenty of them on the web. – The campaigns we are witnessing seem to be more focused on the prevention of prostate cancer in men over 50 years of age, diseases of the genitourinary system. Do you also have such observations? Yes, these are serious and significant diseases and it is good to talk about them a lot. But we shouldn’t ignore young men, they have their problems too. Even some “male” diseases are more common at an early age, such as testicular cancer. In addition, it is highly unlikely that, unless spoken to, young men will realize on their own that they too may be suffering from male-specific issues at an early age. – Do you think that reproductive health remains in the shadows in this campaign and how could this change? Reproductive health is always in the shadows. The way to change is to not give up, although it is difficult, to continue to inform the public about the possibilities in the field of reproduction. To stand up for the rights of patients and to demand from the institutions for more commitment. To be persistent in our efforts for better health care. – What care should a man of reproductive age take for himself, what should he not do and what should he do in order to have a normal sex life and preserve his reproductive abilities? The advice on healthy living is already well known to the young man, or at least I hope so. Unfortunately, it is difficult to give up habits such as smoking. In today’s stagnant lifestyle, excess body weight is a serious and significant problem. Young men train and resort to anabolics, which also harms them. We do not have screening programs for sexually transmitted diseases or hereditary diseases. These are all guidelines that can be worked on. – Should young men take care of their health even before entering reproductive age? We have been working in this direction for a long time, and for years we have been conducting the campaign “Be on the clock for reproductive health” aimed at young people with the “Conception” association and with volunteer work. We are particularly happy and a bit proud that this initiative has been approved at the European level and has now started to take place in other countries in Europe in the form of the FActs game. – Why does a man’s reproductive health deteriorate with his age? What changes occur and at what age does sperm quality decline? Time is not our friend, time is our enemy. We don’t get younger and healthier with age. But still, time is kinder to men than to women. They remain fertile until a later age,as after 40 and especially after 50 years of age and their indicators begin to deteriorate, but significantly more smoothly than in women. – Does male fertility decline before middle age, even in the 20s-30s? What caused this? No one is immune to reproductive problems, even at the age of 18. Alas, young age is no guarantee of health. In recent years, covid has also affected the male population very badly. Unfortunately, in some young men, their spermatogenesis has been irreversibly damaged after a past coronavirus infection. There are congenital diseases that cannot be detected in any other way than through specialized research. And they are done only when the man realizes that his partner is not getting pregnant. Before that, there is no way to go in this direction, since men do not have complaints and other health problems that would bring them to the doctor. The usual suspects from the point of view of factors affecting male fertility are lifestyle and occupation, certain diseases and predispositions, for example to diabetes or high blood pressure. But also some drugs can negatively affect reproduction. – When should a couple consult a reproductive specialist? After what period of time since trying to conceive? In a future and better world, respectively a better health system, I would say before trying to get pregnant. This is precisely what prevention is all about – to protect themselves from sexually transmitted diseases, to see if they have immunity to some significant diseases, to prepare for parenthood by cleaning up their harmful habits, etc. – Why is it that when a couple encounters difficulties in this direction, the first thing they should do is for the man to examine his semen? Because it’s easy, cheap and very informative. And because the causes of infertility are equally distributed between the two sexes. Still, some things are good to say in this direction. First, there are requirements, read them and follow them. The reliability of the results depends on this. Second, there are licensed medical facilities that are allowed to do spermograms and many more that are not allowed but do. It is to your advantage to show interest and learn exactly where to do a spermogram. And thirdly, the spermogram is only a laboratory test, it cannot make a diagnosis. Go to the doctor with the result. – What are the causes of male infertility? Could the problems be the result of past illnesses? Sometimes yes, for example after trauma to the testicles or past inflammation of the testicles due to mumps – viral parotitis with orchitis. But more often they are combined with hereditary diseases or predispositions, occupational risks – for example, prolonged work in a sitting position, exposure to heavy metals and radiation, endocrine diseases, etc. I pay special attention to parents of boys. Reproductive health care begins at birth.A risk factor for future problems with spermatogenesis is the condition cryptorchidism. This is retention of the testicle in the inguinal canal as a result of problems in its descent – the descent of the testicle into the scrotum. This process must be completed by birth, and if not, an operation to remove the testicle must be performed – no later than the age of 2 years of the child. If you are the parents of a boy, pay attention to the position of his testicles after birth. – What are the treatment methods? In most cases, the treatment is conservative – for example, infections are treated with antibiotics, endocrine disorders – with hormone therapy, sometimes an operation is necessary for varicose veins – varicocele. And in cases where improvement cannot be achieved, assisted reproduction – in vitro fertilization – can be offered. It is good to realize that different groups of causes and diseases can lead to infertility and their treatment is specific and individual. And please do not resort to self-medication, it can harm you. – When is medicine powerless? When there are genetic problems, they are usually intractable. We also cannot deal with advanced reproductive age. There is a limit to fertility that is reached with age, even though men still feel young and healthy. After all, the doctor is only human, not a magician. But I always tell the couple – there is no solution unless you stop loving each other. In all other cases, you can become parents in one way or another. – Do you have cases where men at a younger age show an interest in their fertility, undergo research to be aware of their condition and even freeze semen without trying for a baby? This is a positive trend in recent years and I am glad that more and more young men are interested, asking and exploring. And I have always said that prevention will save the world. Even if there is no problem, it is always good to know what our health is. As for sperm freezing, it is not very popular yet, but it is highly recommended in several situations. When undergoing testicular surgery or chemotherapy/radiotherapy due to cancer. In athletes who aim for high sports performance and are exposed to gonadotoxins. In people who travel and are far from their partner, especially military personnel on overseas missions. In patients undergoing aggressive testicular therapy due to a chronic disease. – Does the Bulgarian man confuse reproduction with quality sex life? He is no longer informed enough to know that a child requires not only sex, but also sperm. We should not underestimate the literacy of young people, but they also need specific information, not just general culture. – What specific advice would you give to a man of reproductive age who has not yet become a father, how to take care of his health in this direction? To think about this matter,not to postpone the visit to the doctor (I, for example, do not bite), not to be afraid to share his problems and to be constant in the search for a solution. To realize that medicine is only a crutch, and in most cases it is important to make some effort to improve the lifestyle, to maintain a healthy diet, to avoid a stagnant lifestyle, etc. Things that are for life, not just until the partner’s pregnancy. – What are the most common questions asked by male patients who have problems with reproduction? “I’m young and healthy, how can I have sperm problems?” is the most frequently asked question in the office. It is logical that a person who feels well and does not suffer from anything is surprised when he has reproductive problems. They usually occur without any symptoms. And also – “A friend got cured, how are you?” Why are you prescribing me another type of treatment?” Diseases are different and what works for one does not mean it is suitable for another. There is no panacea in medicine and each disease is treated individually. – In your opinion, is reproduction and quality sex life a taboo topic? There are no obstacles in the office to talk about everything. But there is still a stigma attached to reproductive issues in society. There is also discrimination against people with reproductive difficulties, although less and less. Campaigns like this one are a small step in the direction of the stigma disappearing and us perceiving fertility topics in the same way as everyone else – with understanding, with care and with responsibility.like everyone else – with understanding, with attention and with responsibility.like everyone else – with understanding, with attention and with responsibility.