Stefka Sarafova-Zaharieva is the chairman of the Board of Directors of the Association “Conception” – the first non-governmental organization of patients with reproductive problems in Bulgaria. It was created by 6 strong Bulgarian women in 2004. The association puts the problems of infertile couples on a wide public debate with its initiatives and participations. To date, the “Conception” Association has achieved several significant legislative changes in its joint work with the Ministry of Health. In 2009, the “Assisted Reproduction” Fund was established, and in 2011, again thanks to the Association, the age limit of 43 years for in vitro treatment. “Conception” continues to alert the responsible institutions for the lack of legal regulations for couples with reproductive problems. What is the current number of couples in Bulgaria who are struggling with infertility? Bulgaria couples with sterility are over 145,000, but this is data from our last survey conducted in 2017. I don’t think that even this data can be considered up to date. – Bulgaria is rated at 68% on the scale of the ‘ideal’ country for infertility treatment in the produced European fertility treatment policy Why is this a ‘good’ rating because the European Atlas covers the funding programs available in the Member States. Bulgaria is in a very good position in this regard due to the existing Assisted Reproduction Fund. Such funding is not available in many countries. – Do you think that equal, safe and efficient access to fertility treatment is provided to all needy couples in Bulgaria? Yes, absolutely yes! There are enough clinics in our country, which are not even concentrated only in Sofia. There are in Plovdiv, Burgas, Pleven, Stara Zagora, Ruse, Tutrakan. Another issue is that the Bulgarian patient does not like to search. It’s as if he expects that once he has decided something, someone else should help him. There is so much information out there already. It is necessary for the patient to read, inform himself, seek the relevant specialist. – For more than 1 year, Bulgaria has officially had no legislation regulating the treatment of sterility through assisted reproductive technologies. What is your response to this? There was a single Ordinance N:28 that regulated assisted reproduction in Bulgaria. In 2020, it was repealed and there is currently no sterility legislation in place. We have repeatedly written letters to every health minister, with the exception of the official minister, Dr. Stoicho Katsarov, as it was clear to all of us that within two months, he did not have enough scope to make a reform. – Have you started working together with the representatives of the new Ministry of Health? We are not yet, as we are right at the start of the New Year. We are about to send a letter to the Minister of Health Prof. Asena Serbezova. Our specific appeal is to form a working group,to re-legislate in this area. We are of course ready to participate and help in any way we can. – What will the lack of regulations lead to in the future? Purely legislatively, there will be no problem for patients. However, there are two problems. Firstly, Bulgaria does not fulfill the European directives in this area. Secondly, in the normative act, which unfortunately is not currently in force, the various conditions for conducting in vitro procedures were defined. For example, it was indicated at what age group a certain number of embryos could be returned, etc. Either way, these conditions protected the patient. That is why this kind of medical standard was created. – Did the prolonged lack of a regular government affect the couples? I would not say so. The fund, as a body related to the governing authority, then continued to work and finance the attempts of couples with reproductive difficulties. Rather, the pandemic took its toll, as routine examinations were suspended. – What other problems caused by the pandemic have couples with reproductive problems faced? The postponement. In reproductive problems, it should not be delayed. Time is indeed very precious. People, being afraid to conduct their examinations, in one way or another postponed solving the problem, which was definitely not in their favor. – What is the amount of funds that the “Assisted Reproduction” Fund allocates to each patient? The fund was created to fund up to four in vitro trials in couples with infertility. The maximum amount granted is BGN 5,000 per procedure. Even if the first attempt is unsuccessful, the couple can apply for a second, third, then fourth. There are even cases where a baby is born after a successful first or second attempt. After two years, say, the family decides they want a second child and re-apply with the rest of their attempts. The number of in vitro attempts for each woman was registered according to the EGN. After the fourth attempt, if the woman fails to get pregnant, she must self-finance, since the state does not provide funds after that. – In 2011, with your help, the age limit of 43 years for in vitro treatment was removed. How old are the women who contact you? The age range is very wide. People of all ages are calling, I even recently spoke to a 43-year-old woman who was interested in information on how to apply for the Fund. – How do you address women over 43 years of age, in whom biologically getting pregnant is not so easy? I believe that any woman who has the opportunity to conceive before reaching this age should do so. Life is colorful, everyone’s story is different. Some meet their partner later, for one or another personal reason they do not have the opportunity to start trying for a child earlier. For these women, the moment for a baby comes at the age of 42-43. Most of them understand that at this age their chances are not so great. Others don’t react that way.I’ve had cases where my wife calls me and says “I’m 45, I look like I’m 30”. I usually tell them that even if they look 20 years old, biology is biology. I would like to point out that in no case should we decide that it is too late. We should not give up if we sincerely wish to raise a child and give it with love. Medicine is advanced enough. There are not a few women who conceive successfully at such an age. – Do you think that the fight against sterility can partially solve the demographic collapse in Bulgaria? It is impossible to solve it categorically, since the demographic crisis is due to a number of other factors affecting our society. I think partially treating the sterility would help. I have said before that families who suffer from reproductive problems are people who really want children. And not one, not two, but even three children. They are wanted, waited for and accordingly nurtured and cared for in a pretty good way. If these people are helped, and I firmly believe that by creating the Fund in Bulgaria we already have a fairly well-functioning program, I believe that we could solve part of the problem with the demographic crisis. – What is happening with your initiative “Be in class on reproductive health”? The pandemic put an obstacle in the wheel of our activity on this very good initiative. During the campaign, our volunteers entered the classrooms in front of the 8th, 9th, 10th and 11th and 12th grade students. We gave lectures, distributed information brochures, specialized for girls and boys. For us, this was important, because prevention of reproductive health can save us many possible problems in years to come. For 18 years now, we have also held Reproductive Health Day, which was a great alternative for patients and doctors to meet in an informal setting. We held the meetings in different regions of Bulgaria so that families could meet the specialists more easily. Unfortunately, due to the pandemic in the last two years, we have not held it either. I very much hope, if not this year, at least next year, that we will resume the activity of all our initiatives. – What is the digital ovulation calendar developed by the “Conception” association? From the summer of 2005, the interactive application “Ovulation Calendar” was launched on the site. It is used to track ovulation and fertile days, i.e. it is easier for a woman to be informed about the most suitable days in which she can get pregnant. The app also offers plotting and sharing of graphs of the basal temperature, as well as tracking the pregnancy by gestational weeks with the indication of the important periods for specialized tests. It can also be used as a notebook for the procedures performed, stimulations, examinations, and medications taken. Such an app would be useful for every woman, not just women with reproductive problems. – What address will you make to the couples,who are afraid and mostly ashamed to share about their reproductive problems in public? Unfortunately, this is a problem. When we created the Association in 2004, our main idea was to show our faces, even our families. We wanted to affirm that we are ordinary people whose reproductive problems are a normal part of life that is not shameful. Just as people with diabetes or autoimmune diseases seek help and speak out about their problems in society, those suffering from infertility should do so freely and without concern. This is our main appeal. 19 years later in the 21st century it’s a shame that people are ashamed of something like this. But this is partly understandable, since in our country there are all criticisms of women, that she is “barren”, that she cannot have children. Still, many women are afraid to share, lest they be criticized. We should not be ashamed and bothered. If we had done it years ago, the Association wouldn’t exist, the Fund wouldn’t exist, maybe our children wouldn’t exist either. Neither would the children of all the families we have helped. It is also useful and courageous to share our personal story, because we never know when “word of mouth” will not be of help to someone or he to us. There is no room for fear or shame.