Professor Rafal Kurzawa – one of the pioneers of modern infertility treatment in Poland. Contributor of systemic solutions for the treatment of infertility. National leading expert in gynaecological endocrinology and reproduction and Senior Clinical Embryologist certified by ESHRE. A well-respected President of Polish Society for Reproductive Medicine and Embryology and Medical Director of TFP Fertility Poland.
We all remember the sad day of February 24 when the war against Ukraine started. What Ukrainian people faced in that situation is unspeakable, but I have a feeling that we were no strangers to the fate of our eastern neighbors. In the Ukraine crisis, thousands of guests found shelter and safety in Poland. The efforts of the Polish nation to support and accommodate Ukrainian war victims is worthy of praise and respect.
Me and my close work colleagues met the Ukrainian Association of Reproductive Medicine representatives during ESHRE conference in Milan this year. We invited them to participate in the two-day Scientific Symposium of Polish Society of Reproductive Medicine and Embryology, held on October 7-8, 2022, at the Crowne Plaza Hotel in Warsaw almost straight away and quite spontaneously. UARM accepted the invitation with great openness and agreed to involve in conducting two important sessions: “Clinical and Embryological KPIs” and “Infertility Treatment in Poland and Ukraine”. Not only wanted we talk about the reproductive health system and its set up in Ukraine, but also – and maybe even most importantly – we were curious to know how it is handling the conditions of a direct war attack.
To our great contentment, tens of Ukrainian guests, led by Prof. Oleksandr Yuzko, the president of the Ukrainian Association of Reproductive Medicine, arrived. They were both clinic owners and medical specialists. Interestingly, their journey took up to countless hours – they traveled by train and car, as they could not get to us by plane. For some, it was literally dozens of hours to reach our country.
It was natural for us to start our scientific meeting with drawing the attention to these issues that are important now in the context of the war against Ukraine. We got to know that currently the Ukrainian fertility clinics try to work normally, providing consulting and treatment to their patients. However, they are undoubtedly struggling with unprecedented problems, such as power outages (particularly recently), issues with securing the disposable material or media used in the IVF lab. They also lack access to liquid nitrogen that is a mandatory to cryopreservation. Things that are basics in contemporary medical world remain a daily concern in a war situation. What was emphasized is the fact that the clinics in the east of the country were unable to work, as the frontline stretches there. The medical centers, even if not intentionally targeted, while being under serious assault, had to shut down or to move.
Some clinics loudly admitted that they were thinking of moving operations to EU countries, where they have developed relationships. For years they have taken over patients coming from there, and now they have an idea to act the other way around. They have the know-how, the technology, the contacts; the only thing missing in Ukraine is the ability to function normally.
What was outlined and – in my opinion – is quite remarkable, is the fact that clinics help each other. They develop and use the inter-center connections, moving to the background any competition spirit. They do it to ensure unlimited access to treatment for patients. They all understand that when medical facilities are not accessible, and destroyed, or healthcare personnel and medical products are scarce or unavailable, the general wellbeing and safety is endangered.
In terms of getting to know the standards, exchanging experience, and bringing the specifics of the Ukrainian reproductive medicine market to our local doctors, we looked through the legal conditions for infertility treatment. What we could see is that IVF market is developing rapidly there. Ukraine is one of the few countries in the world where egg donation, surrogacy and pronuclear transfer in human embryos are legal and accessible to both Ukrainians and foreigners. That makes it a good destination for medical tourism for those who – due to serious restrictions in the use of ART – cannot get specific treatment in their country of origin. Foreign couples also turn to Ukrainian medical centers because of the financial aspect. There is also no age limit for male patients. Termination of pregnancy, when indicated, is legal at accredited facilities in Ukraine, although the number of restrictions increases as the term of pregnancy lengthens.
We also looked at the topic of surrogacy. In many countries, surrogacy is banned or restricted. In other jurisdictions, the practice exists but lies in an unregulated grey area, causing serious dangers and additional legal and practical risks for intended parents. In Ukraine, surrogacy proves to be safe and is fully legal and regulated and it compares closely with other countries regarding the availability of such specialized infertility treatment techniques. The main difference is that the cost of such service can be lower in Ukraine. Consequently, Ukraine has become a major destination for many prospective parents who search for affordable surrogacy arrangements outside their country. The phenomenon has got more international attention as other countries (such as India or Thailand) significantly restricted access to such services for foreigners.
It is estimated that around 2,500 babies a year are born in Ukraine through surrogacy. Being a surrogate is a job for many Ukrainian women, but not one that they can leave or put on hold. The war brought very serious concerns for all the parties in the surrogacy arrangement – for the pregnant women, the newborn and the intended parents. Should a pregnant woman stay in Ukraine? Is it safe for her and the baby? Should she seek refuge in a neighboring country, such as Poland, where surrogacy is forbidden and the laws consign the intended parents to legal complications, or should she be heading to a country such as the Czech Republic, where laws for parents are more accommodative? The truth is that the interests of the surrogate, the baby and the parents do not always align, and war can put people in situation that jeopardizes their wellbeing, safety, and health.
The meeting was not only fruitful but also… was giving hope. We – Poles and Ukrainians – have our past with numerous correlations and dependencies, but what is happening right now is the priority. How to deal with this? I would put it in triple A rule: accountability, assistance, and action. I believe we ought to stand with solidarity, awareness, and full accountability to respect and support the strength and fierceness in the fight against the invader.
Prof Dr Rafał Kurzawa, MD