The draft law “on the use of assisted reproductive technologies” (No 13638) may drastically change the provision of medical services on reproductive technologies and lead to Ukraine losing its status of a “reproductive hub of Europe”, it requires significant revision with the involvement of the professional expert community, experts interviewed by Interfax-Ukraine believe.
“According to various estimates, up to 40-60% of patients in large clinics of reproductive medicine are foreigners (especially from the EU, UK, USA, Canada, Israel, China). If the law does not provide transparent mechanisms for foreign patients, such as official medical visas or agreements between countries, Ukraine may lose its status as a ‘reproductive hub of Europe’,” said Dmytro Biletsky, head of the department of assisted reproductive technologies at the Adonis Medical Gynaecological Centre (MGC), a leading reproductologist.
According to him, Ukraine is now among the world’s top 10 destinations for the use of reproductive technologies, in particular, due to “democratic cost: an IVF cycle in Ukraine costs three to five times cheaper than in most EU countries or the USA”, the high level of specialists and technologies, certification of many clinics according to international standards, as well as due to the fact that “Ukrainian legislation allowed almost all methods of ART – donor eggs, sperm, embryos, IVF programmes for spouses and single women”.
“Ukraine allows anonymous donation and the creation of embryos for storage, which is not acceptable everywhere,” he said.
Predicting the impact of the bill if passed, Biletsky expects in the short term (one to two years) that Ukraine may lose some patients to reproductive technology (RTT) programmes, although overall demand will remain high, as IVF, donation, embryo banking procedures will remain permitted, and Ukrainian clinics have a recognised international reputation and competitive costs.
However, he predicts that in the medium term (three to five years), “if the rules regarding foreigners remain strict (especially at the level of embryo transportation, donation and surrogacy), the demand will decrease by 20-40%”.
At the same time, commenting on the infusion of the prohibition of embryo donation (donation) envisaged by the bill on the development of reproductive perspective in general, Biletsky noted that “the prohibition of embryo donation (donation) will lead to the fact that some patients will simply lose the opportunity to treat infertility, as well as to an increase in the number of ‘unused’ embryos in clinics.”
“Right now, some couples voluntarily give frozen embryos to others. If this is banned – the embryos will either have to be stored (which is expensive) or destroyed. This also raises an ethical question:” What to do with embryos that could give life,” he said.
He estimated that donor embryo programmes could account for up to 10-15% of all IVF procedures, so clinics specialising in “full cycles” (creation, donation, surrogacy) would lose a significant proportion of clients.
“Many foreign patients came specifically for programmes with donor embryos – this was a unique Ukrainian advantage, because in many countries (e.g. Germany, Italy) it is prohibited. The ban will mean the loss of one of the key areas of reproductive medicine. Ukraine actually loses one of the most humane mechanisms to help infertile couples,” he said.
For her part, the leader of the direction of assisted reproductive technologies of the medical network “Dobrobut” Svetlana Shiyanova also predicts that “the adoption of this bill will lead to a sharp decline in international demand, because it provides for two critical restrictive norms – a ban on the provision of surrogacy services if one of the spouses is a citizen of a state where such a method is prohibited, as well as the requirement that one of the spouses be a citizen of Ukraine (for surrogacy).”
“These regulations effectively shut down the international surrogacy market, which used to bring significant investments in the medical field. A sharp drop in international enquiry is expected,” she said.
In addition, Shiyanova noted that the embryo donation ban envisaged by the bill “is one of the most restrictive and contradictory norms of the bill,” which, moreover, contradicts the principles of evidence (of the European Association of Reproduction, ESHRE) and takes away the last chance from the most vulnerable category of patients, forcing them to seek this service abroad.
“For clinics, this means excluding an important service from the list, which limits the ability to provide the full range of ART and comprehensively accompany the patient,” she said.
According to Shiyanova, such aspects of reproductive medicine as the definition of infertility, the definition of who is the subject of the right to ART, the need to consolidate the anonymity of donation, the regulation of compensation, as well as the lack of a clear mechanism for the creation of a unified national register of ART and standardised monitoring of performance, now require regulatory regulation