The desire to have a child is something fundamental to nearly all humans, indeed to most species.
One of the most emotionally demanding jobs I did years ago was working with a gynecologist specializing in infertility and consoling those who could not conceive.
At the time, about 10 percent of couples were unable to have children and about half of those could be medically assisted. Science has, however, moved on and now, despite the desire for many women to have children in their late 30s and 40s, when their fertility can decline, the outlook is so much better in what medicine can offer.
Paradoxically, this advance in technology has, in Western Europe and the Americas, been accompanied by an increasing regulatory climate surrounding infertility treatment and the payment for such – even in countries where health care is essentially free. High profile scandals concerning the loss of donor eggs and the mix up of embryos has further fueled anxiety.
It is therefore not surprising that Ukraine has emerged on the European scene as a real choice for infertility treatment, offering several specialist centers and a climate of privacy and respect for parents and children alike.
A Valentine’s Day kiss in Uzhgorod on Feb. 14. (UNIAN)
Technological advance in medicine is nothing new to Ukraine, a country that has developed some of medicine’s most widely used techniques, such as corneal surgery to correct short-sightedness.
The various procedures in infertility treatment require disciplined adherence to well-established scientific methods, something that is inherent in the psyche of Ukrainian scientists. It is, therefore, not surprising that treatment results and success rates across a whole range of procedures are comparable to many Western and American centers.
I have always been impressed that Ukrainian health care has, as one of its strengths, a formalized and very disciplined attitude to the collation of tests, specimens and screening procedures and the paperwork that accompanies them with sound in-depth documentation at all levels. I can therefore understand that the loss or mix up of such embryonic materials is much less likely than in the relaxed atmosphere of some other centers.
Given that the scientific procedures and results are comparable to other European and American centers, and the costs less, perhaps the most challenging area is the lack of regulatory control that surrounds treatment and the rights of parents and children. These differ in major ways from Western Europe and America.
The major differences lie in the fact that a Ukrainian child conceived by either sperm or egg donation has no rights to know its genetic parents. That person will be registered as the child of the parent(s) undergoing the treatment. In this, it will be treated in exactly the same way as an adopted child. Obviously, when the adoption takes place at a later age, the child will be aware of the circumstances.
At first, this may seem to detract from the child’s inherent rights to know its genetic parents – a view taken by many European countries. However, closer examination of the facts shows that in countries where children born through donor sperm or eggs have the right to know their genetic parents – as do those who are adopted, that right does not extend to children seemingly born within fertile relationships even when we are aware that maybe as many as some 5 percent are fathered from outside such a relationship.
Such paradoxes are born from an over-indulgence of lawyers in parental and child rights. My own opinion is clearly in favor of the Slavic norm, where such children are reared as no different from others and will have no stigma about their parents. In practice, I have seen many adopted children who have not only struggled with that difference through their childhood. But also, in seeking some relationship with their genetic parents, they have been rejected and deeply and psychologically scarred in the process. Ukraine has this right and should not bow to the regulatory dragons of Europe.
Both surrogacy and selective embryo transfer are unregulated in Ukraine. Surrogacy is when a third party carries and delivers a child who may have some or no genetic material from the parent or couple who negotiate a contract with a surrogate mother. While such contracts are legal in Ukraine, some countries, such as the United Kingdom, require parents to obtain a parental order on returning such a child to their home country. Conditions of such orders require evidence that payment to mothers is no greater than it is in the UK. It is also important to establish the nationality of such children. Again, the ethics are questionable in countries where many couples pay gynecologists and smart clinics thousands of dollars rather than a surrogate.
Selective embryo transfer was developed as a technique to analyze genetic material from already fertilized embryos grown outside the mother’s womb and to transfer only healthy embryos.
In most countries, the regulatory climate demands social, psychological and age screening for parents seeking in-vitro fertilization. The freedom from screening and the subsequent respect of privacy are very Ukrainian and appeal to many seeking treatment.
Ukraine is up to speed in carefully selecting and screening egg and sperm donors and offering information to recipients about such results, while obviously maintaining the privacy of the donor. Donors are tested for the usual range of diseases and their family histories documented.
The Internet, modern air travel, international technologies, cooperative specialists in home countries and economic factors, all make the possibilities of successful in-vitro fertilization treatment in Ukraine a very real reality. The big choices may lie in the regulatory climates, both in Ukraine and in Europe, and the ethics that surround them. If Ukraine moves westwards, the question will eventually be asked whether it should stand fast or adopt the prevalent regulatory climate of Europe. It may be in such answers that Ukraine will define its identity and the freedoms of its population.
Dr. Richard Styles is a British family physician at American Medical Centers, a full-service clinic, in Kyiv.
