07 Apr 2022 Ukraine War Changes International Surrogacy Landscape

The daily images of mass graves, blasted out apartment buildings and long lines of refugees attest to the terrible toll of war. Ukraine will never be the same, nor will Europe nor the world.

One change is Ukraine’s role as a popular destination for international surrogacy and other types of assisted reproduction. All that changed abruptly with the Russian invasion, leaving hundreds of surrogates, foreign intended parents, newborn babies and reproductive medical professionals in limbo and in danger for their lives. The outcome is likely to be a shifting of the international surrogacy “map,” as well as to the way in which surrogacy agreements address the uncertainties of a world at war.

Russia’s invasion of Ukraine has revealed many heroes—mothers struggling to get their children to safety, ordinary working men and women taking up arms to defend their nation, a president standing defiantly in harm’s way to inspire and lead his people.

Assisted Reproduction War Heroes

The reproductive health profession also has seen its war heroes. The New York Times caught the world’s attention with its report of rows of babies born by surrogacy, waiting in a Kyiv basement for foreign parents unable to get into the country to establish legal parentage and take them home. Their heroes are the nurses who refuse to abandon them, sheltering from Russian shells while tending to their helpless charges for who knows how long. “Of course we cannot abandon the babies,” one 51-year-old nurse tells the Times, even though her husband and two sons, all serving with the Ukrainian defense, urge her to leave.

Another professional who matches international intended parents with Ukrainian surrogates was forced to flee Kyiv with two newborns, hoping to meet up with their parents at a safer location. A surrogate, after giving birth to twin boys in a Kharkiv hospital under bombardment, traveled across Ukraine with the newborns and her own two sons to meet the intended parents at the border, as reported by BBC.

One expectant surrogate, married with one son of her own, told the Times she would not leave Kyiv, where her husband serves as a volunteer for the Ukraine defense. She is pregnant with twins, whose genetic parents in China want her to evacuate to another European country for the birth. She worries about the consequences: In many of those bordering countries, she, as the birth mother, would be deemed the legal guardian of the twins, further complicating their reunion with their parents.

Although many Ukrainians were skeptical Russia would really invade, some intended parents saw the runup to war and took action beforehand. One French couple moved to Ukraine in November to be near their surrogate and her family in Lviv, but left documentation proving their parentage behind in France, The New York Times reported.

On the day Russia invaded, another expectant couple drove toward war, leaving their home in Germany for Poland and then Ukraine, braving checkpoints and tanks to reach their twin daughters, born prematurely to a surrogate on March 4. The babies spent much of their first days in the hospital’s basement shelter, their parents uncertain how or when they will be able to take them home.

Ukraine War Endangers Frozen Embryos

But the impacts of the Russian invasion on intended parents and their families aren’t limited to those with surrogacies in progress: Ukraine offers a broad range of fertility services, including egg and sperm harvesting, in vitro fertilization and cryopreservation, or freezing, of eggs, sperm and embryos. Now, amid the chaos and destruction of war, the sensitive equipment and facilities currently storing hundreds of thousands of embryos and oocytes are at risk.

Commercial surrogacy is legal in Ukraine only for heterosexual married couples who have been unable to conceive naturally or through IVF, but its relatively low cost—$40,000 to $60,000 compared to $120,000 or more in the United States, according to Euronews Next—has made Ukraine a popular destination for would-be parents from all over the world. With some 50 reproductive clinics and numerous surrogacy and third-party matching agencies, more than 2,000 babies are born to surrogates in Ukraine every year, the BBC reports, most from foreign parents.

In addition to the responsibility of protecting hundreds of surrogates and babies, reproductive health clinics and surrogacy agencies also store thousands of eggs, sperm samples and embryos for clients’ intended future use. Some in the Ukraine surrogacy industry estimate as many as 3,000 foreign couples have frozen embryos stored in the embattled country.

Just as heroes are helping to evacuate and care for surrogates and babies, others are working desperately to preserve embryos and oocytes that may be their owners’ only and final chance to reproduce. Before Russia’s invasion of Ukraine, Dr. Valery Zukin directed some 500 staff members and 50 to 60 doctors at his Kyiv reproductive clinic, which facilitated some 1,000 individual IVF cycles per year, as reported by Today. Since the Russian invasion, most of the staff have joined the 10 million Ukrainians who have left the country or been internally displaced. Zukin remained, almost solely responsible for the safekeeping of the 19,000 frozen embryos housed at his clinic.

At the time of the Today report, Zukin had successfully transferred 1,000 embryos to safety in western Ukraine and other countries, basing the agonizing decision of which to send on freshness and on which clients would be able to continue treatment elsewhere.

In the meantime, he struggles with inevitable wartime shortages and disruptions, including a shortage of the liquid nitrogen that much be replenished weekly to keep the embryos frozen and viable, which he is purchasing out of his own pocket.

War Ends Ukraine’s Role as Surrogacy Destination

As hard as these stories are to hear, they left have left me proud and in awe of the amazing resilience and determination exhibited by so many surrogates, intended parents and reproductive health professionals in the face of unimaginable hardship and terror. Our profession has just come through an immense crisis in the form of a deadly global pandemic. As we wrote last year, the fertility services profession endured and came through that crisis stronger, safer and more effective than ever. The pandemic even changed the practice of fertility law, requiring intended parents, surrogates and their legal counsel to consider and document their expectations and intentions around COVID vaccination and other protective measures.

The war in Ukraine has changed the assisted reproduction profession as well. It will likely be a long time before Ukraine is again viewed as a safe place for surrogacy. For months leading up the war, most Ukraine surrogacy agencies and clinics downplayed the likelihood that Russia would invade. For that reason, few contingency plans were in place, and most clients never imagined their path to parenthood would lead to a war zone.

But intended parents are on the alert now. Some agencies report that would-be parents considering surrogacy in other European countries are beginning to ask for guarantees that Russian aggression won’t also interrupt their family creation plans.

The demand that made Ukraine a popular destination for international surrogacy won’t disappear. Experience tells us that would-be parents struggling with infertility living in countries where surrogacy and other forms of assisted reproduction are banned or severely restricted will find a way.

The war in Ukraine will inevitably change the “map” for international surrogacy. Georgia, where surrogacy is legal for married, heterosexual couples, is one alternative expected to see an increase in surrogacy births, as is Greece, where commercial surrogacy was legalized in 2002 and opened to foreign intended parents—as long as they are heterosexual couples or single women using their own genetics—in 2014. Sadly, LGBTQ intended parents need not apply. Both countries consider the biological parents, rather than the surrogate, to be the baby’s legal guardians. Other countries such as Cyprus, Albania, and Columbia where there are no laws governing surrogacy, also are expected to see more inquiries from intended parents.

This shifting of international surrogacy “hotspots” is not a new thing. We’ve reported several times on the dilemma of pregnant surrogates, stranded babies and desperate parents as  former surrogacy hotspots such as India, Cambodia, Mexico and Thailand have been abruptly shut down due to government response to malfeasance or scandalous headlines. As I wrote before, the relatively high cost of surrogacy in the U.S. drives many intended parents to seek cheaper alternatives. Too often the tradeoff is questionable medical or ethical practices, lower success rates and unstable legal and government structures to protect families. Tragically, the extreme danger and uncertainty facing surrogates and intended parents in Ukraine today provides us with yet another cautionary tale.

For more information about surrogacy in wartime Ukraine, see our February article, including advice for surrogates and intended parents navigating the ongoing crisis.