Anna Bashlii, Head of International Department at the reproduction center “Parens-Ukraine“ talks about surrogacy. Together with her team, she has already guided many couples from all over the world through IVF and surrogacy. In this Online Patient Meeting, she discusses medical, organizational and legal aspects of surrogacy in Ukraine and gives the most essential information about how to make your surrogacy journey easy, comfortable and successful.
It is legal but under certain conditions. It has to be a heterosexual, officially married couple and the woman in the needs to have a specific indication for surrogacy. This means that she needs to consult a doctor and her doctor has to support her decision. There must be a specific reason why another woman has to carry the baby. According to Ukrainian legislation, this could be four or more unsuccessful IVF attempts, the absence of uterus there might be some deformations of the uterus also. But also another doctor, who is a specialist in another sphere can write a letter for you with the recommendation that you need surrogacy indicating specific medical reasons. In that case, it will be done. As for the age, there isn’t a specific age written down in the law. However, as a rule, patients who decide on surrogacy are between the age of 30 and 55 or 60 years old so that is all good.
There are medical reasons I mentioned earlier. However, if patients do not have such a letter of recommendation from the doctor, any clinic they will turn to here will be able to review their medical history and help them with indicating the issues. This can be the basis to start surrogacy. There are sometimes couples who will not be accepted for the program. This can happen if the only issue they can point out is the age, and they haven’t tried the IVF yet. Since age limit is not strict for IVF here, they may not be accepted for the program, but these are rare cases.
First of all, there are legal aspects of who can become a surrogate mother which is regulated by the order of the Ministry of Health of Ukraine, regarding assisted reproductive techniques and surrogacy in particular. It specifies that each woman who would like to become a surrogate mother must, first of all, have at least one healthy biological child, her age must be between 18 and 35. But we prefer to accept mothers starting from 20 years old to 33 years old. If the woman is legally married, we need to get consent from her husband that he agrees that she will be taking part in the surrogacy program, and she will become a surrogate mother. This regulation is also important, as it helps us to make sure the couples take an informed the decision and make sure the conditions in the family are safe for the mother and the baby. Each surrogate needs to feel loved and taken care of. From the medical point of view, she needs to be healthy, she cannot have any bad habits, like drug addiction or something. Once the woman comes into the program, the first evaluation starts with the IVF specialist and the ultrasound. Once the doctor has done the consult and the ultrasound, she will decide if it is worth proceeding with another medical testing. There is a long list of various tests which are required by Ukrainian law. But many clinics add even more to make sure that prospective surrogate is healthy and, she can start the surrogacy process and that she can carry a healthy baby. Our IVF specialists say that surrogate pregnancy and any other IVF pregnancy in its course carries the same possible complications as a regular pregnancy. So we need to make sure that the woman can and will carry the child to term and that everything will be good. She will have many ultrasounds, she will have her smears done and blood tests for hormone levels for different diseases. The surrogate also has a conversation with a therapist. The last doctor who confirms a woman can become a surrogate is the general practitioner who looks at all tests results and consults the patient before recommending her for the surrogacy program. So it is quite a long process, but in this way it is honest, and it is the right way to do it both on the legal part and medical part.
The first thing is proper documentation. We need the confirmation from a doctor that surrogacy is the option for a particular couple. Each clinic will require a copy of passports of the couple and a marriage certificate translated into Ukrainian, sometimes with the apostille. Such countries as Poland don’t need the apostille, but in any case, you will be given the information and recommendation at the clinic, whether you need this or that document. To start the process it is needed to sign the documentation, to select the surrogate. She can be selected distantly, and all the documents can be signed distantly. As a result, to make sure the couples choose the right surrogate, they will receive two or three profiles of surrogates, who have already been tested and are in perfect health and are ready to help. We understand that it may be difficult to choose a surrogate, just based on such a profile. So we organise video conferences with the surrogates, the couple and the coordinator who will be ready to translate all the information, so you will not feel any discomfort or anything like that. Then you sign a surrogacy contract. Several documents are signed at the clinic. These are consents for the provision of medical services, different agreements but there is one surrogacy contract which is signed at the notary public together with the surrogate mother. Once all the paperwork is done, we can start the preparation of the uterine lining of the surrogate for the embryo transfer.
So, I have already described the procedure regarding the surrogate mother. There is a list of tests required by the Ukrainian law, but many clinics add some more specific testing to make sure the surrogate is one hundred per cent healthy. As for the egg donor, egg donation is also legal in Ukraine. The requirements to become an egg donor and a surrogate mother are the same: she must have given birth to one healthy child, must be between 18 and 35 and must undergo all the same tests, including genetic testing, to ensure she has no hereditary diseases. Also, her background, family status and habits are checked.
It is always better if the intended parents come to Ukraine, but it isn’t always necessary. Sometimes couples just can’t come. It can be done distantly, but it must be done with the help of law firms. For example, we cooperate with an international independent law firm which helps our patients with all the legal aspects. It is already included in all our programmes because we do not understand how to work without that. So this firm can prepare the power of attorney which will be given to your representatives in Ukraine. Sometimes people use their friend’s help and give this power of attorney to them. Another way is to give this power to one of the lawyers. There is nothing extraordinary written in the power of attorney, so it is not that scary to give this document to someone, because it is clearly stated that this document only allows to sign surrogacy related documents, and it will be done only upon your consent. This is the way to do it if the couples cannot come.
From the moment that your surrogate starts the uterine lining preparation, each of our patients receives regular updates on anything that is done to the surrogate. Once the surrogate gets pregnant, it is possible to organise video conference calls during ultrasound check-up for the prospective parents who are staying abroad. It can be recorded or put online, but it is the way that must be agreed with the intended parents. We would like the couples to be involved in the process as much as they want to. The intended parents will be sent photos, test results and any other updates on the surrogate’s health. All of our surrogates are also happy to join in the conversation online, so you will be able to know everything about the moves of the surrogate and any doctors reports throughout the pregnancy.
No, there won’t be surrogate’s name on the birth certificate. Once the baby is born, a medical birth certificate is issued at the maternity hospital where the labour takes place. Later our lawyers take this document and all the documents prepared for the registration of the child, and they go with you (the intended parents) to the civil registry office and on the basis of that documentation the registry office issues the Ukrainian birth certificate. It is a beautiful blue certificate, by the way. There will be your names only in that document. The intended father will be written as the biological father, and the intended mother will be written as a biological mother.
It all depends on the type of surrogacy programme you need. For example, we may do surrogacy with both the intended mother’s and intended father’s biological material, which means the intended mother needs to do the ovarian stimulation in advance. So the procedure will be as follows: we will sign all documents, the intended mother has to be fully tested before the ovarian stimulation and do the simulation itself. In the meantime, you can select your surrogate and prepare all the documents with her. So, in this case, the start depends on the start of your ovarian stimulation. As a rule in our clinic, the waiting time is about two months until the start. The first month is usually devoted to testing, and in the second month at the beginning of the cycle, we can start the ovarian stimulation. Then, after 10-12 days, you will go for the egg collection and then five days for the embryo culture, and then we can do the fresh embryo transfer. But there are also cases when the couple needs to use donor’s materials. One important thing is that in Ukraine the embryo which will be transferred to surrogate’s uterus cannot be linked genetically to the surrogate mother, so she cannot be the donor and the surrogate at the same time. They have to be different. And another important thing is that the embryo that will be transferred must be genetically linked to at least one of the intended parents. This means that only part of the biological material may come from a donor. We need to have intended father’s sperm and donor’s egg or the intended mother’s egg and donor’s sperm. In any way, this preparation time is similar, and it will take about two months if the couple wants to start right away. One thing that can delay the process is the genetic testing of the embryos. Some couples would like to have their embryos tested on the genetic level to make sure they transfer healthy ones. The last case is when the couple already has healthy embryos stored at some medical facility. They just need to hire a company/ a medical courier to transport this biological material to Ukraine. In this case, the whole process including the transport and the preparation of the surrogate, should not take more than a month.
It is definitely much more affordable than in the US, for example. The costs in Ukraine may differ because there are a lot of clinics and agencies that offer surrogacy services. The cost could be anything between 30 000 and 50 000 Euro, depending on the programme the couple needs. In the USA the cost is between 100 000 and 170 000 Euro. So, it is quite understandable why people decide to come to Ukraine because besides the price you get the actual services done.
Yes, it’s possible. You only need to provide a document which is a certificate of affinity before the shipping of those embryos. The Ukrainian clinic will send you the document, and you need to give it to the facility where your embryos are stored, and they just fill it in and give it back to the courier who transports the material.
Well, you don’t need to be in Ukraine or sign any documents here. But you need to contact the facility where your embryos are stored and inform them you need to have your embryos transported to Ukraine. This facility may want to have your consent for transportation. We can recommend a courier company that has been working with us for years. We pass the contact with our patients, but the company works independently from us, so you need to get in touch with them to learn about the prices.
First of all, each surrogate has a coordinator who is in touch with them daily. The coordinator makes sure the surrogate has everything she needs, that she feels fine and does not need anything additional. She has her scheduled visits to the doctor, she is informed well in advance. She receives all the pregnancy care that all pregnant women need. In addition, her psychological needs are also addressed. At the very beginning of the process, the surrogate has a consult with a therapist who checks if she will be capable of taking that role from the psychological point of view. Throughout the process, she will also be offered psychological support whenever she needs it or regularly. From the medical point of view, she has all the required tests done, all medications and supplements provided, so she is closely monitored all the times. If you are worried about anything you can always ask the surrogate yourself whether she is well taken care of, as we can organise video conferences for you.
I don’t want to misinform you, as our law firm takes care of that. They collect all the consents, copies of the parents’ passports, certificates of genetic affinity etc. Once they have all the documents they go with you to the registry office to help you receive the Ukrainian birth certificate. The lawyers will help you with the registration of the baby in your country based on this certificate. As to the journey to the country, this may vary. For example, some countries require evidence that the baby is yours before they issue a travel document for the child. This may need additional proof from DNA testing. It takes about a month to get the results of such DNA testing. Some countries have other procedures, so this is why at the beginning of our cooperation the lawyers will consult you about your particular country, and they will give advice on the exit process. In any case, you will not be left without help.
Preparing the necessary documents takes approximately two weeks. This is the time when you can also select your surrogate. We can then arrange a date when you can come to sign the documents, meet the surrogate, and the medical staff in person, talk to the doctors, coordinators, embryologists to see how everything works. So, from the moment of your initial inquiry to that meeting, it can be several weeks. As to the documents, there are several types of those. At the clinic, you need to sign consents and agreements for the provision of medical services, like the consent for the embryo transfer or the warming of the embryos. There is a document for every medical manipulation that will be done. The surrogate will also sign the documents that she agrees to have all the manipulations done on her. Another agreement is signed between you and the surrogate at the notary public in our presence. This is the surrogacy contract drafted by our law firm. You will receive the surrogacy contract a week or two in advance, so you will be able to read it through and offer your suggestions or ask your questions. All documents are both in English and Ukrainian.
Yes, egg donation is one of our programmes. But remember that at least one part of the biological material must be genetically linked to the intended mother or the intended father. So in other words, you can use donor’s eggs, but you must use your intended father’s sperm.
Alternatively, you can use the intended other’s egg and donor’s sperm to create the embryos. You can also use the frozen embryos that remained stored in any medical facility if they meet these conditions. You just need to have them transported to our clinic.
Most of the intended mothers prefer to stay in touch with the intended parents in our presence because they feel more comfortable this way. It all depends on mutual consent, of course, but 99% of the time those meeting whether online or in-person are done with the coordinator’s presence. Especially, if you are from abroad you must realise the surrogate mothers don’t always speak foreign languages, of course, some do, but we cannot guarantee it. So the coordinators simply facilitate the communication process.
To be honest, I don’t know. As I told you, our lawyers take care of those issues. I remember a similar case where the parents needed to decide how to register the baby, and I believe it was their choice to register the child as intended mother’s or father’s nationality.
Yes, we have coordinators who speak different languages so they will help with the translation. Each patient has their own coordinator who will help with arranging anything, booking accommodation and help to make your stay in Ukraine comfortable, they are available at any time, day or night.
I know that some clinics offer guarantees of live birth or money-back guarantee, but ours does not have such a programme. We have agreed it wouldn’t be ethical to guarantee something that is not a thing and is unpredictable. In most cases, surrogate mothers do get pregnant from the first transplant. If, however, the surrogate mother needs another egg transplant, the intended parents pay an additional fee, but much lower than the initial one, as we have most of the procedures covered.
We haven’t had any intended parents from Switzerland, but you may contact me later, and I will consult the lawyers on the exit process.
If any abnormalities are detected during pregnancy you will have a consult with your doctor, and you will have the final word with what to do in that situation. You are the people who will decide how to deal with the situation based on the recommendation you will receive from the doctors. The only case when the parents won’t be able to decide is if there is a high danger to the surrogate’s health or life. In this case, the parents do not decide, but the doctors.
According to Ukrainian legislation, the maximum number of embryos transferred during IVF procedure is three. But we never do that. The maximum number of embryos for surrogacy is two. We always try to select surrogates who haven’t undergone any operations or even c-section because if the couple decides to have two embryos transferred in this case. As a rule, we transfer one embryo. You will receive all the information from our doctors and embryologists regarding your case and based on that you will decide whether to transfer one or two embryos but we will need to know this information well in advance because not all surrogates want to carry two children, because they are not quite sure if this pregnancy goes well, since such pregnancies are connected with more complications and are more difficult.
The Ukrainian birth certificate is translated, and if you need the apostille it will also be done. Then the lawyers will advise you on the documents you will need while addressing your specific embassy. Sometimes a DNA test is required to confirm the parenthood as well, which can be done here, and the results are available in about a month.
All the worst-case scenarios are written down in the surrogacy contract drafted by the lawyers. There are sentences which state what should be done when one of the intended parents dies, or a surrogate mother dies, or the baby dies during the labour. But the worst case we had was when a surrogate mother was hospitalised for two months before the due date because of a medical problem she had and the doctors stated it was better for her to stay in the pathology department and be under the full doctor’s control. She had to have c-section, but it all ended well as she was in good hands.
You will, unfortunately, have to start the whole process from the beginning. If you only had one embryo from your IVF than you will probably be recommended to use the donor’s eggs for another trial. If you had used a frozen embryo yo may be recommended to go through the whole process of creating fresh embryos. Of course, the pricing will be different, lower this time.
We do not do an amniocentesis, but we do all sorts of tests detecting genetic abnormalities in the early stages of pregnancy.
Yes, it is in Lviv.
I don’t have those numbers with me. But on average we start two successful surrogacy programs a month.
No, there is no such condition. It can be a recommendation from the doctor or the geneticist, or we can do it at your request. Most couples over 35 do prefer to have their embryos tested.
Enough to start between two and four programmes a month. At the moment we have more than ten surrogates waiting to be paired with the couples.
I know that the success rate is 78% with IVF and 70% for surrogacy. Remember that we must take into consideration the genetic material and the age of the intended parents.