In Ukraine is promptly develops rather new market to the country — reproductive tourism. Among a lot of foreign infertility clinics foreigners choose the Ukrainian. They are attracted by a ratio “the price — quality” and the loyal legislation.
The first Ukrainian “from a test tube” — the age-mate of independence Ukraine. 27 years ago success of the Ukrainian doctors in the field of reproductive medicine was a big hit all over the country. Their pride — Ekaterina Kuleva was born in Kharkiv. She is 13 years younger than Louise Braun from England — the first-ever homo sapience who was born as a result of artificial fertilization. Since then the western fertility doctors considerably succeeded in the business, having left far behind competitors from the former USSR. But recently the situation changes: the flow of the foreigners seeking to solve an infertility problem in the Ukrainian clinics steadily grows.
The capital of surrogate tourism
“In 2005 among all our patients of foreigners there were no more than 5%, today is about 50%” — Vladimir Butenko, the chief physician of capital clinic of genetics of a reproduction “Victoria” tells. The similar trend is noted also in other medical institutions. As there is no official statistics in this respect, it is necessary to be guided by estimates of doctors. According to their information, only for the last two years about 5-7.5 thousand foreign couples in comparison with one thousand in 2007 addressed for treatment of infertility to Ukraine.
Treatment in Ukrainian clinic costs them on average about $30-40 thousand and it is two-three times cheaper, than in the USA or Europe where the prices of similar programs start from $80000.
“As for cost more favorable terms can offer only India— Sergey Antonov, the director of Center of the Medical Right law firm notes. — But for Europeans to go to Ukraine is much more simply and closer. And climate for them is more usual here. Thanks to it, demand for services in surrogacy programs in Ukraine for the last year grew in several times”.
Ukrainian clinics emphasis that they already compete with foreign colleagues not only at the price, but also on quality of the provided services. So, according to the Ukrainian Association of Reproductive Medicine (UARM), on average on 100 medical cycles 35% turn out successful. For various reasons, childbirth reaches not in all. But the indicator of successful birth rate in Ukraine is even higher, than Central European.
“We have about 35% for each hundred cycles, they have about 33%. At the same time the prices in 10 times less.Definetely, it attracts foreigners” — Alexander Yuzko, the president of UARM, professor of medicine supplements. The words of the expert confirm data of European Society of Human Reproduction and Embryology (ESHRE). In 2006 the indicator of successful birth rate in Ukraine was 25.8% at 24% in Europe.
However, for many foreigners not only the cost and quality services of local clinics, but also the legal framework of their work is decisive factor.
Loyalty legislation
Ukraine is one of the few countries where it is possible to receive legally a full range of services in reproductive medicine. Whereas abroad quite often this sphere is too regulated, and even is beyond the law. It is natural that foreigners show keen interest just in those technologies which they have no right to use in the homeland.
At the beginning of this year in one of Kharkiv centers of reproductive health the young Austrian couple asked for the help. They just had no other way to give birth to own child except how to resort to services of surrogate mother. But in Austria this technology is prohibited. Thanks to the help of the Kharkiv physicians in several months their daughter has to be born.
“In this plan our legislation is more progressive and loyal. The legislator supported desire of the person to genetically continue the sort, allowing to use practically all latest medical technologies. For example, in Russia, the woman who was carrying out and giving birth to a baby admits mother. We have only biological mother, and surrogate has no right for the baby. In Russia it is necessary to receive the consent of surrogate mother, and in our country we do not need it. I consider that it is fair and logical” — Mr. Antonov says.
Many foreigners in order to avoid excess legal red tape, just hold back passing of any therapy in the Ukrainian clinics. “It is the conscious choice of people. They go on it at own risk, sometimes dooming themselves to long judicial and emigration proceedings — Sergey Antonov notes.
— We do not accompany doubtful cases. We can consult on some aspects, to tell that it is authorized and that — no at what stage they can have legal problems with the legislation of their country. Further they decide what to do: to tell how exactly their child was born, or not”.
In addition to auxiliary reproductive technologies, foreigners address to services of the Ukrainian clinics and for the sake of carrying out genetic diagnostics of an embryo. Its essence that the embryo even before implantation is diagnosed on existence of hereditary diseases. So parents are given a choice. They can refuse to continue a treatment cycle if there is a risk that the child can be born with deviations, and wait for creation of a healthy embryo or continue process.
Battle for the market
“Today in Ukraine there are more than 40 profile clinics, and any of them, as far as I know, was not closed. On the contrary, new is opening ” — Alexander Yuzko claims. The minimum threshold of an entrance on this market — $3 million. But investors put in the industry as are sure that it is one of most crisis-resilient.
Potential of reproductive medicine around the world — is huge. “In the world about 80 million couples suffer from infertility. In Ukraine — more than one million” — Tatyana Bakhteeva, the head of VRU committee concerning health protection says. Heads of the Ukrainian reproductive clinics not unreasonably count on further increase in demand from foreigners. There are all prerequisites today to increase commercial attractiveness of this direction.
At the same time the legislation of many countries indirectly protects the interests of the clinics of reproductive medicine by creation of additional barriers to those citizens who will decide to resort to services of the auxiliary reproductive technologies (ART) abroad. For example, complicating process of registration of nationality of the child.
Often in order that to make it, foreigners are forced to undergo additional procedures or even to have legal proceedings with the authorities. If they mention that their child — result of use prohibited in the homeland technologies, chances to positively resolve an issue with the child’s passport disappear at all. In this plan Italy differs in special severity. Legally to import the child who was born by means of ART into this country it is very problematic. It will be definitely lawsuits.
On this background the foreign clinics working in less loyal conditions will hardly reconcile to the prospect of outflow of the clients to Ukraine. Publications in a number of the western media can indirectly demonstrate to it. On the German social TV channel ZDF there was a plot with heading: “Ukrainians for money carry children for foreigners”. The little later the largest Scandinavian tabloid Aftonbladet published article under the name: “The Swedish children are made at factory”. It was about one of the Ukrainian reproductive clinics.
Ukrainian and Russian legislations
The legislation of Ukraine concerning surrogacy is considerable more liberally in comparison with Russian. Surrogate mother in Russia, in addition to consent to record of spouses as child’s parents, has to sign also the application that she will not have parental rights for the child after the birth, thus refusing it.
In Ukraine the procedure of refusal is not required, rather notarially certified consent of surrogate mother to record spouses as parents of the child. Besides, the Family code of Russia also demands execution of additional documents and from biological parents in the form of consent to implantation of an embryo to surrogate mother.
Besides, surrogate mother has the right to challenge motherhood of biological mother in court according to Article 52 of Paragraph 1 of the Family code of Russia.
In Ukraine absolutely other approach to this issue. Article 139 of Paragraph 2 of the Family code of Ukraine claims that contest of motherhood is not allowed in case of the child’s birth by means of the surrogacy program.
Valery Zukin: “Foreigners come to us for those types of treatment which they do not have”
The director of clinic of reproductive medicine “Nadiya” considers that the world popularity of the Ukrainian reproductive centers is directly proportional to the state image.
What services most foreigners are interested in?
They come to us for those types of treatment which they do not have in the homeland. The main demand is on donation of ova (fertilization of a donor ovum and its transfer in a cavity of the uterus of the woman having infertility). Among those who come to our clinic, such not less than a half. Further on level of demand there is genetic diagnostics of an embryo, after that — surrogacy. If to take all foreigners who are served in Ukraine, then the picture will be the following: donation of an ovum — 80%, surrogacy and selection of a sex—10%.
Ukraine is the world center of reproductive tourism. Is it a myth or our future?
— I think, we have all chances to become the center of medical tourism. Not only reproductive. On the level of technologies and quality of service we on an equal basis with such countries as Greece, Turkey, the Czech Republic. But we have a price advantage. Though we also do not position ourselves as the state with cheap services. The matter is that the industry in itself cannot exist. It develops in the state, and on it the shadow of the international image of the country in general is imposed. And how looks at our country the West? The corrupted country with shadow economy and moreover politically unstable.
Have somebody estimated the size of the market of reproductive technologies in Ukraine?
– Demand of Ukraine is about 70 thousand cycles a year. It is possible to call it potential market size. This number of those who need treatment by methods of auxiliary reproductive technologies. But real market much less. It consists of the money allocated by the state and that part of the population which is able to pay such services independently. The last category is 10% of all persons in need.
In Ukraine is demographic crisis. Whether the reproductive industry is capable to save the nation from aging?
— There is rather simple arithmetics. On hundred patients who used auxiliary reproductive technologies a certain number of children is born. The indicator of “cost” of one child is calculated. In Ukraine it averages 300 thousand UAH. If the state wants to receive, for example, 10 thousand new citizens, it will cost 3 billion hryvnias.
But these services are inaccessible to most of Ukrainians …
— One of ways to achieve opposite is to make a compulsory health insurance and to include in it auxiliary reproductive technologies. Thus, for the state money both private, and state clinics will be able to serve people. Mutual benefit. The clients are guaranteed to private clinics, and the state does not need to create own infrastructure. Its task comes down to control over an expense and efficiency of use of the mean
Victor Kozin: “The image of the country stops the foreigners having infertility”
The director of obstetric and gynecologic clinic “Isida” convinced the French of progressiveness of the Ukrainian reproductive medicine. But the future of the industry seems to it difficult.
What is the geography of reproductive tourism to Ukraine?
—Patients go from Israel, England, Italy, the CIS countries, in particular from Georgia and Russia. In total in our practice there were patients from 32 countries. Even from Kenya.
Why do they go to be treated abroad, in particular to Ukraine?
— In the field of treatment of infertility medical tourism is based on the following reasons. First, the legislation of many countries does not allow carrying out some procedures for treatment of infertility. The second motive — economy. The cost of services is important for many. In Ukraine the provided services in the field of auxiliary reproductive technologies are equivalent on quality to the European clinics and are competitive at the price. Speed of the provided service is also important for foreigners. In Europe leaders of medical tourism are Spain, the Czech Republic, Belgium, Ukraine and Russia. Advantages of these countries are high quality and reasonable prices.
How did the interest of foreigners in reproductive medicine in Ukraine for the last few years change?
— Demand grows steadily. It depends on recognition of service and knowledge of foreigners about our clinics. The image of the country has a great influence on a flow of medical tourists. Alas, today it is a barrier to many foreigners needing treatment of infertility. The patient, most likely, will go to be treated to small, with low level of quality services clinic in Spain, than in much better, but in Ukraine.
Today in our clinic the average value of growth of number of foreign clients makes 50% a year. In 2017 growth to 40% was recorded. By the invitation of Association of fruitless couples of France our clinic participated in a forum of the French committee on bioethics. There with great sympathy treated the statement for liberal views of the Ukrainian reproductive legislation. We convinced them that it does not contradict the laws of nature in any way.
What the future of the industry considering economic realities?
— Difficult. First, I do not see the development strategy of the industry, and medical insurance can have two sides . Medical insurance is not a panacea which guarantees quality. Secondly, there is a restriction of resources for implementation of different programs in the field of medicine.
One more moment is leaders of the direction. Bright persons who will be able to take the responsibility have to deal with issues of medicine. Unfortunately, in Ukraine I do not see a discussion. A discussion in which would be involved, as in France, many — from the Attorney-General to couple which gave birth to the child with the help of surrogate mother. There has to be an interest of society in questions discussion of reproductive medicine, media have to be involved. We are infected with populism! Between society and the power there have to be contractual corporate relations: a promise — result. Then promises would decrease and power steps would be concrete.