In the “new reality” caused by the outbreak of COVID-19 most intended parents were forced to put their cross-border fertility treatments planson hold. And, indeed, it was a reasonable decision that made perfect sense. New vaccines and mitigation measures introduced by most governments all around the world allow us to look into the nearest future with cautious optimism.
Nevertheless, the questions “what to do?” and “when?” remain open for those intended parents that consider traveling outside of their country of domicile to seek assisted reproductive services and treatment, such as egg donation or surrogacy programs. On the one hand, it seems too early to start a treatment, taking into account that COVID-19 related risks are yet too high, on the other hand, just waiting and doing nothing feels like a waste of time. And to certain extent it is.
Let’s have a look at a classical surrogacy program with donated oocytes (eggs). The following steps are required even before any medical procedures may commence:
- Notarised copies, apostille on documents required for enrolment to the program – 1 – 2 weeks;
- Agreement with clinic, consent forms and waivers (translation and signing) – 1 week;
- Medical screening of intended parents – 1 week;
- Search and matching of oocytes donor – 1 – 3 month (may take longer);
- Search and matching of gestational carrier (surrogate) – 1 – 3 month (may take longer);
- Drafting and negotiating agreements with donor and gestational carrier – 1 – 2 weeks;
- Signing of a notarised agreement with gestational carrier – 1 week;
Early planning and completing formalities on cross-border egg donation and surrogacy programs may greatly reduce waiting time once things get back to normal. Dramatic increase in demand expected, as programs were delayed for travel limitations and fear of coronavirus infection.
As you may see, even during ideal conditions, it takes around 3 – 4 months to duly plan and prepare for a treatment cycle. In some cases, if intended parents have very specific requirements in relation to an egg donor or a surrogate, it may take over 6 months to find the appropriate candidate and arrange for her screening, interviews, etc.
In 2020 most of the new surrogacy and oocytes donation programs were put on hold. Many intended parents were forced to delay their cross-border fertility treatments for fear of coronavirus infection and related travel limitations. As a result, we are likely to face a dramatic increase in demand for such services, as soon as things will start getting back to normal.
What does it mean for intended parents?
As we don’t have credible statistics available, let’s try to build a model based on very rough estimates, just to understand possible consequences of such postponed demand. The Ukrainian Ministry of Justice in response to DW enquiry informed that almost 1,500 babies commissioned by couples from abroad were born to surrogate mothers in Ukraine in 2019[1]. Taking into account that in some cases there were twins, we may roughly estimate that the normal demand for Ukrainian surrogacy programs by foreigners was around 100 new cases per month (although we believe that real figures are much higher, lets stick to the official numbers). It is also fair to assume that fertility clinics worked at around 70% of their capacity to accept new patients, similarly to the agencies searching for gestational carriers and donors. COVID related restrictions are now in place for around 12 months. Let’s be optimistic and make an assumption that closer to the end of summer 2021 things will start getting to normal (restrictions on international travel are lifted and it is relatively safe to commence fertility treatment). We can even make an assumption that 50% of intended parents changed their plans and decided not to proceed with treatment involving surrogacy.
[1] https://www.dw.com/en/coronavirus-babies-born-to-surrogates-stranded-in-ukraine-clinic/a-53547276
Consequently, we arrive to the following results:
- time of delay – 18 months (February 2020 – August 2021);
- number of postponed cases – 18 x 100 x 0.5 = 900 cases;
- assuming 100 new cases = 70% of capacity of clinics and agencies, 100% = 143 new cases per month;
- demand exceeding 100% capacity = 900 / 143 = 6.3 times.
As you may see from this simple calculation, unsatisfied demand for surrogacy in August 2021 will be 6 times higher than available capacity.
Let’s add a bold assumption that fertility clinics and agencies will be increasing their capacity by 20% each month. It is indeed a bold assumption, since many service providers, especially those that were focused exclusively on assisted reproduction, had to make cuts in number of personnel and most likely it will take them some time to even reach 2019 levels. We make one more assumption that patients waiting for a treatment will not come all in once (for the purposes of our exercise we will distribute such excessive demand equally by first 3 months).
Rough estimate as to when the capacity is likely to match the demand:
Without claiming any accuracy in relation to numbers, this model clearly shows that current situation with postponed demand will, in the best case scenario, get settled not earlier than the first quarter of 2022, provided that things will start get back to “normal” this summer.
What to expect?
First of all, most likely we will see waiting lists for treatment in reputable clinics, due to limitations in their capacity. Second, it will take more time to find an appropriate egg donor and/or gestational carrier. And last, but not least, a rapid increase in demand is likely to cause increase of prices (applicable to both, medical and ancillary services providers, as well as compensation for egg donors and gestational carriers).
Is there a way to mitigate those risks?
We recommend completing legal and organisational formalities as soon as practicable and get ready for a medical part of program as soon as it becomes relatively safe. Such approach will allow intended parents to skip any waiting lists at fertility clinics and effectively use the time that many other patients will simply waste. Legal team of our agency (Fertility Ukraine) has also developed a set of preliminary agreements with donors and gestational carriers that offer some comfort for intended parents, allowing them to secure availability of their chosen candidates and fix any pre-agreed terms and conditions of their involvement.
The most time-consuming non-medical procedures can be performed remotely and do not require the physical presence of intended parents, in particular:
- Enrolment (legal and organizational)
In most cases our agency can handle all formalities remotely, via audio or video calls, emails and exchange of original documents by post. For certain actions, intended parents may be required to provide a notarized and apostilled Power of Attorney.
- Search and Matching Egg Donor and/or Surrogate Mother in Ukraine
This is another time-consuming process that may be performed by our agency with no need for a physical presence of intended parents. In open or semi-open donor cases, we may substitute personal meetings with video conference calls that will be organized by Fertility Ukraine.
Treatment Programs that May be Started without the Physical Presence of Intended Parents
In cases when there is a clearly documented medical condition (e.g. certified by a licensed physician in your country), we may enrol intended parents to the program without having to travel to Ukraine and being physically present at the clinic (initial communication with physician may be done online). If it is possible to send cryopreserved gametes to the Ukrainian clinic, the program can start remotely while maintaining all communication online.
In cases when there is a clearly documented medical condition, we may enrol intended parents to egg donation or surrogacy program without having to travel to Ukraine
Egg Donation Program:
Once selected and carefully screened, the egg donor may be stimulated with following retrieval of oocytes (harvesting eggs) and their vitrification (freezing) or fertilization with the intended father’s sperm (that was earlier shipped to a Ukrainian clinic) or a donor’s sperm, followed by embryonic culture and vitrification (at this point the preimplantation genetic diagnosis (PGD) may be also performed).
Basically, the intended parents or a single woman don’t have to visit a clinic until the embryo is ready to be transferred. This relatively simple procedure limits the exposure to COVID and other related risks.
Surrogacy Arrangements:
Once the gestational carrier (and when applicable also an egg donor) is selected and carefully screened, intended parents may proceed to create embryos with their following vitrification (freezing). Additionally, depending on recommendations of the physician in charge of the program and the general COVID situation in the area where the gestational carrier lives, it is also possible to make the embryo transfer without the actual presence of intended parents. The embryo transfer can also be performed when the intended parents possess cryopreserved embryos and will ship them to the Ukrainian clinic. Since our agency will be handling all the formalities and will supervise the pregnancy on behalf of intended parents, their presence will only be required during the happy moment of birth and when applying for their newly-born child’s travel documents (passport).
When a Physical Presence of Intended Parents is Required:
- If it is not practically possible or not recommended by the physician to ship to Ukraine sperm of the intended father in a cryopreserved form;
- If the egg donation program (without surrogacy), presence of intended mother is required for preparation of transfer and embryo transfer itself;
- If the surrogacy program, when oocytes of the intended mother are used to create an embryo and it is not practically possible or not recommended by the physician to ship them to Ukraine in a cryopreserved form;
- In all cases when the presence of both intended parents is required to check out from the maternity hospital and to complete formalities related to travel documents (passport) for the new born.
