Poor legal regulation threatens health of Ukraine’s egg donors
Paid surrogacy and the practice of egg donation remain unresolved regulatory issues in both Poland and Ukraine.
The COVID-19 pandemic’s toll on the economy might be pushing Ukrainian women to search for extra income. Nearly a year after the “surrogate scandal” the country’s legislation in the field of assisted reproductive technologies (ART) has not become more protective of women providing the services.
While industry representatives do not side with human rights activists who have called the industry dangerously unregulated, both agree that for many years the state’s involvement has been minimal. This has created risks for the physical and mental health of Ukraine’s egg donors and opportunities for human rights violations.
This topic has not been discussed publicly until last year, when it became evident that Ukraine desperately needs regulation in this sphere. The closed borders and restrictions on movement introduced last year due to the COVID-19 pandemic left many surrogate mothers in limbo and biological parents unable to meet with their newborns. The economic decline pushed more vulnerable women searching for extra income using surrogacy or egg donation as a way to make ends meet.
Assisted reproductive technologies are used to treat infertility around the globe and are generally perceived as a needed practice. Thousands of couples have the chance to experience parenthood due to modern medical developments. Yet, in countries like Ukraine, the use of ART has many problematic aspects including health risks, to which the government has been turning a blind eye. Ukraine’s current legislation allows egg donation to be done by healthy women aged between 18-36 with a healthy child. In reality, the choice of donors is made solely by the clinic, which in many cases takes no responsibility for the life and health of the women.
Olga, a 28-year-old from the Zaporizhia region in south-eastern Ukraine, has donated her eggs three times, but stopped after going through a painful recovery after the last donation. The young woman says the clinic did not take responsibility and did not cover her medical expenses for the recovery.
“I donated eggs both in 2017 and 2018 and it was fine. I did not have any pain or bleeding after. But the third time I donated eggs in 2019 at the same clinic it hurt. I had the operation in the morning and in the evening I started having terrible pain in my lower stomach,” she recalls. “I called the doctor at the clinic. He asked if I had a fever or bleeding, and when I said no and that I’m in pain. he said that it was ok and it was just my body reaction and suggested taking painkillers.”
The pains lasted for weeks during which Olga ping-ponged between different medical facilities trying to find out the cause of the pain and the egg donation clinic trying to get them to cover her medical expenses.
“The clinic told me that whatever happens to me after the egg donation is not any of their business and they would not cover the medical expenses. I was lucky that it was not anything serious, but I spent a lot of money and I felt absolutely unprotected,” she concludes, adding that she would not recommend egg donation as a way of making extra cash since the health risks are too high.
“While many clinics in Ukraine care about the safety of donors, there are still the ones which don’t,” believes physician Lada Chernenko. “Not every clinic explains the dangers of donating large numbers of eggs and the use of high doses of hormonal drugs. And since the women’s payments are depending on the number of eggs they donate, they try to give as much as possible, which can lead to infertility.”
Also, the medic points out that Ukraine has no national registry of egg donors and since some women go abroad to donate eggs it’s impossible to say how many times a woman has been a donor. “One can be an egg donor up to eight times during their life and that’s only the very healthy and strong ones. But some women do not know about it or do not comply. The system that does not regulate it puts their health at risk,” Chernenko adds.
Liberal or unregulated?
The loose legal ART regulation, which some call liberal, led to a booming industry and made Ukraine one of the top global destinations when it comes to the quality of reproductive medicine. But it also created a space for human rights violations. Ukraine’s Commissioner for Human Rights, Lyudmila Denisova, has called for a stricter ART regulation in the wake of the scandal that unfolded around the dozens of surrogate babies stranded in Ukraine during the first wave of the COVID-19 lockdown in spring of 2020.
“We need a legislative normative document that will comprehensively address this issue: set standards for the work of centres that provide these services, permission to work, etc. It is necessary to clearly state the rights of all participants in the process,” the ombudsman stated nearly a year ago. Yet, little has been done since then.
In an attempt to understand the right of egg donors and if they are protected we got in touch with five clinics in Kyiv, the capital of Ukraine. Representatives of two out of the five clinics stated they do not take responsibility for the donor’s health if it is not proven that the medical condition is caused by egg donation. Three offered to provide health insurance with the third parties since they do not provide any.
Besides health concerns, the egg donors point out personal data protection issues. Although egg donation is anonymous in Ukraine, some clinics allow potential parents to select a donor based on medical and personal profiles, which include donor’s photos. Besides the medical history of the donor and her family members, the profiles sometimes go as far as describing the donor’s hobbies and interests, workplace, lifestyle and even college degree.
25-year-old Anastasia (who asked us not to use her real name) says that she travelled to Kyiv to donate eggs after discovering the printed-out profiles with the donors’ pictures in the lobby of the reproductive clinic in her hometown.
“The magazine with all the girls who were willing to become egg donors was just lying in the clinic lobby. It’s not a metropolis, we all sort of know each other and I even recognised a woman in that magazine. I was wondering if she agreed to that,” says Anastasia who prefers to be discrete about her donating eggs.
The personal profiles also can be sent online to potential foreign clients and can state if the donor is willing to travel abroad for the egg donation. Anastasia is one of the women who does not mind traveling abroad.
“This is my main source of income, which supports me and my two children. Last time I received 1,500 US dollars. It is a lot of money for me. I do not have a steady job and jobs are hard to get, so I want to keep donating eggs and I’m willing to travel abroad if it pays more,” she adds.
Donation, no selling
“It is said that in Poland eggs cannot be sold, so they do not sell …” says Alicja (who asked us to change her name), who has already donated her eggs twice. “In Poland, it is called a donation, and the money we get is the so-called reimbursement of medical exam costs, travel expenses, etc.” For her donation, she received a $2,000 “refund”.
In fact, the sale of eggs in Poland is prohibited. As the legislation in force states: “the human body and its parts cannot, by themselves, constitute a source of profit”. Only infertility clinics can provide paid services with such genetic material. Therefore, as with transplants and other human organs, eggs are usually being “donated” to banks. However, the old saying goes that what is not regulated, can easily become a source of abuse.
Apart from the fact that the sale of eggs provides financial aid for her, Alicja is interested in the topic and spends a lot of time on internet forums, where she talks with other women. “People’s interest in the subject has grown, a lot, as has interest in IVF treatments,” she admits. “But there are more and more offers of the sale of eggs from women who want this money to satisfy their whims, for example, go on a luxury holiday abroad.” Alicja describes them as young, rather well-educated women from the cities. For her, this decision was a financial constraint – she was paying off her debt with earned money.
She adds that from time to time there are also entries from Ukrainian women. “They ask how it is done in Poland, they ask for details, about clinics. But I worry about them. We, Polish women, have insurance, national rights, and they? I know a woman who was cheated. A couple failed to pay the full ‘refund’. And where was she supposed to go? Where to complain?” Alicja asks rhetorically.
Due to the fact that Polish law does not define the procedure, women have no grounds to demand the promised money. A separate issue is the protection of the health of women donating eggs and the obligations lying on the part of recipients, or the clinic. Alicja managed to put us in touch with Vala, the Ukrainian woman. “It often happens that people skip procedures. They find a donor-woman on their own, they go with her to the clinic, and she declares on the spot that she selflessly donates her eggs to them,” Vala explains. She does not want to name the clinic, nor even a city where the clinic is located. “You need to understand. What rights do I have here in Poland?” she says.
As in the case of surrogate mothers, Ukrainian women who offer their services and help are much more likely to face financial fraud or lack of adequate care. The lack of regulations and stretching of the law mean that if something happens, they will have nowhere to seek help.
It is estimated that about 20 percent of couples in Poland of reproductive age struggle with infertility problems at various levels. Seeking help, they decide on numerous hormonal therapies and treatments, and if that does not work, they seek help with insemination and in vitro treatments. There are several thousand such procedures in Poland annually, but both in Poland and Ukraine, it is difficult to obtain accurate data.
Another issue is the effectiveness of those treatments, which, of course, can result in a long-awaited pregnancy, but are often associated with a long process, preceded by unsuccessful attempts. “The effectiveness of IVF methods is very poor, contrary to what people say. IVF is a lot of money earned by people who prey on desperate and deceived couples wanting offspring,” says Maciej Socha, a gynaecologist from Bydgoszcz.
Conservative and right-wing circles in Poland say aloud that such treatments should be banned in general. More liberal circles argue that everyone’s right is to have access to medical treatments, including infertility treatments, and that includes IVF methods. But while people are debating whether IVF is an ethically acceptable medical treatment at all, the de facto sale of egg cells is still going strong. With the advancement of science and medicine, people are experimenting with genetic material more and more. Sperm banks, egg banks, or other types of clinics are being created. Women can freeze and store eggs (an increasingly popular method among women who postpone motherhood).
The COVID-19 pandemic may have slowed globalisation processes, where more open borders made the transfer of the genetic material extremely easy. Yet, there remains a “grey zone”, since the Ukrainian and Polish legislation seems to be lagging behind the progress.
This piece was supported by a grant from Journalismfund.eu.
Kate Baklitskaya is a freelance journalist specialising in the post-Soviet space. She has been reporting for international media outlets including Daily Mail, Euronews, Siberian Times, amongst other. She is based between Kyiv, Moscow and Chisinau.
Magdelena Chodownik is a Polish freelance journalist, photographer and producer.