In vitro boom in Ukraine

Photo: Anatoliy Cherkas / Shutterstock

When they enter the clinic, Olena holds her husband’s hand. Olena had been there before, but now she is accompanied by her husband. Thirty-five-year-old Ivan is a soldier fighting in Donetsk and received a pass thanks to which they could come together to a reproductive clinic in Lviv. For years the couple has been trying to have a baby.

“I want to have a child, I have always wanted to have two. War multiplies fears, but we cannot stop living because there is war. It kills anyway,” said 37-year-old Olena.

Ivan up to the very last day believed that war could be avoided but when it broke out he enlisted immediately. He got weapons and ammunition and with other men went to the front line with Russia.

“I could shout many negative things but I will keep it short: war is just blood, dead bodies, and wounded,” said Ivan.

“I will raise a child, even alone. Then I will be telling him that his father was a hero,” said Olena.

According to UN data, before the full-scale invasion, Ukraine had one of the lowest fertility rates in the world. Projections said that by 2050 Ukraine would lose a fifth of its population.

To keep the population steady it is necessary to have an average of about 2.1 babies per family. Since 1990 the fertility rate in Ukraine has remained less than that. The outbreak of the war and emigration have made the situation even worse.

Ukrainian doctors are alarmed that the number of couples who have problems with infertility has grown, especially among soldiers.

“Fifty per cent of the injuries suffered by our soldiers on the front involve the reproductive organs. In addition to physical injuries, some traumas affect infertility. There is also stress, tension, hypothermia and disturbed eating,” notes Professor Stephan Khmil, a gynaecologist at the Medical University of Gorbachev in Ternopil.

For that reason, in vitro clinics have been very busy since the war started. The exact number of Ukrainian men who have frozen their sperm is hard to come by. Some of the clinics take biological material from up to ten soldiers every week.

Not everyone can afford it. Comparing the data gathered by Professor Yuzko Olexandr Mykhailovych, the President of the Ukrainian Association of Reproductive Medicine, preliminary tests and cryopreservation (freezing sperm at very low temperatures) by themselves may cost from 1,320 to 4,000 hryvnia depending on the clinic and region of Ukraine. In addition, the largest cost is the in vitro procedure itself.

That is why, since the beginning of the war, some of the in vitro clinics, like Professor Khmil’s, have offered free procedures for soldiers.

“We are doing it for our victory. We started the project when the war started and we will continue it. It is the way to preserve the biological material and when there is a need they can use it and fulfil their dream of having a child,” said Khmil.

On November 22nd, the Ukrainian Verkhovna Rada adopted Law 8011, financing the freezing of the biological material of soldiers fighting at the front. In the case of female soldiers, this is also possible, although the procedure is much more complicated and the woman must undergo hormonal therapy.

The act provides financing for the in vitro procedure in a public facility, or assistance if a soldier wants to choose a private clinic. Military personnel are to be granted leave for the duration of the procedure. Law 8011 is valid only in times of war or a state of emergency.

“Thanks to this, defenders of Ukraine will have a chance to start a family, even if they are injured during the fighting,” said Oksana Dmytriieva, the initiator of the law.

The state will also pay for the storage of sperm during the war and five years after the end of the war. In the case of missing people, the state will be paying longer. Now most of the biological material from soldiers has been stored in the west of the country, which is considered safer. At the beginning of the war, the authorities even had to transport and store it in some EU countries.

The law in the future can be extended also to more groups.

Kyiv protects statistics about how many Ukrainian soldiers have died on the front since February 2022 like a state secret. According to the “Book of Memory” project (Книга пам’яті), about 30,000 of them may have already died. Therefore, the possibility of freezing biological material is important, as are the regulations regarding its possible use after the death of a soldier.

There are groups of women who are now appealing to MPs to create regulation concerning this scenario. In Ukraine, the use of the sperm of a deceased person for in vitro is neither regulated nor prohibited. It should be described in detail in contracts concluded with clinics, and then confirmed by a notary.

“If, despite such an agreement, the clinic refuses the in vitro procedure, it will be possible to force it to do so in court,” said Helen Babicz, a lawyer from Kyiv specializing in medical law.

The Ukrainian parliament has a few times wanted to regulate reproduction after death but so far this has not been achieved. Member of Parliament Oksana Dmytriieva does not rule out the possibility that the Verkhovna Rada will soon return to regulating the issue of reproduction after death.

One of those who has campaigned for this is Nadiia Lytovchenko, who lost her husband Andrii last summer. He was killed in a Russian ambush, leaving her alone with their ten-month-old baby boy.

Nadiia wants Marco to have a brother or sister. Theoretically, it is possible because Andrii had frozen his sperm a few years ago due to tensions with Russia.

In practice, 37-year-old Nadiia just found out that to use Andrii’s biological material she needs his testament, as it is described in their contract with the reproduction clinic. Without changing the law, she cannot give birth to their next child.

“My child is not only a continuation of my family and lineage. This is another citizen in a country that is becoming very depopulated. We must realize that this will be a long war. The next stage of our several hundred-year-old history is underway, and children are our future,” she said.

Psychologists agree that reproduction after death brings also some ethical dilemmas.

“Women decide but children do not decide and will just appear in the world. In this case, they will be “the child of heroes”. They may be burdened with expectations that they must do better and achieve their parents’ goals. It can also be difficult to talk about their origins, where and how they came into being,” said the psychologist Ewa Kaczorkiewcz.

The use of the sperm of a deceased person for procreation is not new. It is allowed in countries like the US, United Kingdom and Australia. In Israel, after the war with Hamas broke out, the health ministry permitted the use of sperm taken from the bodies of dead soldiers. So far, this opportunity has been used by several dozen families.

Agnieszka Zielińska is a Polish journalist based in Spain. She has covered mostly social issues, human rights and migration. She has reported, among others, on the eruption of the volcano on La Palma, the protests in Belarus after the rigged elections, and migration issues from refugee camps in Greece. She is a finalist for the 3rd and 4th editions of the Zygmunt Moszkowicz Journalist Award. Now she is working on her first non-fiction book.

demographics, family, Health care, in vitro, Ukraine at war