Reproductive medicine is practiced in a distinctive environment. The rapid pace of medical progress, and the fact that reproductive medical tourism tends to involve third parties (e.g., sperm donors, egg donors or gestational surrogates), shapes this environment. There are some unresolved challenges and a need for guidelines to advance proper reproductive medical tourism practice. There are also differences in historical, political, religious, and social views of patients involved in reproductive medical tourism. These generate issues relating to the rights and welfare of both patients and unborn children. Most significantly, the issues are accompanied by a failure to acknowledge the outstanding importance of the rights not only of patients, but also of unborn children. To engage in reproductive medical tourism without regard for these rights is not possible.
The most revolutionary progress in Ukrainian reproductive medicine came in 1990, when the first successful In vitro fertilization (IVF) and embryo transfer was performed. This new technique was swiftly adopted across the globe, and was first performed successfully in Ukraine in 1991 when there was born the first child “from a tube”. With the subsequent success in micro-insemination since 1990, it became possible to conceive a child with just one sperm, one egg cell, and a uterus. People who previously had no chance of conceiving a child now had choices that gave them hope. These dramatic progresses opened up possibilities for reproductive treatments in combinations hitherto unimaginable, employing any set of different techniques. Reproductive and fertility treatments that were previously impossible now came within reach, if patients were prepared to travel to Ukraine.
Reproductive medical tourism, however, differs in many respects from other forms of medicine, and in the context of medical tourism, poses many issues not encountered elsewhere. Ukraine is one of the world’s most advanced countries in the field of reproductive medical tourism. Almost 50 clinics offering assisted reproductive technology (ART) are currently registered with the Ministry of Healthcare of Ukraine. This is a relatively smaller number when compared, for example, with the 464 registered clinics in the U.S. as of 2015, and the approximate 1,064 clinics across of Europe.
Ukraine also lacks the U.S. and Europe in terms of the number of ART cycles performed. Anyway, the number of children born through ART in Ukraine by 2011 was higher than 12,000. It is concluded from these numbers that births involving some kind of fertility treatment, whether ART or otherwise, account for a significant part of all births in Ukraine. Furthermore, embryo-freezing technology in Ukraine is also advanced as in the West. Today, more children are actually born through the thawing and transfer of frozen embryos than through the conventional techniques of IVF and embryo transfer.
Although Ukraine is leading the way in reproductive medical tourism, there are inevitably some cases where success is not possible due to a complete absence of sperm, egg cells, and uterus. In those cases, reproductive treatments involving third parties foregoing are required. Usually, the practice of such treatments is informed by legislation and administrative guidelines, ethical considerations, and specific social and economic environment. In Ukraine, fortunately, there is such legal framework, and medical practice in this area is steered at the legislative level.
Generally speaking, reproductive medical tourism in Ukraine is driven by three major factors concerning the kinds of demand it meets: advanced medical technology, social environment in terms of the legal permissibility of the treatment sought, and the simple economic motivation of Ukraine. The medical technology factor is explained in terms of patients travelling to Ukraine to access advanced medical treatments not available at home. In some cases, this type of movement is also related to Ukraine social and economic conditions. Reproductive medical tourism in Ukraine is directly linked to economic growth in Ukraine.
Reproductive medical tourism involves patients crossing borders to seek better medical care. Because Ukraine is leading the way in the field of reproductive medicine (mainly, in reproductive treatments involving third parties foregoing), the number of Ukrainian patients engaging in overseas reproductive medical tourism in this field is thought to be negligibly short. However, the transparent guidelines on reproductive treatments in Ukraine have led to a considerable increase in inbound reproductive medical tourism recent years (mainly, in the fields of egg donation and gestational surrogacy).
This increase raises some common challenges of economics, safety, and ethics. It is particularly important to remember that such a cross-border reproductive care (CBRC) often takes place in the context of economic disparity between the source country and Ukraine. There are also legal differences that can sometimes result in uncertain status for the newborns resulting from CBRC. In the worst case, newborns can be born with no fixed nationality, requiring a court judgment to determine their status. Furthermore, questions of the welfare and rights of those newborns, the most important of all considerations, have been left largely unaddressed to date. It will be important to tackle these questions head-on from now on.
Ukraine must face up to these challenges and embark on a process of legislative improvement with the consent and involvement of all parties. Nevertheless, it must be acknowledged that this situation in itself represents a protection of the rights and welfare of both patients and newborns.