On 23rd January 2018 EggDonationFriends held the fifth free webinar, this time on the topic of surrogacy in Ukraine: options, legal aspects, documents – how to start? The webinar attracted fertility patients from the USA, UK, Ireland, Germany, Poland, Italy, Hungary and the Netherlands. The webinar was presented by Kateryna Sokolovska – a medical coordinator of the surrogacy program at Intersono IVF Clinic in Ukraine. Ms Sokolovska assists intended parents throughout their surrogacy journey and provides them with the most comprehensive and up-to-date information on the progress of their program. Kateryna also works with surrogate mothers starting from their examinations, through stimulation and during the pregnancy process.
Below we have included the full transcript of the webinar’s Q&A session with Kateryna Sokolovska.
Q 1: Who/which doctor can give the recommendation for surrogacy? Can a Ukrainian doctor do that? Suppose I had 7 failed IVFs and everything is normal, in Germany, for example, it would be hard to obtain a recommendation.
I would say that you would need to provide documents from those IVF cycles, or some protocols of simulation, some cultivation protocols, because failed IVF is by itself an indication to surrogacy. More than four failed cycles is an indication to surrogacy.
Q2: What is an apostille?
An apostille is a special, stamp normally given by the Ministry of Foreign Affairs. It legalizes documentation for those countries which have signed the apostille convention.
Q3: What about couples of mixed heritage?
In case of mixed background, normally it is it is taken that the residence of the child is given by the residence of the father, even if the people are using a sperm donor. In a case where, for example, the father is Irish and mother is English, the baby would receive an Irish passport.
Q4: Is surrogacy indicated for a woman who is over 50 years old?
A woman who is over fifty years old would not be indicated for surrogacy. This can be an indication for egg donation but, unfortunately, not for surrogacy.
Q5: Do you have egg donors from different ethnic backgrounds?
Yes. We have different phenotypes. You need to speak to our coordinator and choose whichever phenotype you are interested in
Q6: Is the immunity of the surrogate mother tested?
This is tested by general tests. If there are any problems shown by the general tests, or in the tests that I mentioned earlier [in the presentation], then additional consultations with doctors are prescribed. Where there are any immunological problems, the surrogate does not proceed to the confirmed program.
Q7: How do you bring the baby back to the United States?
The process for the United States is pretty clear, and I would say easy, because, compared to other countries, a United States citizen will just need two DNA tests to confirm paternity. The child and father will need to provide DNA samples and when the lab sends the results these will be submitted to the US consulate in Kiev, where they will issue a passport, usually within two working days.
Q8: We have 4 frozen own embryos and looking for gestational surrogacy only. Is there a package for this request?
This is one of the packages that we offer; the package regarding frozen embryos. In order to get information on frozen embryos, please contact us by email, phone or via our website so we will be able to clarify all the issues and organize transportation.
Q9: How complicated is it to obtain a birth certificate and travel documents? We are citizens of the EU. Can these be obtained by the parents themselves, or is it better to go through the clinic? How much does this service cost, as part of the whole package, approximately?
The European Union is a very wide term so I would need to clarify which country you are from, because for different countries there are different procedures. In Bulgaria, for example, regulation is not the same as for Ireland, so the cost would depend on these factors.
Q10: 7 failed IVFs and one pregnancy, lost in the first 8 weeks – is this enough to be qualified for a surrogacy program? We are not married – is this an obstacle? Can we have a certified partnership or is marriage mandatory?
Firstly, seven IVFs and one lost pregnancy is most certainly an indication for surrogacy, but we would need some documents confirming this. Not being married is an obstacle and we would be unable to start the program without an apostatized marriage certificate.
Q11: Can we use both donor eggs and own eggs with a partner’s sperm for implanting embryos in the surrogate?
Yes. Combined cycles are also popular.
Q 12: What are the backgrounds of egg donors and sperm donors? Are they of worldwide ethnic background? I am Caribbean; my partner is Irish.
There are lots of ways we get our donors into the database, so we can get any person from all over the world. You will just need to say what you need.
Q 13: What is the program cost for gestational surrogacy with own frozen embryos?
It is approximately 37,000 Euros.
Q 14: We are based in the UK. What is the average time to gain a UK passport to travel home?
There is a DNA test involved in this process, so normally it takes a one-and-a-half to two-and-a-half month stay in Ukraine, so you will need you’ll need to take this into account.
Q 15: What if you have 2 failed IVF cycles and a hydrosalpinx, which prevents you from having the embryo implanted. Is this sufficient for the surrogacy program?
I would need to consult with our fertility doctors not to give you the wrong information. We would need us to clarify this. Sorry.
Q 16: What happens if there is something wrong with the baby (e.g. Down’s syndrome)?
In case of some serious defect (i.e. Down’s syndrome) is detected and confirmed by non invasive test, amniocentesis is prescribed. In case it also shows high risks, the intended parents have a right to decide about abortion of the pregnancy before week 20.
The chances of developing pathological pregnancies using donor material are lower compared with the use of patient material. However, only the difference in age plays a role, since the risk of genetic mutations increases with age. Also, pathologies are more closely related to oocytes and double donation is not allowed in the surrogacy programs.
The practical guarantee of the genetic health of the embryo is the PGS of the embryos and in case of potential risks – performing amniocentesis.
Q 17: Can I have an embryo and an egg of the same ethnicity?
I would need to clarify this.
Q 18: Have you treated couples from Ireland?
Yes, sure. We have really good experience cooperating with Irish couples.
Q 19: Do you accept frozen embryos which are deposited in Prague and which can be transported to you?
Yes, sure. We have had such an experience. We have a courier department that can transport from anywhere in the world to our clinic.
Q 20: Do you test couples before they go onto surrogacy? What if you can’t help them?
Normally, we ask our couples to come to the clinic with their test results because, as you understand, surrogacy is often a last resort, and couples have normally undergone all kinds of pre-treatments. But, if needed, or where there are no test results available, our clinic provides the possibility to test everything from head to toe.
Q 21: How long does it normally take to find a surrogate mother?
It doesn’t long, as there is no waiting list. Normally, we need between one and one and a half months in order to check the candidate before we can offer her to the intended parents.
Q 22: How many embryos are transferred in surrogacy program?
Up to two. You can choose either one or two.
Q 23: How long does it take to start surrogacy after signing the agreement?
Here I would need to clarify whether it would be frozen own or donor cycle. We have the surrogates but we would need to know how soon the donor would be ready and how soon the patient would be ready. If everything goes according to plan, we can transfer in one or one and a half months. To tell the truth, we very rarely use frozen donor eggs as, statistically, for clinical pregnancy rates, it’s better to use fresh donor eggs. If the donor is available in the database immediately, then it will be between one and one and half months.
Q 24: Do you accept frozen embryos deposited in the USA?
Yes, we can do that.
Q 25: What about matching the egg donor’s looks?
The database includes photos of the donors, so you will be able to choose by yourself, or, if you wish, you can give your photos to our coordinators and they will choose donors who best look like you.
Q 26: How long do we wait for the donor and surrogate mother? How many embryos will be transferred in one cycle?
You will need to check the availability status of the donor in the database. You don’t need to wait for the surrogate mother as they are already waiting for the intended parents. We can transfer up to two, either one or two, embryos in one cycle.
Q 27: How many attempts does a couple need to have to get a baby with your package?
If it is the basic package, if we are speaking about donor eggs, it would be as many as they are ready to pay for; every try is paid additionally. If they have the guarantee package, it not a matter how many tries, they will get a child.
Q 28: What is the success birth rate of your surrogacy?
This depends upon the cycle. In the case of egg donation, it is 87% percent, in the case of fresh own IVF cycles, 73%, and in the case of frozen cycles, we have 59%.
Q 29: What are the costs for egg donor + surrogacy and what is included (number of attempts)?
Speaking about the basic program, this is paid stage by stage. So, you pay, for example, for the signing of the documents, then you pay for one transfer. If this is successful, you move to the next stage, which is paid in the 12th week of pregnancy and then, if everything goes well and the pregnancy is progressing, this is paid in the 26th week. If the first transfer is not successful and you have frozen embryos, you can try another cycle with frozen embryos, paid additionally, until pregnancy is achieved. So the number of attempts is what you are ready to pay for. With a guaranteed package, there would be an unlimited number of attempts.
Q 30: Where are the prices published?
In order to get the prices, you will need to contact us because we need to understand which problem you are interested in.
Q 31: Do you help with the legal documents once the baby is born? Does this cost extra?
Yes, of course, we can help with this. We would need to know your country of residence. After the baby is born, the program covers obtaining a Ukrainian birth certificate, the basis for all the rest of the documents and if you need help, apart from the Ukrainian birth certificate, this would cost extra. This is our Go Home package and the exact cost would depend on your country of residence.
Q 32: When you transfer the embryo into the surrogate can you also do the same for the intended parent?
Yes we can do this, but, for the parent to do the transfer to herself, this raises some questions about indications to the surrogacy services program in the first place
Q 33: Are we able to bring the baby home right away or do we have to wait for the paternity test?
You cannot return home without the paternity test because, without it, your embassy is not able to give you a passport or emergency travel documents. Before you get the travel documents you will need to stay in Ukraine.
Q 34: Could you give an example of an egg donor + surrogacy program price with one transfer? How much do the several stages cost?
The whole program costs 41,000 euros, and in order to get a description of the stages, I would need you to contact us.
Q 35: How long does it take to have the papers of the baby ready for Portugal?
I guess this would be up to two months.
Q 36: On average, how many attempts you need to achieve pregnancy?
On average, from all the statistics that we have since 2005, for over 500 cycles, it is two and a half attempts.
Q 37: What is the process for shipping embryos from the USA? Do we need to come two times or just once after shipping embryos?
Firstly, regarding the process, you will need to clear everything with the lab where your embryos are stored. You need to sign the consent forms to release them and then sign the documents for our couriers, giving them the right to transport them. Next, you can come to take your baby home, because it is possible to sign the documents for surrogacy programs in your own country.
Q 38: Do we need to stay in Lviv until the papers are ready? 2 months?
Yes. It is also possible to stay part of the time in Lviv and part of the time in Kiev, where the embassy is.
Q 39: How long do the papers take to travel to Romania assuming both parents have Romanian citizenship?
The process should take up to three weeks.
Q 40: How long do we need to wait for an appointment after shipping embryos?
We can organize an appointment even before shipping the embryos. We can discuss all the details and then just proceed with the shipping, so there is no need to come back after they arrive here at INTERSONO.
Q 41: If you can’t stay 2 months in Ukraine, who would look after the baby?
That’s an interesting question. We have the possibility of hiring a nanny to help one of the parents if the second parent needs to go back to work, for example.
Q 42: What information do we get about the egg donor? Is it published somewhere?
Yes. A short portfolio is in the database and, on request, the coordinator of the egg bank is able to give a family medical history and also an extended profile.
Q 43: How long is the waiting time to be matched with a surrogate mother? Do we select or do doctors select the surrogate?
There is no waiting time because there are some surrogate mothers already waiting. We combine your requests with the doctor’s recommendations, and of course, you will have your say.
Q 44: What is the normal wait time to get travel documents for a baby for Irish citizens?
Q 45: Is the egg donor’s photo available as well?
Yes, definitely. I think Ukraine is one of the few countries where you can actually see their photos.
Q 46: Are the surrogate mothers vaccinated against MMR (measles, mumps, rubella)?
Yes. This is a part of the vaccination plan for all people in Ukraine so the surrogates will have been vaccinated.
Q 47: Does the hospital have a NICU available for babies in case they need intensive care units?
The maternity hospitals in Ukraine have standard stage-one NICUs. If help and intensive care are needed, the children are transported to specialized children’s hospitals where the stage-three and stage-four intensive care units are located.
Q 48/49: Is the birth certificate in Ukrainian or English?
This is a national document so it is in Ukrainian, but we provide an English translation and apostolization and, on request, the birth certificate can be translated into any language.
Q 50: If the mother is a US citizen and father is only a resident, how is this handled?
I would need to consult the lawyers whether it would be possible for such a couple to start the program.
Q 51: Does mother or father get a hospital room during the birth of the child? Or can the child only be visited at certain times prior to hospital discharge?
Parents can only visit the child, unfortunately, as there is no possibility at this time to stay in hospital with the child after the birth.
Q 52: How many donor eggs are guaranteed from the donor? Is the number of embryos also guaranteed?
They guarantee 12 eggs and at least two blastocysts.
Q 53: Can you perform surgical sperm retrieval?
If you mean TESA, yes we can do that.
Q 54: Does Ukraine have any strict requirements regarding the import of embryos for surrogacy?
This is a very good question. In the next Webinar, our courier will be speaking, but as far as I know, the embryos need only to have been tested, nothing more.
Q 55: Do we have an initial meet-and-greet before signing up?
If you wish and if you have time, you can come personally to our clinic, but it is also possible to sign the documents in your own country.
Q 56: If we have embryos ready, is there a package available just for surrogate and hospital without IVF meds?
The surrogate needs to have her endometrium stimulated and if the embryos are frozen, they still need to be thawed, cultivated, undergo assisted hatching and then transferred, so we won’t be able to avoid the IVF medication.
Q 57: For the question about the guaranteed number of donor eggs, is 12 the guaranteed number for all surrogacy and egg donor packages or just for the unlimited attempts package?
This is for all the surrogacy and egg donor packages.
Q 58: What is unlimited then 20 plus?
It’s not a question the number but of the quality. A bigger number does not mean a better quality of eggs.
Q 59: Can you please answer again about the guaranteed number of blastocysts?
We guarantee 2 blastocysts.
Q 60: What is the recommended number of embryos for transfer?
Where these are fresh embryos and of good quality, up to AB, doctors normally recommend transferring one. If they are of lower quality, if the woman is over 40 years of age or if these are frozen embryos, the doctor will most probably recommend transferring two. So, if, for example, the embryos are of C quality, the doctor would most like recommend transferring two.
Q 61: If on the first egg retrieval there are neither 12 eggs nor 2 blastocysts, is another cycle performed?
If on the first egg retrieval there are not 12 eggs or 2 blastocysts, then another cycle is performed free for you.
Q 62: Can we decide to transfer 2 embryos or is it up to the doctor only to pick a 1- vs. 2-embryo transfer?
Of course: it is up to you. The doctor can only make recommendations, but you make the final decision. It is important that patients understand this.
Q 63: What if the intended parent’s eggs are over 40 and her eggs are used? Does that mean you transfer more than one embryo? Is age a factor here?
Yes. It is statistically confirmed that implementation is lower if the patient is over 40 and that’s why, to increase the chances of pregnancy, it is recommended we transfer two. But of course, it is ultimately the patient who makes that decision.
[If you are interested in this subject you can also watch our webinar on “IVF with Donor Eggs Over 40” where Dr. Uljana spoke on that topic.]
Q 64: Does it mean we could ask to transfer 2 embryos to the surrogate mother (with donor eggs)?
Yes. The coordinator will ask you to sign a consent form that you understand that there is a risk of a multiple pregnancy, which is considered to be a risky pregnancy. But still, you have such a right.
Q 65: What specific letter do I need to provide from my MD in the USA that states we need to use a surrogate? Or do I just send my medical records over for a review?
I think that, firstly, we would need to check your medical records. If there is no direct indication, we will need the doctor to state that the patient is either unable to conceive or gestate the pregnancy. If the patient’s home State allows for surrogacy this can be stated and a gestational surrogacy is recommended.
Q 66: Do you get involved in the surrogate’s diet, etc.?
During the pregnancy screening, the gynocologist works in pair with the nutritionist and the nutritionist creates a diet specifically for this lady.
Q 67: How do you confirm the surrogate is not using alcohol or cigarettes during the pregnancy?
She is tested during her visits to the clinic. We select surrogates carefully and make sure that if the surrogate uses alcohol she does not go further than the first interview. They undergo three tests every visit, a nicotine test, a test drug test and an alcohol test.
Q 68: What about exposure to sexually transmitted diseases by their partner?
In their agreements, there is a condition that the surrogate mothers are not allowed to have intercourse during the pregnancy and so it’s not possible to be exposed.
Q 69: How frequent are the visits by the surrogate generally? How often does the surrogate come for alcohol, drugs and nicotine tests?
The tests for alcohol drugs and nicotine are done during every visit, so the moment she steps into the clinic she goes first for these tests. Generally, when the surrogate enters to the program she comes, maybe, every 10 days to every two weeks in order to be examined. During the process of stimulation, she comes to us every four, five or six days, depending on how often the doctor wants to see her. After two weeks of the transfer, she will have an HTG test and if this is positive, after two more weeks she will have the six-week scan, and then the nine-week and 12-week scan. She will come to the clinic for pregnancy screening in the second trimester, once in a month, sometimes more frequently if the obstetrician wants to check them more often, for example, in the case of with twins. Then, the closer to the delivery date, the more often they need to come. Starting from week 12, and closer to week 40, firstly, they come once every three weeks, then once every two weeks, then every week and sometimes at the end of the pregnancy, they come two times a week.
Q 70: What if there is a problem with the unborn child? Do we get to decide what happens to the unborn child? Is the unborn child classed as successful?
Only the intended parents are able to decide what happens to the unborn child. If there are any problems, in case of some genetic diseases, we would need to go through the procedure in order to confirm this. Sometimes it can happen that an IPT test comes back positive and we are obliged to do an amniocentesis, which can confirm any issues 99.9%.
Q 71: Does the doctor recommend the surrogate to abstain from sex 2 weeks before transfer and 4 weeks after transfer? Do they have bedrest one day after transfer?
Starting from stimulation, that is one month before the transfer, abstination is required and until the end of pregnancy. Regarding bed rest, normally they stay in the clinic overnight after the transfer, sometimes for a couple of nights and then they are free to go home.
Q 72: Does the surrogate mother live in the hospital accommodation during the process?
She doesn’t live in the hospital itself, but in a rented apartment very near; a five-minute walk away.
Q 73: If the unborn child is aborted and we have an unlimited package, does this mean we lose other chances?
In case the pregnancy is aborted before week 12, the next embryo transfer will be performed with no additional cost for the intended parents. In case the abortion takes place after week 12, the couple will need to pay extra to proceed.
The exact sum will depend upon the term of abortion. Under abortion here I mean silent abortion when the embryo stops developing.
Q 74: Can you apply a notch process/scratch test to endometrium when the doctor places the embryo?
I will need to clarify that, but yes it can be performed, no problem.
Q 75: What is the average waiting time to be matched with a surrogate? Once matched, how long to begin a cycle for surrogacy?
We don’t need to wait to be matched because there are surrogates waiting for the intended parents. In order to begin a cycle for surrogacy, and it would depend on which cycle, I guessing frozen, we would just need to consider the cycle of the surrogate mother and we can start the program in the second phase of her menstrual cycle.
What is surrogacy?
Let us make things straight – surrogacy is not a fad or a whim. This method has been successfully since 1986. Surrogacy is a fertility solution for women and men for whom pregnancy (even with the help of IVF) is not medically possible, too risky to the mother’s health or simply not possible because the intended parents are male same sex couple.
There are different types of surrogacy:
1) Traditional/straight surrogacy (also dubbed partial or genetic surrogacy). In this method:
- the surrogate’s eggs and the intended father’s sperm (or donor sperm) are used in artificial insemination so called “turkey baster” method. Actually, in this method there is no real turkey baster involved. The surrogate uses a sterile, disposable syringe to insert sperm in her vagina. This procedure can be performed privately by the parties without the need for a doctor, however, you can also have it done at a fertility centre.
2) Gestational/full surrogacy – also known as host surrogacy. This method involves an IVF procedure and the resulting embryo being implanted in a surrogate. Sometimes gestational surrogates are referred to as gestational carriers. Full surrogacy may have different forms, for example:
- the intended parents’ genetical material is used (egg and sperm) – the baby is genetically related to their intended parents; this is a great option for women whose oocytes are of high quality however, they cannot, for some reason carry and give birth to a baby.
- the doctor uses the intended father’s genetical material and oocyte coming from a donor – a solution that will only work if the father’s sperm of sufficient quality.
- the intended mother’s oocyte is used along with donor sperm – the baby is then related to the intended mother only.
- also donor embryo can be used.
More about surrogacy – costs and legal aspects
In countries where surrogacy is legal, for instance in Ukraine, infertile couples may use the help of a fertility clinic like Intersono which assists the intended parents through the entire process.
Here you can read more about surrogacy cost and legal aspects at Intersono IVF clinic. Compare surrogacy costs in the USA, Canada, South East Asia and Ukraine, also, see some photos of surrogate babies born through surrogate services of Intersono.
Many famous people have used surrogate services, among others Tyra Banks, Jimmy Fallon, Lucy Liu, Sarah Jessica Parker, Kim Kardashian, Elton John or Neil Patrick Harris. They have done it for a number of reasons, some of them being multiple failed IVF cycles, having medical conditions like preeclampsia or placenta accrete. If you have a medical condition preventing you from becoming pregnant, have a healthy and safe birth or surrogacy may be your only option for parenthood. Once again EggDonationFriends would like to thank all participants for joining us online and asking so many questions. We hope the answers, which are published above, will help you make an informed, well-thought-out decision.