Assisted Reproduction

“Do you know how it feels to have your own child? For us, there is only one way we could share that feeling – if another woman donates her eggs or will be going through the process of gestational surrogacy for us...”

Assisted reproduction at Rikas Medical

A very warm welcome from Rikas Medical! We have put together the below articles to introduce our Centre and to describe how Rikas Medical can support you through every stage of an assisted reproduction journey, including IVF & Egg donation, also gestational surrogacy. We hope that you will find it useful, and that it may be the first step on your journey towards making your couple’s dreams come true.

We hope you enjoy reading this, and that it helps you work out whether assisted reproduction and Rikas Medical are the best choice for you.

Meanwhile, we would love to hear from you! If you would like to have a confidential chat about Rikas Medical, the support we can offer you, and our services, please fill free to find the contact details at the end. Please get in touch with us if you have any questions you would like to ask.

Diagnosis of infertility

A rapid diagnosis and subsequent fertility treatments are particularly crucial for the efficient treatment of patient infertility. Determining that there is a need for fertility treatments is often a difficult and somewhat arbitrary decision. Some professionals suggest that after 6 months of carefully timed unprotected intercourse or, more commonly, after a year of random attempts to conceive, a couple seek some form of infertility evaluation. Although an individual’s reproductive capacity can be estimated with several methods, fertility is a product of the specific interactions within a couple. Evaluation of infertility, therefore, must consider the couple as a whole.

A thorough assessment of fertility extends beyond an evaluation of reproductive organs and reproductive germ cells (sperm and eggs). Physical examination of the infertility patient, for example, includes assessment of circulatory, endocrine, and neurologic function. Oral or written history of medical and lifestyle characteristics that may influence reproductive health is also important.

Examination of a male patient is simplified by the fact that his reproductive organs and germ cells (sperm) are readily accessible. However, this ease of accessibility is not accompanied by better and more varied fertility treatments in the male patients. This is due, in part, to a continued lack of knowledge about male reproductive physiology. Although semen analysis does permit evaluation of several aspects of male reproductive function and of semen quality and quantity, much uncertainty remains about what parameters can reliably differentiate sperm capable of fertilizing an egg from the one that is not.

Female reproductive health can be estimated through a variety of indirect indicators (e.g., menstrual regularity, hormone levels, properties of cervical mucus, etc.) and direct methods (e.g., tissue biopsy, laparoscopy, ultrasound imaging, etc.). These tests can often pinpoint easily treatable conditions or, in contrast, disorders so severe that successful pregnancy is highly unlikely. Even with the current sophisticated level of diagnostic technology, however, no fertility test can positively predict a woman’s ability to conceive or maintain a pregnancy.
Present diagnostic methods are able to identify a factor contributing to infertility in the majority of cases. In cases of idiopathic (unexplained) infertility, diagnostic technologies have failed. Techniques that consider the interaction and compatibility of a couple as a whole (e.g., interaction between sperm and cervical mucus) provide some of the best predictors of a couple’s ability to have a child. More basic and applied research is needed in this area. Until more is known about reproductive dysfunction, successful reproduction will remain the only absolute verification of a couple’s fertility.

Key treatment areas

We work individually with each couple to determine what the best choice of treatment for their personal situation is. No fees are charged for such evaluation – simply book an appointment with us. We may keep your own personal doctors well informed, and once you are pregnant, you can go back to them for your care. In addition to the entire spectrum of reproductive medicine solutions, specific focus is placed on the urology, andrology and gynecology.
We are happy to take the most difficult cases, which have poorer prognosis, that other programs may refuse to treat or even cancel in mid-cycle (for fear it would lower their reportable pregnancy rate and thereby hurt their “marketing” efforts). We will give you an honest appraisal of your chance for pregnancy in any given treatment cycle and will not artificially “inflate” statistics by “patient selection.” We are happy to take female patients over 35 with only small numbers of follicles or no follicles at all, couples with previous IVF failure, and men with severely low sperm counts or no sperm at all in the ejaculate (requiring microsurgical testicular sperm extraction (TESE)). Nonetheless, by maintaining the highest possible quality of care and always being on the cutting edge of new technology, we will give even these difficult, poorer prognosis patients their best possible chance. We achieve relatively high pregnancy rates despite taking on some of the most unfavorable cases. We have been ranked as one of the leading providers of infertility and assisted reproductive services to couples in Ukraine.

We do employ the most effective stimulation protocols, the most advanced culture systems, and very refined micro-techniques in the lab (such as ICSI, assisted hatching, fragment removal, and even blastomere biopsy to maximize your chance for having a baby) with no add-on fees or gimmick payment plans.
We do specialize in the most difficult infertility problems, where there has been a failure to fertilize or to achieve pregnancy in previous efforts, and our results are quite positive even with such cases. Patients with difficult infertility problems fly to us from all over the world. However, we will also treat simpler cases as well. We always prefer to avoid needless and expensive conventional testing and treatment approaches that give low success rates and just add to the couple’s mounting frustration. Our policy is to recommend the most effective fertility treatments that are likely to get you pregnant the soonest.

Fertility treatments can be emotionally wrenching and can place a great deal of stress on the patient. We insist on providing personal care and attention as we guide you through this difficult period of your life. You should please feel comfortable to call us at any time regarding any questions, problems or worries.

IVF & Egg donation

In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) solve the quandary presented by our frequent ignorance of why couples are not getting pregnant. If the cause of infertility really is low sperm count, the sperm can be microinjected directly into the egg. If the cause of the problem is poor ovulation, the hormonal stimulation and aspiration of eggs from the ovaries removes the need for ovulation. If the issue is poor cervical mucus blocking the entrance of sperm into the womb, these new technologies can bypass that problem as well. If the problem is endometriosis (a highly questionable but very popular diagnosis), again IVF overcomes the unfavorable environment for fertilization that endometriosis supposedly creates in the woman’s pelvis. If the problem is poor pickup of the egg by the fallopian tube from the surface of the ovary (a tricky feat in which the fallopian tube has to “reach over” and grab the egg by twisting back on itself), IVF as well as gamete intrafallopian transfer (GIFT) once again bypasses this obstacle.
Almost anything that can go wrong during the arduous process that sperm and eggs normally have to go through and these issues can be bypassed with IVF and ICSI. If the couple is committed to several fertility treatments cycles, and the woman is not too far along on her biological clock, most will eventually get pregnant no matter what the diagnosis and no matter how severe the problem.

With the advent of ICSI, there is now only an occasional need for donor sperm, but there is still a strong need for donor eggs. It is our hope that women who read this will learn how to plot their own biological clock, and thereby will be able to avoid having to resort to egg donation by planning their life more knowledgeably. However, an older woman who has already run out of her own supply of fertile eggs can still get pregnant (using her husband’s sperm, of course) with embryos derived from the eggs of a younger woman. Couples much more readily accept egg donation emotionally than sperm donation, because the woman still gets to carry and deliver the baby. Because the woman carries the baby, emotional bonding is rarely adversely affected by the fact that the baby has been derived from a donor egg. Follow-up on the children who have resulted from egg donation, and on their parents, is wonderful. These are happy families.

The question, "Whose baby is it?" creeps into every aspect of egg donation, gestational surrogacy, and adoption controversies. Adopting eggs, i.e. using donated eggs, are much more secure for the infertile couple than struggling and traveling around the world to try to find a baby to adopt at an enormous cost. With donor eggs, which are legally recognized in Ukraine, there is no risk (as with adoption) that the egg donor could ever interfere or lay claim to the child or to the embryos as egg donor remains fully anonymous.

Even a woman without a uterus can have a child. It is possible for her mother, a very close friend, a sister, or a surrogate (through the process of gestational surrogacy), to carry her biological child for her and then give that child back to her after the delivery. This is called gestational surrogacy. It is possible to arrange legal adoption from the surrogate just after the delivery. These procedures are medically and legally extremely safe and reliable in Ukraine. If you have no friend or family member who can carry your baby, we can, nonetheless, find you gestational surrogates who can do this for you with love in their hearts.

Gestational surrogacy in Ukraine

Gestational surrogacy is a process when a woman carries a baby for a couple who is unable to conceive or carry a child itself. Usually the intended mother cannot conceive, or carry a child to term, due to a medical problem. Common reasons why intended parents may look at gestational surrogacy are: recurrent miscarriage in spite of all possible treatments, repeated failure of IVF treatment, premature menopause often as a result of cancer treatment, a hysterectomy, or an absent or abnormal uterus.
Over the last years, significant changes have taken place in the legal regulation of gestational surrogacy in Ukraine. Since the Order of the Ministry of Health of Ukraine No. 787 was issued on the 9th of September 2013 "On the Approval of the Procedure of Assisted Reproductive Technologies Application in Ukraine" (hereinafter – Order No. 787), Rikas Medical immediately reflected this legislative change in our rules. Ukrainian legislation in the sphere of application of assisted reproduction does not cover all aspects of the gestational surrogacy, especially when it comes to foreigners. However, it worth noting that in recent years there has been significant changes in the legal regulation of gestational surrogacy, in particular:

  1. The right to undertake gestational surrogacy program was given only for married couples, for husband and wife. Meanwhile, singles cannot exercise such a right;
  2. The right to use donor gametes in gestational surrogacy program was clearly provided by law;
  3. The need to confirm the genetic link between the parents or one of the parents and child was provided by law. A certificate in the form prescribed by the Order No. 787 must confirm such connection;
  4. The need to execute in gestational surrogacy program written consent of the surrogate mother’s husband in the form prescribed by the Order No. 787 was provided by law;
  5. The need to execute in gestational surrogacy program notarized agreement between the surrogate mother and the couple was provided by law.

Gestational surrogacy, the only one that is permitted in Ukraine, is when IVF is used, either with the eggs of the intended mother, or with donor eggs. In gestational surrogacy program, the surrogate mother therefore does not use her own eggs, and is genetically unrelated to the baby. It is physically more complicated and considerably more expensive than straight (or traditional) surrogacy, and treatment always takes place in an IVF & Fertility clinic. Ukrainian law strictly prohibits usage of surrogates’ own eggs in gestational surrogacy.
In essence, there are three stages are involved in gestational surrogacy, namely:

  1. Egg donation: the female intended parent, or the egg donor, undergo special procedures to extract a number of eggs;
  2. Fertilization: the eggs are fertilized with semen in the lab;
  3. Transfer: the 5 day blastocyst is transferred into the womb of the surrogate mother resulting in high pregnancy rates with low multiple pregnancy rates. After a double blastocyst transfer, a much higher percentage of pregnancies were of two or more fetuses, approaching 50% in women aged 18 to 34 years.

The embryos can be transferred to surrogate mother either "fresh‟ or frozen. For a fresh embryo transfer the monthly cycles of surrogate mother and egg donor must be synchronized, and this is done using hormone medications. In cases where embryos have been frozen already, only surrogate mother will need to be “prepared” for a transfer, again using hormone medications to get her womb ready. The IVF & Fertility clinic may require surrogate mother to undergo a “mock transfer” to ensure she is physically capable of being a surrogate mother. This is no more painful or uncomfortable than the usual cervical smear.

Indeed, gestational surrogacy requires IVF, which requires the services of IVF & Fertility clinic. Clinics may vary, but some will insist that their ethics committee approve your case before allowing treatment to commence. If you have not received gestational surrogacy implications counseling, the IVF & Fertility clinic may require you to see one of the clinic’s independent counselors. The clinic will require all parties involved in the gestational surrogacy arrangement to undergo a number of checks or procedures. These will vary, and your clinic will advise you which ones are required. Because of the long incubation period for HIV, your clinic will usually require that the semen used has been frozen prior to use.

Gestational surrogacy is very much about personalities and you will be spending a lot of time together with your surrogate mother before and probably after the baby is born. At Rikas Medical, we very firmly believe that friendship should come first and gestational surrogacy second. If you find a surrogate mother that you like, and whom you trust as friend, then you will have a strong foundation for a gestational surrogacy arrangement.

After multiple requests from our patients who were looking for the proper and efficient treatment for their fertility issues, we have prepared this fertility guide to help you find the right way in your fertility treatment process...
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