The impact of the war in Ukraine on the Russian fertility industry

The devastation caused by the Russian invasion of Ukraine on 24 February, as well as the unspeakable sufferings experienced by Ukrainian civilians, have rightfully been at the centre of international attention.

In the context of surrogacy, the human disaster unfolding with surrogates and newborns trying to escape places of immediate conflict to other parts of the country or hiding in bomb or makeshift shelters has been well documented (see BioNews 1130 and 1137), as has the plight and sorrow of intended parents based in other countries racing to Ukraine to meet their babies but then struggling to find routes to leave Ukraine. Many have also struggled to reach Ukraine to be present at the birth of their children and collect them. There is also the risk of bombardment while there.

Yet, while the world rightly focuses on the developments in Ukraine, it is necessary to pay attention to how the fertility industry in Russia is impacted by the war. Much like Ukraine, the Russian fertility industry, and surrogacy specifically, is dependent on the cross-border mobility of equipment, drugs, intended parents, egg providers, surrogates and cryopreserved gametes, as outlined by Siegl (2018) and Weis (2021).

As researchers on surrogacy in Russia, we are drawing on our contacts and ongoing research in the Russian fertility sector for an ad hoc analysis to crystallise the most pertinent questions for this commentary and future research. On request, our informants remain anonymous.

As outlined in BioNews 1087, in 2021 two draft bills were submitted to the Russian Parliament aimed at restricting surrogacy in Russia to heterosexual, married Russian infertile couples, thus reserving surrogacy for 'domestic' use only. The bills were submitted on the wave of anti-surrogacy and anti-gay sentiment in the country and followed the resonant criminal case initiated after a surrogacy-born child was found dead in a rental apartment, where several surrogacy-born babies for Filipino intended parents were also being cared for.

The impact of COVID-19-related mobility restrictions which caused many babies born through surrogacy for foreign clients to get 'stuck' in Russia were also fresh in people's minds. Both bills received negative reviews by the legal department of the State Duma and have been recently declined (Bill draft number 41630-8 and Bill draft number 1191971-7). However, according to Ostanina N, a deputy of the State Duma and a representative of the Committee on Family, Women and Children, the authors of the draft bill are ready to resubmit the document in a new edition.

These legal uncertainties and the COVID-19-related challenges are now exacerbated by the international sanctions on Russia due to its invasion of Ukraine, and the war itself, even though far less dramatic than in Ukraine. Economic sanctions on Russia have included the removal of banking service SWIFT, making it difficult or even impossible to transfer money to and from bank accounts.

While the Russian Association of Human Reproduction (RAHR) responded to the draft bills and the case of the child born by surrogacy who died, it has not issued any public statements on the war in Ukraine. However, in his public address to RAHR members, Vladislav Korsak, president of RAHR, has expressed the importance of staying 'united in the service of the patients in the present circumstances.' Responding to our inquiries, both RAHR and the recently founded Russian Association of Surrogate Motherhood have pointed out that in these volatile conditions making any forecast of how the situation will unfold is difficult.

On the one hand, medical staff and agency managers have informed us that private fertility clinics in Russia continue operating as normal. Some even reported an increase in the number of fertility treatments, which they associated with the risks Russia's residents are facing regarding a devaluation of their savings and a potential surrogacy ban.

On the other hand, however, medical staff also have reported a degree of caution from patients in Russia as, though treatment costs remain the same, increasing living costs due to economic sanctions strain patients' financial capacities. Furthermore, as pharmacies across Russia have started reporting drug shortages as reported by the Financial Times, the fertility industry is likewise starting to feel the impact. One clinic manager's response to this inquiry was that 'clinics are working internally on logistical restructuring to counter difficulties', whereas another informant pointed out that the currency purchase restrictions imposed by the Russian Central Bank make it increasingly difficult to purchase the necessary consumables, such as needles for ovarian puncture and oocyte extraction, from abroad. Yet another cryo-transport company has already left Russia, and is relocating its business elsewhere.

With regard to the impact on international patients' fertility treatment in Russia, one senior doctor stated that these patients are left on their own to manage international travel to and from Russia and arrange international payments. Yet while for most international patients continuation or finalisation of treatment is merely more complicated, Ukrainian citizens or residents are currently unable to pick up their children born through surrogacy in Russia, as their newborns are required to temporarily be taken into Russian state custody.

Further to surrogacy and the intricate connections between Ukraine and Russia, Russian surrogacy for the longest time has been relying on the reproductive labour of women migrating or commuting from neighbouring former Soviet countries. Like all labour migrants, it has been reported their earnings are now diminished by the sanctions, and the inflation and reduction of remittances impacting their families and home countries' economies. Companies we contacted that organise surrogacy in Russia maintained that surrogacy continues to be a comparatively lucrative employment opportunity for women there.

In 2014/2015, intended parents expressed hesitation over using Ukrainian surrogates after the annexation of Crimea due to concerns over a future armed conflict with Ukraine. Many intended parents were worried about the impact this might have on their surrogate's wellbeing, and ultimately on their child.

For this commentary, we desisted contacting Ukrainian surrogates in Russia to ask them about their experiences. But it is worth noting that there will be dozens if not hundreds of Ukrainian surrogates in Russia – pregnant for Russian and international client parents, witnessing their homes being bombed, their families besieged, fleeing or being torn apart, and their male relatives drafted – while unable to return home or to travel to be with them, as their contracts tie them to where and how to deliver the babies they carry.

Our inquiries show that while fertility service providers in Russia seek to portray the situation as under control, and avoid making public statements, the impact of the invasion in Ukraine is palpable in Russia. It will have consequences on the development of fertility services in and beyond both countries for a while yet.

We dedicate this commentary to surrogates, intended parents and children affected by the Russian invasion in Ukraine.