Frozen future: why the military should preserve their genetic material

Hundreds of thousands of brave men and women who went to defend Ukraine from the russian enemy planned their lives differently. But war has begun bringing a high risk of severe injury or death.

Nataliia Kyrkach-Antonenko's husband, Vitalii, died on November 9 in the Svatove region, defending the Luhansk region. The couple met while studying at the Donetsk National University, then lived together in Slovyansk. From the first days of the full-scale invasion, Vitalii decided to defend the country from the enemy.

Nataliia and Vitalii expecting a child. Photo from Nataliia's Facebook

Nataliia was then pregnant with her first child but lost the baby a few weeks later. She got pregnant for the second time in August when she could still see her husband. Now Nataliia is holding on with all her strength for the sake of her future daughter. She decided to raise awareness of an essential topic of preserving the genetic material of defenders for the possibility of later procreation.

Rubryka decided to find out how such a procedure works, its legal side, and everything you need to know about cryo-freezing.

The future father is now far away — on the battlefield near Kharkiv, in Ukraine's east. The wife is in the rear in Ternopil, western Ukraine. They are united by boundless love and the desire to become parents. For a long time, the couple went through all possible infertility examinations. A reproductive medicine doctor from the Clinic of Professor Stefan Khmil chose the best option for them — in vitro fertilization.

"We started preparing for the program, and when the wife came for a follow-up examination, we learned that her husband is now defending Ukraine. Without any hesitation, they were offered the opportunity to go through the protocol with a special offer. This was the very first couple who entered the protocol under the program for the Armed Forces of Ukraine and paid UAH10 for in vitro fertilization and the ICSI method," the clinic says.

The process of evaluation of cells by an embryologist. Photo of the Clinic of Professor Stefan Khmil

Currently, the biomaterials of the woman and the man have already been collected, and fertilization has occurred. Doctors are now monitoring the woman's condition after the puncture and are preparing for embryo transfer.

"These two weeks drag on, but the wait is worth it to see the shining eyes of the patient afterward. The happiness that lights up a woman's eyes when she finally learns about her dream pregnancy is difficult to describe in words," the clinic says.

This is just one of the stories of how defenders today can solve issues regarding future children. Another option is cryopreservation, which is also in demand in Ukraine today.

Cryopreservation of reproductive cells (eggs and sperm) and embryos is a method of suspending biological processes in cells under low temperatures (-196 degrees). After warming up, the cells resume vital activity.

This is Stefan Khmil.

It is possible to carry out cryopreservation of both male and female germ cells. "Delayed motherhood" programs remain more popular because a woman's ovarian reserve is limited and over time the number of oocytes and their quality decrease significantly, says the director of the medical centers "Professor Stefan Khmil's Clinic," professor and reproductive specialist Stefan Khmil.

To carry out cryopreservation of seminal fluid, it is enough to contact a reproductive specialist and pass a series of tests — a spermogram and the so-called "critical" tests for infections. After receiving the results, provided there are no contraindications, the day of submitting the biological material is set.

The process of evaluation of cells by an embryologist. Photo of the Clinic of Professor Stefan Khmil

In the case of cryopreservation of oocytes (egg cells), everything is a little more complicated. First, a consultation, a general examination, and an assessment of a woman's reproductive system are carried out. The ovarian reserve is predetermined, and the superovulation stimulation protocol is selected individually. In the case of reduced ovarian reserve, "soft" stimulation is performed.

Next, the patient will undergo a follicle puncture with egg aspiration. The resulting eggs are vitrified in the embryological laboratory and placed in cryo-storage, where they can be stored for many years.

There is no "expiry date." Such oocytes can be stored for an unlimited amount of time and do not undergo aging processes. Storage in a cryobank is possible for as long as it takes to realize the readiness to give life to the baby.

Stefan Khmil shares that children born with the help of cryotechnology are no different from those conceived naturally. This year, for example, two twins were born in the US from embryos that had been deep-frozen for 30 years. This is the longest period in history during which frozen embryos have been waiting to be born. The embryos have been in liquid nitrogen storage since April 22, 1992, and have remained viable. Nothing is impossible.

Egg cells in the monitor during study. Photo of the Clinic of Professor Stefan Khmil

For a woman and even a wife to use a man's reproductive cells, she must have legally approved permission. The same applies to a man if he decides to use a woman's frozen egg by using the services of a surrogate mother.

There are no contraindications or negative consequences of cryopreservation for men. Similarly, for women, there are no contraindications to egg freezing. There may be contraindications or negative effects of hormonal stimulation, in which oocyte "banking" is carried out — the accumulation of eggs in the natural cycle. A reproductive specialist will be able to explain everything in detail.

Bohdana Motuzyuk, a medical lawyer at the legal company White Law Laboratory, says that today cryobanks are successfully operating in many countries following local legislation. In Ukraine, a relevant regulatory act regulates the use of assisted reproductive technologies (ART) — the Procedure for the Use of Assisted Reproductive Technologies in Ukraine, approved by the Ministry of Health. 

Cryobank at the Clinic of Professor Stefan Khmil

Together with the issue of cryopreservation, there is the issue of further determination of the origin of the child born as a result of the use of ART. This, in turn, is regulated by Art. 123 of the Family Code of Ukraine.

Two parents will be listed on the birth certificate. If a woman, with her husband's consent, gives birth to a child using ART, even if genetic material from a donor is used to create the embryo, the man will still be the official father of the child.

Conversely, if a woman, with the help of ART, gives birth to a child whose embryo was created from her husband's sperm and a donor's oocyte, then the spouses themselves will be recognized as the child's parents. The issue becomes more complicated if the man who owns the genetic material dies.

The movement of spermatozoa during a spermogram

The issue of the use of cryopreserved gametes after the death of their owner in Ukraine is actually not settled and is somewhat ambiguous in the interpretation of lawyers and medical professionals.

Bohdana Motuzyuk

To apply ART, the spouses sign the appropriate consent. And only if it is available if the husband has frozen genetic material can the woman use it in the ART program after the husband's death. But here, the issue becomes ambiguous since it can be interpreted that, in fact, with the death of a person, such consent loses its validity.

Because of this, not all healthcare institutions are ready to take such a step. The legislator does not give an answer as to what to do in such a case.

Cell evaluation process. Photo of the Clinic of Professor Stefan Khmil

To use the genetic material of a partner after death, you need the following:

• the consent of the person whose biomaterial is frozen to the use of ART;
• a contract with a health care institution for the storage of cryopreserved cells, which clearly prescribes actions in the event of the death of their owner;
• a notarized statement about who and how can use genetic material in the ART program.

In this case, both spouses will be considered parents, even under the condition of the death of the one whose genetic material was frozen.

In general, the topic of cryopreservation is still poorly defined from the point of view of legislation. But if we talk about implementation, there are already many hospitals where such a procedure can be performed quickly and without negative consequences. Currently, such services can be free of charge for defenders.

Among the clinics where defenders can use the cryopreservation service free of charge are the "Mother and Child" Medical Center, Yuzko Medical Center, MEDICOVER Clinic, and the above-mentioned clinic of Professor Stefan Khmil.

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