War babies: the business of managing human emotions

The Russian invasion has disrupted Ukraine’s $1.5 billion surrogacy industry and posed logistical and ethical challenges for agencies operating in the country. Susan Kersch-Kibler, founder of the Delivering Dreams International Surrogacy Agency, describes how she is managing to keep her operations running.

As the founder of an international surrogacy agency, I am in the business of bringing life into the world. Since the war broke out in Ukraine in late February, I’ve been working to ensure that none of the women who work for and with me dice with death.

I set up the Delivering Dreams International Surrogacy Agency six years ago. Having worked as a real estate developer in Russia and Ukraine in my 20s, I had deep ties to the region. When my husband and I struggled with infertility, we adopted our son from an orphanage in Kharkiv. After this experience, I founded an agency helping couples grow their families through adoption and, when the rules around international adoption tightened, I moved into surrogacy.

While nothing prepares you for running a baby business in a war zone, the regional expertise and contacts I gained when developing real estate to rehouse hundreds of families after the collapse of the Soviet Union have helped me navigate the logistical hurdles of transferring women, sperm, eggs and embryos to safety.

I have also learnt to manage emotions and expectations, to turn away potential clients who may be too hard to work with, and I have certainly found that war brings out the best – and worst – in people.

As early as October and November of last year, I started receiving messages from my clients, known as the “Intended Parents” in industry jargon. They’d been watching nervously as Russia started amassing troops near the Ukrainian border and wanted to know whether we had contingency plans. In early January, we rented apartments in Lviv, a city in western Ukraine close to the Polish border. People in Ukraine laughed at us; very few were expecting Russia to take any action. Then on 15 February, nine days before the invasion, we moved our surrogates there.

Ukraine is estimated to account for around a quarter of the $6 billion global surrogacy market with some 2,000 children of foreign parents born in the country each year. Compared to the largest surrogacy agency in Ukraine, BioTexCom, which reportedly has around 600 surrogates, we offer a boutique, high-end service. We pay our surrogates $24,000 per pregnancy, a lifechanging sum of money in a country where the average annual income is around $5,000.

When Russia rolled its tanks across the border into Ukraine on 24 February, I had 13 pregnant surrogates and five employees in the country and an equal number in preparation to start.

As Russian missiles rained down on Ukrainian cities, I came under increased pressure from the intended parents to move the surrogates again, this time over the border into Poland. I was reluctant at first. Many of the surrogates, all of whom already have their own children, didn’t want to move further from their families, and the rules around surrogacy are more onerous in many of Ukraine’s neighbouring countries.

On 11 March, when Russia bombed two airfields close to the city, I was in Krakow, Poland, on my way to Ukraine. With the threat of war closing in, I decided it was too dangerous for the surrogates to stay in Lviv. I hastily arranged apartments in Krakow and asked one of the surrogacy coordinators to travel with the women to the city. But one of the surrogates, who was pregnant with twins, was deemed a high risk for premature labor. Doctors had put her on bed rest and wouldn’t let her be moved. I was faced with an impossible decision: Do I leave her alone in Lviv? Or do I ask a staff member to stay with her, potentially putting her life at risk, too? In the end, my employee Oksana Hrytsiv, a married mother of two, agreed to stay instead of fleeing with her family to the relative safety of the mountains.

I set up Delivering Dreams for two reasons: first, to give couples who have long struggled to get pregnant themselves a chance to have a biological child; secondly, to support Ukrainian women. The women that work with us want to use the money to get ahead; to buy a house or put their children through private schools. One woman used the funds to set up her own businesses.

Surrogacy is a topic that often divides people. Misunderstanding and stigma remain rife. Some people in Ukraine still believe that the woman is selling her child, while Americans have asked me whether the father has to have sexual intercourse with the surrogate. But there is no genetic connection between the surrogates and the child. The eggs of the intended mother, or a separate donor, are fertilized with the father’s sperm and the embryo is transferred into the surrogate. I’ve also heard criticism that it commoditizes the female body and goes against the wishes of God. Our response to that has been that Mary was, in fact, the first surrogate.

Ukraine is one of a handful of countries worldwide that allows for legal international surrogacy. Legally, foreign couples can conceive children in Ukraine provided they are married heterosexuals who can medically prove why they can’t have a child themselves. Parents’ names and nationalities are immediately listed on the birth certificate with no mention of the surrogate, avoiding legal complications prevalent in other countries, such as Poland, Slovakia and Hungary, where the surrogate is considered the child’s mother. The parents also have custody of the child from inception, meaning that if there is an issue with the pregnancy, as long as it doesn’t threaten the life of the surrogate, they can have the final say.

Those that sign up to become a surrogate understand that it’s a job with rules and contractual conditions. Our screening is intense. Only around one in 40 applicants is successful. The women must have already given birth and fulfil a list of criteria, encompassing their physical and mental health. We also ask that their close circle of family and friends be supportive of the surrogacy. Before signing the contract, we encourage them to have independent legal counsel and get them to speak with former surrogates to make sure they truly understand the process.

While the money is undoubtedly a major draw, the surrogates are also motivated by doing something for other people. From the very beginning, they talk to the fetus about their parents; we get baby buds to put on the stomach so that parents can read stories. In a way, it’s a kind of extreme babysitting.

Following the outbreak of the war, we stopped the program altogether for just over a month because we had to focus on security and didn’t know what would happen next. We had a harrowing experience with one surrogate trapped in Sumy, a city in the northeast of Ukraine that fell under Russian occupation, and we didn’t want to be faced with having to move other surrogates through dangerous areas to get them access to quality care.

The surrogate from Sumy had endured a 36-hour journey to Lviv, including a 12-hour drive in a minibus on unpaved roads and through fields to Kyiv. Before we transferred her, we received written permission from both the parents and the surrogate herself. During the journey, we kept in touch every 20 minutes to keep track of where she was. When she eventually arrived in Lviv, she had some bleeding. We rushed her to hospital, and the ultrasound showed that she hadn’t lost the child. She is now staying in Poland with her own daughter and is around 17 weeks into her pregnancy.

"If we have a surrogate that is currently living in a dangerous area, we ask the intended parents if they would be willing to pay for her to live in accommodation elsewhere until week 25."

We also had to make evacuation plans for our clients’ biomaterials. We transferred all cryopreserved eggs and embryos to Slovakia and the sperm to Lviv. We also set up the option to give birth in Georgia and Albania. Now that Russia is focusing on the eastern front, we are in the process of resuming the embryo transfer in Kyiv.

Unlike other surrogacy agencies operating in Ukraine, which reportedly abandoned their surrogates or lost contact with them, leaving them without access to medicines, we stayed on the ground to ensure they continued to receive the very best care.

This has paid off, with couples who are looking for an agency with the highest legal and ethical standards continuing to opt for our services. We typically accompany between two and four pregnancies per month, and currently have 14 new couples matched with surrogates. In mid-May, we did our first embryo transfer since the war broke out.

Our 21 pregnant surrogates are spread out across Lviv, Krakov and Zhytomyr, a city in the middle of Ukraine around two hours west of Kyiv. Others, in the early stages of pregnancy, have decided to stay in their hometowns to be close to their extended families and protect their properties. In our contracts, the surrogates are required to move from week 26 to be close to the best medical care. If we have a surrogate that is currently living in a dangerous area, we can only work with them if the intended parents are willing to pay for her to live in accommodation elsewhere until week 26 when we start paying. This can add considerable costs to the process – the price of housing in Lviv, for example, is around $1,000 per month. But some parents are willing to pay.

“While the money is undoubtedly a major draw, the surrogates are also motivated by doing something for other people. From the very beginning, they talk to the fetus about their parents; we get baby buds to put on the stomach so that parents can read stories”

- Susan Kersch-Kibler

As an independent agency, we aren’t partnered with an individual clinic but work with several clinics which we audit yearly to assess their standards. This flexibility has paid dividends during the war. Because we aren’t tied to a bricks and mortar building, it has allowed us to move our surrogates and to hire the exact expertise we want as and when we need it.

The biggest challenge right now is still explaining the constant changes to parents. We try to think ahead, but the war is dynamic which means decisions must be constantly re-evaluated and re-assessed. Every time we want to move the surrogates and biomaterial, such as sperm and embryos, we have to get written permission from the parents. We have found that proactive communication works best. We send the parents daily logs on the situation on the ground and explain our decision making around any changes.

Our team consists of myself in New Jersey, one staff member in Krakow and four in Ukraine. To cope with the continued demand, we are looking to hire two to three people. Due to the extra costs of renting apartments in Lviv and elsewhere, we will shortly raise our prices.

Undoubtedly, the hardest part of my job over the past few months has been managing the emotions of parents. I’ve lost count of times people have asked me what’s going to happen next in the war. I’ve come to realize that all they want is for us to stop the fighting.

War brings out the best and the worst in people. It is common for pregnancy to be a time of worry for expecting parents, even more so for those who are thousands of miles away from their babies. For couples who have been through miscarriage after miscarriage, surrogacy is often a last-ditch attempt for a family. When their children are suddenly immersed in a war situation, it’s only natural that they will feel great stress.

Yet it is important to remember that the surrogates are women, who are facing their own worries; they are not just wombs for hire.

"We try to think ahead but the war is dynamic … we send the parents daily logs on the situation on the ground and explain our decision making around any changes."

At Delivering Dreams, we encourage our clients to build a relationship with the surrogates and stay in touch after the birth. Some of the intended parents have, however, let us down in recent months and caused distress to the surrogates, my staff and myself, by failing to show gratitude.

In Ukraine, it is customary to give a woman an odd number of flowers after birth. We had one set of parents who just came and took the baby and left. They didn’t even write to the surrogate to say thank you. Another couple failed to respect the wishes of the surrogate. She had to undergo an emergency procedure and requested that the parents remain outside the operating theater. Instead, the parents barged into the room and had to be escorted out by the medical team.

Another set of parents ignored our advice to stay in Poland until shortly before the birth and arrived in Ukraine two weeks early. Unnerved by the constant sound of air raid sirens, they started pressuring the surrogate to give birth early, even though this went against medical advice.

In the other extreme, another couple who had long promised the surrogate they would be by her side for the birth sent a message three days beforehand informing her they were going to stay in Poland and asking for the baby to be brought to the border.

This may be a business and you are supposed to be objective, but you can’t help but let these things affect you. As a result we have established a new list of guidelines for intended parents, which includes not making promises in case they cannot keep them. If we think clients are going to be particularly hard to work with, we recommend that they hire someone else.

The war has also exposed the hidden courage in so many people. One of my staff members, who came across as shy and retiring before the war, displayed a real heroic streak. Fearing that the conflict might lead to a collapse in the banking system, we had stashed cash at various places across Kyiv. When the war broke out, this staff member had risked her life to go and collect this money and important documents before hitch-hiking for three days across the country to Lviv. When she arrived, exhausted, she told us, “I never knew I had this in me.”

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