How to freeze embryos and continue procreation in times of war
Planning a pregnancy in times of war is unpredictable and difficult. Men and women are at the front, one of the spouses may be killed. Embryo freezing and in vitro fertilisation are the options offered by reproductive medicine to such couples in times of war and beyond. In addition, sperm or ovum can be frozen. Such programmes are offered in case of infertility. But it is also quite possible for a woman who can have children and wants to have children in the future to store her ovum for a long time. This is called cryopreservation.
Embryologist Olha Maliuta told Dovidka.info how to procreate in times of war.
The clinic has a power cut. Do the chambers keep their temperature or is the freezing of embryos over?
The biggest danger in the event of a power outage is that the incubators where fresh embryos are cultivated will stop functioning. But every clinic has generators for these cases, and these generators were installed before the full-scale invasion began, because such situations are foreseen, and having a generator is a requirement for every embryology, for every laboratory. Frozen embryos will not be affected because they are stored in a cryo storage facility that does not require power, and they are stable. Nowadays, clinics often store them in bomb shelters or in basements, so it is absolutely safe.
What additional safety measures do clinics have?
Dewar’s cryo-tanks are these huge thermoses with a volume of about 100 litres, and they store cryopreserved embryos, that is, the whole thermos is filled with liquid nitrogen. It is not connected to the electricity grid. Liquid nitrogen in such a thermos evaporates very slowly. Even if liquid nitrogen is not topped up, this vessel can safely store cryo material for one to one and a half months. Embryologists constantly monitor the level of liquid nitrogen in such vessels.
Speaking in more detail about incubators and laboratory equipment, during a power outage, all sockets and critical equipment are usually connected to the backup power grid, which immediately switches to generator power. There are also additional batteries to ensure smooth switching, as the generator doesn’t start immediately.
And initially, all these devices operate on powerful batteries. Therefore, even if the power outage occurred when the patient was under anaesthesia in a medical sleep, it is absolutely safe, because no device stops working. Likewise, if embryos are stored in incubators and are being cultivated, these embryos are never disconnected from the guaranteed power supply.
If the power outage lasts longer, the entire lab goes into power saving mode. Employees try to turn off all equipment that is not in use at the moment. Only the incubators where the embryos are directly cultivated are left on.
Can embryos get lost?
When the patient’s embryos are frozen, they are marked with certain labels on the cryo-carriers. Everything is also recorded in cryo logs. The number of the cell where it is stored. And this address is duplicated in the electronic system used by the clinic. Therefore, such cases are almost excluded. Of course, there is a human factor, for example, an embryologist may forget to write down the place where he or she placed the embryo. But this happens rarely, and even in this case, embryos can still be found later.
How can a person without special education understand that embryos are stored in proper conditions?
The patient himself can’t carry out such a check because he doesn’t have access to a laboratory. But you need to ask the clinic in advance whether they have a system for monitoring the level of liquid nitrogen in the cryostorage. Do they have a system for warning of problems, such as an imbalance of gases or a decrease in the level of liquid nitrogen in which the embryos are stored?
Wouldn’t it be better to carry out the cryopreservation procedure outside the country, taking into account possible power outages and war?
In our circumstances, undergoing an in vitro fertilisation programme abroad is safer and may be the right decision. But you need to understand that this procedure abroad will cost much more. You need to spend time looking for a doctor and a clinic to do it. In reproductive medicine, there is a concept that there is no time to waste and it is better to undergo these programmes as soon as possible. Because time equals the exhaustion of the ovum reserve. Therefore, decisions should be made with this in mind.
If you do it abroad, which country is better? Where is the legal framework similar to the Ukrainian one?
Almost every country has its own legislation on in vitro fertilisation. If we talk about countries that are similar to Ukraine in terms of opportunities for patients, for example, to have embryos genetically diagnosed if there are indications (when a woman is over 39 years old), then these are Spain and the UK.
Speaking of other European countries, such programmes are often either funded by the state or provided for as part of insurance healthcare programmes. Therefore, sometimes Ukrainians will not have access to such private programmes, and it is difficult to join them.
Many countries have committees that will consider each case separately and give permission to take part in such programmes. In some European countries, it takes 4-5 months to get this permission. In Ukraine, it is faster. The clinic and the doctor make their own decisions. The legislation in Spain and the UK is most similar to ours.
Is there a difference in the cost of storing embryos, ovum and sperm? What is better stored?
The cost of storage is usually almost the same. Storage of embryos in clinics may be slightly more expensive. But sperm is most effectively stored in a cryopreserved state, because the cells of the spermatozoa are the least sensitive to temperature changes and other processes that occur during freezing and thawing.
Then, good quality embryos survive best. They are almost completely unaffected by freezing and thawing, and they survive with a 98% probability after thawing.
And ovum is the most sensitive for cryopreservation. Their survival rate ranges from 90 to 95%. They are technically more difficult to freeze, so they are less reliable to store than embryos…