Dr Tomasz Rokicki Courtesy of Invimed

Karolina Kowalska: How many of your patients are from abroad?

Dr Tomasz Rokicki: Approximately seven percent of our patients come from different parts of Western Europe, the United States of America or even Australia. Just today I spoke to a Swiss journalist who wanted to know why our clinic is so popular with the Swiss.

Considering the ideological divisions in our parliament on the in vitro fertilization, one could hardly expect Poland to be the destination country for people trying to get pregnant. How is this possible?

Our patients from abroad don’t know or care what politicians have to say on the in vitro matter. They come here to get high-quality treatment for half the price they would have to pay in their countries or to undergo procedures that are unavailable there. It is Polish patients who are hurt by the delays in the proposed state refund policy, which is caused by the disputes between right- and left-wing factions.

Where exactly do your European patients come from?

One group of our patients from abroad are Poles residing in other European countries. They come here to treat their infertility, because they feel safer, closer to their families and, most of all, they feel they can communicate better and thus get better quality of care when the doctor speaks their mother tongue.

There is also a group of foreign patients who have attempted in vitro fertilization unsuccessfully in their homeland or in another country and are now trying their luck here. These people usually find us on the internet. European Union citizens usually decide to come to Poland because it’s cheaper. They have gone through all the government-subsidized programs at home and now would have to pay for the procedures themselves if they wanted to continue the treatment. Our prices are still about half of those in the UK and about 30 percent lower than in other European countries. One complete round of treatment costs around zł.10,000. There are also those who come to Poland to undergo procedures that aren’t allowed in their own countries.

Does it mean that Poland is more liberal in terms of fertility procedures than other EU countries?

Contrary to what you might think, it is. In Poland there are no regulations and therefore no restrictions regarding sperm, egg and embryo donations. The majority of EU countries have implemented Directive 2004/23/EC on setting quality and safety standards for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells. But it was up to the countries’ governments whether to allow egg or sperm donation and cryopreservation in liquid nitrogen or the adoption of embryos. In Germany and Norway egg donation is forbidden, while in Italy you can’t donate either eggs or sperm. In other countries you can’t preserve embryos for more than a few years. There are no such restrictions in Poland.

Are we the most liberal country in Europe, then?

Not exactly. In Poland it is impossible to use surrogate mothers, so we can’t help same-sex male couples, for instance. There are no restrictions on that per se, but according to the law, the woman who gives birth is the child’s mother, and thus its legal guardian. There is no way to legally claim your child from the woman who carried the child to term, even though it has your genes.

In the UK, where surrogacy is legal and controlled by the state, there are special supervising bodies and the whole process is precisely regulated by the law. The whole process is handled by state institutions. It is also forbidden to advertise for a surrogate or to offer your womb for surrogacy. Surrogate mothers only receive reimbursement of the expenses incurred during pregnancy and no other payment is allowed. All the potential surrogates are thoroughly screened both physically and mentally to prevent complications. I believe this very sensitive process is handled very well there.

You mentioned you cannot treat same-sex male couples. What about lesbians?

Of course we can treat them. Most of them prefer not to disclose their sexual orientation, although we would never discriminate against them. We are willing to help lesbian couples just as much as we want to help the married ones. Sometimes, lesbian patients come to our office with a male friend and introduce him as their life partner. The truth usually comes out anyway when the future father has to sign a document stating he will assume legal responsibility for the child.

Even more frequently, lesbian patients come to our clinic claiming they are single and decide to undergo in vitro fertilization or insemination with donor sperm.

In my opinion, this is the best way for them to conceive, much better than “do-it-yourself” methods, like looking for a sperm donor on the internet or buying sperm that wasn’t properly tested by a health care professional. Such actions are risky as there is no screening for HIV or other STDs. If a woman comes to a clinic, she can be sure that the sperm has been thoroughly tested and the donor went through a strict qualification process.

Is sperm donation in Poland very technologically advanced?

There are a few sperm banks in Poland but we use the Cryos bank from Denmark, the world’s largest sperm bank, which provides healthy sperm and gives our patients the opportunity to choose the donor not only on the basis of impersonal data such as his height, weight, as well as his hair and eye color, but also allows them to, for example, see his childhood photos.

What is important from the medical point of view is that the sperm is tested, preselected and free from any contagious diseases. It is also safe from the ethical perspective, as the donor’s sperm can only be used up to six times and by recipients that live in different countries or different parts of a country. This way, the risk that the children conceived from the same sperm might someday meet is minimal.

Is there an age limit for your patients? Do you treat 60-year-olds, for example, like the famous French lady who gave birth at 62?

We have decided to set the limit at 43 for women undergoing in vitro fertilization with their own egg and 49 for those who will carry an adopted embryo or her own, previously frozen one. But the success rate in 49-year-old patients is significantly lower than in younger ones. Still, 75 percent of our patients are couples in their 30s. The number of patients aged 35-42 is increasing steadily. They account for 30 percent of all the procedures we carry out. There is also an increasing number of women who decide to retrieve and store their eggs in our clinic so they have a better chance of becoming mothers once they have found a life partner or achieved their career goals.

How much do you pay for retrieving and storing eggs?

The procedure itself costs approximately zł.3,000, almost a third of what you have to pay for the whole in vitro procedure. Then you pay about zł.300 a year. There are no time limits for egg storage. Among patients who decide to freeze their eggs there is an increasing number of cancer patients who want to make sure they will have a shot at becoming mothers even when their reproductive systems are damaged by chemotherapy.

Women who decide to preserve their genetic material are usually successful upper middle-class professionals in their mid-30s. We are observing however that the profile of our patients, not only those who want to store eggs, but also those who come for the full in vitro procedure, has slightly shifted away from more affluent towards medium-income families.

How can they afford it?

That’s what breaks my heart. Such programs should be subsidized by the state, especially since it is estimated that 30,000 couples suffer from fertility problems and only 8,000 can afford treatment.

Now, with the government project of subsidizing fertility treatment currently being discussed in the parliament, there is a slight chance the procedure will be free of charge for couples who have problems conceiving on their own. Couples would only have to pay for the drugs, while the majority of the cost – that of the procedure – would be covered by public health insurance. The program would be available to couples over 30 years of age who have been trying to conceive for at least a year and can produce proof of this in the form of medical records. Such couples will be granted three rounds of treatment to be conducted over three years.

How many rounds of treatment does it take to conceive for couples treated in your clinic?

Usually it takes up to three rounds but, theoretically, we could conduct even 10. However, from the medical standpoint, it is safer to try different options if the first three to five rounds of treatments have proven ineffective. A couple can always adopt an embryo. But usually most of our patients conceive during the first three in vitro procedures. There are only about 10 percent that can’t be cured. It is a shame the politicians don’t see how important government subsidies are in this case. It would be a huge financial relief to many couples if their treatment were financed from their health insurance.

How do you feel when right-wing politicians say in vitro is morally wrong?

I try to look at the current dispute in parliament from a different angle. Parliamentary debates on in vitro fertilization can be educational not only for politicians themselves but also for the public.

Nowadays, if asked, most of the members of parliament can answer what an embryo, an egg, or in vitro is. Through the debates they’ve learned a lot about the procedure and what it entails. And knowledge facilitates public discussions among doctors, politicians and clergymen alike.

Apart from ethical issues, in vitro might be feared because of its financial aspect. Isn’t zł.10,000 for 30,000 people an enormous cost, especially in the face of the crisis we are battling?

Not if we are thinking of the long-term future of our society. It is no news that our demographic situation is deteriorating. Soon we will have to find ways to increase our country’s birth rate. Why shouldn’t we start with those who really want children and are ready to bring them up, but need some medical help?

Speaking of money, according to analysts from abroad, fertility medicines have profit margins of up to 30 percent. It is estimated that the market is worth as much as zł.135 million. Is it really that good a business?

Polish reality can’t be compared to the one in other EU countries, where the market is stable and the EU fertility treatment directive implemented. We are still investing, not only in machines, but also in know-how and technology. There are four major fertility clinics in Warsaw – us, Novum, Invicta and the Obstetrics and the Gynecology Clinic of Warsaw Medical University in the Starynkiewicza hospital. Łódź-based Gameta was trying to expand to the Warsaw market but to no avail. It is not an easy field, either in terms of medicine, or in terms of business. People might think we make millions, but the majority of our income must be re-invested in technology, machines and staff training.

Invimed has succeeded and was recently bought by Medicover group, which already operates in 12 countries. Where did the decision to merge come from?

Nowadays, it is impossible to expand without a powerful partner. Becoming part of Medicover group gives us the chance to further expand not only within Poland but also to Eastern Europe. Soon we will be setting up our fertility clinics there. It is a huge step for us.