Olia Maliuta

Specializes in IVF, artificial insemination, reproductive medicine, infertility, etc. Populariser of science.

Work about the future: reproductive medicine and the importance of embryology in wartime

Story of embryologist Olia Malyuta

Embryology is a kind of scientific medicine, a very thin line between science and practice. You can read something and then immediately apply it at work. After all, this is a very young medical field: the human embryo, its behaviour in the first five days, and implantation have not been studied extensively yet. Much research is being carried out on observation, statistics, and testing whether certain things work.

I am interested in studying the molecular structure of the embryo, in particular, how and why specific genes are involved. This fine regulation — which genes are activated or not — determines the embryo’s potential and development. Currently, there are interesting studies on the possibilities of predicting whether an embryo is “good” (genetically healthy) without invasive procedures (e.g. biopsies – removing a few cells for further examination). To do this, scientists study the substances that an embryo releases into the environment where it is cultivated. Artificial intelligence is also used: in fact, embryologists choose the best embryo for implantation by appearance, while artificial intelligence, most likely, sees specific patterns that humans cannot detect.

How did you decide to become an embryologist?

In life, I generally go with the flow and say “yes” to offers I am interested in. That is how I chose my specialization – I entered the department of molecular biology because it seemed cool: genetic engineering, DNA, proteins. Then I started working at the institute, in the same department where I did my internship. Later, I got the opportunity to create a genetic laboratory for hereditary genetic disease diagnosis in the clinic.

Once you have everything set up and you end up doing just mechanical work, it gets boring. Then I was offered to study embryology. I heard about embryologists at the university – we had a tour to a reproductive clinic. At that time, I thought that dreaming of becoming an embryologist was something unreal. I believed one needs connections and someone to teach you because there are no training opportunities in this field in our country. However, one person wanted to teach me in the clinic where I worked. Therefore, I said “yes” to this opportunity and started learning one day.

Is the field of embryology developed in Ukraine?

We are advanced because many things are allowed here. For example, genetic diagnosis of embryos is routine in Ukraine: it can be carried out both for medical reasons and simply at the patient’s request. In many countries, genetic diagnosis is either not allowed at all or permitted in extreme cases only.

We also use nuclear transplantation of embryos, which is prohibited in many countries. In fact, there are patients whose embryos do not evolve and stop developing on day 2 or 3. Nobody understands why this happens because these embryos are often genetically functional. In this case, two zygote pronuclei can be taken (when the embryo is still at the one-cell stage) and transplanted into the donor zygote. Basically, we change the embryo’s cytoplasm (the cell’s inner contents), and it starts developing.

Our egg donation programmes are cheaper than in Europe. At the same time, the quality is high. Also, surrogacy is allowed in Ukraine, which is an advantage too. For many Ukrainian couples, it is vital to have surrogacy as an option — for example, if a woman was treated for cancer and needed to have her uterus removed.

In addition, Ukrainian doctors can perform certain surgeries that are not done in Europe. For example, if a woman undergoes radiotherapy for cervical cancer, sometimes the ovaries can be sutured higher in her abdominal cavity. There are very few specialists worldwide who can perform egg retrieval after that. And our doctors can do that.

The speed is also crucial. Sometimes in Europe, it takes 3-4 months to receive permission for medical treatment. In reproductive medicine, three months (especially for women over 40) is a waste of time because the cell reserve gets exhausted. In Ukraine, everything happens much faster.

In general, we have demand and professional competition in our country, which fosters progress.

How goes the war affect your work?

I guess for most embryologists, the full-scale war started at work. You do not expect such things: you have many embryos being cultivated in laboratories, and you have patients under hormonal stimulation.

I came to work on the first day of the full-scale war: we froze absolutely everything we had. We then transported all the material in dewars with liquid nitrogen (flasks for long-term storage at low or high temperatures) to Western Ukraine and abroad.

We were also taking care of our cryo-storage abroad – adding nitrogen, carrying out certain programmes, carrying out embryo transfers for our foreign patients and Ukrainians abroad. Now the work in our clinic will partially resume, but it is only 20% of our previous volumes. We retrieved many Ukrainian patients. However, 50–60% of patients before the full-scale war were foreigners who would come here for medical tourism. Some decided to store embryos outside Ukraine, while others continued treatment in other countries.

Soon I will leave Ukraine for a while. I will work in Malta – a country with different legislation. For example, only five ova can be fertilized there. If you receive 20 ova from a woman, you freeze 15 and fertilize only 5. That is, you do not create more embryos than are needed for treatment. This approach has long been recognized as not rational on the global level. Religious restrictions apply here. If these five do not work, then you defrost the next ones. Therefore, they are very focused on how to understand which five ova you need to choose.

We will work with the technology of evaluation of the egg’s spindle apparatus. Fertilization is always performed with an immature cell. Its chromosomes are “stretched” on the spindle during division. The quality of this spindle is evaluated, and in this way, healthy ova are selected. This is necessary for work, and at the same time, it creates new knowledge – you understand more about the processes of chromosome separation during cell division.

Why is it essential to work with embryology now?

This is a work about the future. First, we need it for healthy children to be born in Ukraine. Let’s take spinal muscular atrophy, for instance – basic genetic testing of the couple (whether they are carriers of this mutation), and then embryo testing if necessary, is an opportunity to conceive a healthy child.

During the war, it is an opportunity for military personnel to conceive a child. For example, since 2014, the military began freezing sperm — this is insurance in case of injury. If the patients are officially married, the wife will be able to use the material later. I wish any military could come and donate the germ cells that could be used for an anonymous donation. But for now, this is impossible. According to the law, only people who already have a healthy child can become donors of ova and sperm. 

For Ukraine, my field is also an essential economic factor. We need to restore the popularity of medical tourism as it was before the full-scale war because this is how the county’s economy will grow.

 

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