Skip to content

Professor Andres Salumets, Development Director at the Nova Vita clinic

Recently, Estonia’s infertility treatment field had a big celebration – 25 years have passed since our first successful in vitro fertilisation procedures. During this quarter of a century, we have progressed a great deal. Our clinics are some of the best in Europe and the treatment procedures are available to anyone who needs to conceive with the help of medicine. As of now, we can already help many childless couples. Solely thanks to the work of the Nova Vita clinic, about 3,000 babies have been born during that time. What could we change to make even more couples happy?

If the pioneers of this field work with their heart in it and try to do something at least a tiny bit better every day, a lot can change within 25 years. Looking back, I can say that this is exactly what has happened with infertility treatment as well.

Good doctors and active research

Our doctors have acquired long-term experience and become valued experts, whom patients want to visit with their problems, from many countries across the world. All reproductive medicine specialists who started back then studied and acquired knowledge based on the experience of Finland. As one of the first ones, Doctor Peeter Karits and I were also trained next to our colleagues in Helsinki. As of now, based on these skills, Doctor Karits has now instructed a whole generation of infertility treatment experts who sometimes also give advice to Finnish doctors when they have difficult cases at hand.

From the beginning, we have quite quickly implemented all artificial insemination methods and new technological solutions that science provides us with. When we started, we could not even dream of the many opportunities that are now used in the clinics daily. For example, embryo diagnostics that helps to rule out genetic diseases.

Research and development activities around here are also very active. We have many scientist and research groups, also young people, who handle reproducibility problems – this has become one of the most active fields of biomedicine in Estonia. It is positive that research does not stand alone; it is well-integrated with clinical work.

Infertility treatment has become available

Probably, the most drastic change is that many people have the chance to search for help in reproductive medicine. In the early years, only a few people had access to infertility treatment in Estonia. Compared to the wages, the treatment procedures were extremely expensive and the patients had to find money for the procedure, medicine, and all other related costs themselves. As most Estonians did not have such funds, infertility treatment remained inaccessible for them. Today, the situation has changed radically. A field of medicine that used to be expensive and elitist has become a daily accessible field of treatment.

I do not know any other country in the whole world where patients are compensated for infertility treatment procedures so generously. Estonia is definitely leading in this regard. As the state compensates almost the entire infertility treatment, including drugs, accessing the treatment and having children today is no longer blocked by insufficient funds. It is not the same in the rest of the world.

Make the patients heard

All the developments that have taken place within the last 25 years have significantly helped to increase the effectiveness of infertility treatment. What could we do differently to help even more people?

Considering the current level of medicine, we could help about 80-85 percent of childless couples with one method or another. The first obstacle here is going to the doctor. Some patients have a very high internal psychological barrier that they need to overcome to contact a doctor and seek help. The more we talk about these things in public, the easier it becomes to overcome these obstacles and get the necessary treatment.

The second obstacle usually arises when the first treatment cycle was not successful. It is psychologically very hard. Many patients unfortunately give up after the first failed attempt and do not return to the clinic. The reasons are generally not medical, but emotional. If they were to continue the treatment, they would eventually conceive. Constant individual explanations are required to support such patients and they also need psychological counselling to help them continue with the treatment.

Estonia does not yet have very strong patient associations; this also applies to the field of infertility treatment. Establishing patient associations would help to increase awareness and reduce fears and biases related to this topic. With the support of a strong patient association, it would be possible to develop experiential counselling as well. Primarily, the association would help to make patients heard and establish the future of infertility treatment by taking the patients’ opinion into account more than before.

How do you help those who are struggling with funds?

Many women cannot become pregnant with their own ovum and a donor’s eggs must be used for successful infertility treatment. The need to use donor eggs is already now quite high and seems to increase with time. Therefore, we are very pleased that biases related to donating eggs have become less relevant in Estonia and the donating of eggs is generally well-organised. The probability of conceiving by using donor eggs is high and it gives a very big additional option to everyone who cannot conceive with their own cells.

I do recognise that the procedure of in vitro fertilisation with donor eggs is slightly expensive for our people because the health insurance fund does not compensate this. Both our childless patients and the society as a whole would benefit if our healthcare system compensated our patients for using donor eggs.

There are also such women who cannot become pregnant or give birth themselves due to medical reasons. Unfortunately, they can never become a mother without using a surrogate mother. In Estonia, using a surrogate is illegal, but could it possibly be time to open a discussion on this topic in our society?