The head of the Paediatrics Department at St Luke's Hospital has called for the setting up of an independent regulatory body to oversee methods used in assisted procreation.

Simon Attard Montaldo also proposed at a meeting of Parliament's Social Affairs Committee that in In Vitro Fertilisation (IVF) treatment, not more than two fertilised embryos should be implanted, thus reducing the risk of multiple pregnancies.

Dr Attard Montaldo stressed that his presentation was only a representation of his views and not those of the department.

He pointed out that embryos were not frozen in Malta. Had they been, one could allow for a limited number of fertilisations in agreement with the couple on the maximum number of children they would be willing to have. In other countries, surplus embryos were discarded but this was not possible under local legislation.

Implanting embryos at different sessions would reduce the risk of multiple pregnancies, increasing the possibility of normal healthy births.

Limiting the reimplantation per sitting to not more than two embryos would be emulating what other countries were doing.

These suggestions, Dr Attard Montaldo said, would reduce the conception rate of the local IVF programme but would also significantly reduce infant mortality and morbidity.

While the overall mortality rate of infants was eight per cent, that of IVF infants was 15 to 25 per cent, he said. But the higher figure was not because of IVF as such, but because of multiple pregnancies.

IVF was a major cause of multiple pregnancies all over the world. But it was a fluke of nature to have multiple pregnancies naturally. The risk of premature births rose with multiple pregnancies, and the smaller the baby, the higher the possibility of mortality or morbidity.

Likewise, the risk of neuro-disability increased with the order of pregnancy.

In fact, while only five per cent of singletons, whether natural or IVF, were born pre-maturely, the figure went up to 50 per cent for twins and 95 per cent for triplets or more.

Dr Attard Montaldo said that research regarding IVF babies carrying additional risk of cancer and other disabilities was still unclear. Although some reports suggested a link, they were based on a very small number of patients.

There was also no evidence that IVF caused other congenital or chromosomal anomalies.

He felt IVF should be facilitated but regulated. Counselling should be improved and batching, embryo wastage and high order pregnancies should be avoided.

Janet Mifsud, commissioner, National Commission for the Promotion of Equality between Men and Women, said bioethics education should be a must for all health care professionals and students. There should be regular conferences to discuss updates in science, medicine, biotechnology and church teachings.

The Bioethics Committee had done a lot of work over the past few years to inform and educate. There should, however, also be coordination between established bodies such as the health department and the university.

Any law regulating bioethics should not deal exclusively on assisted reproduction technology but also on the implications of research, clinical trials, euthanasia, informed consent, data protection and societal norms and values, Dr Mifsud said.

She said that although the technology and knowledge behind medical practice had changed dramatically and would continue to change rapidly, what had not changed was the fundamental fact that it involved human beings who were hurt or sick or had the potential to become so.

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