Kurt Sansone
MPs pass the buck to government
Target to reduce risk of multiple pregnancies
The parliamentary Social Affairs Committee has ended its discussion on IVF, which has been going on since March, without resolving the key issue under scrutiny and MPs failing to reach a conclusion on whether egg freezing is preferable to embryo freezing.
In its final session this week, the committee, chaired by Nationalist MP Edwin Vassallo, agreed to pass on the transcripts of the lengthy discussions, including the expert opinions, to the government without deciding whether embryo freezing should be substituted by egg freezing (oocyte vitrification) or, if allowed, under what circumstances.
The decision will have to be taken by the government while drafting legislation to regulate IVF.
Government sources said the drafting had gone “beyond the initial stages” with input from different ministries. In fact, Prime Minister Lawrence Gonzi last Sunday hinted that the law would not favour embryo freezing, insisting that egg freezing helped avoid the problems of conscience brought about by embryo freezing.
During the debate at the Social Affairs Committee over the past few months, MPs inched closer to consensus that embryo freezing should be permitted but differences emerged between experts over when it should be allowed.
Embryo freezing was thrust onto the national agenda after a Select Committee chaired by Nationalist MP Jean Pierre Farrugia last year unanimously recommended it be allowed as part of the IVF process.
Nationalist MP Frans Agius and Labour MP Michael Farrugia were members of the Select Committee that had, over the course of nine months, listened to expert opinion and produced a detailed report on the matter.
However, Health Minister Joe Cassar had reacted negatively to the proposal, insisting that egg freezing was a preferable option.
His comments and those of a handful of doctors, calling themselves Professionals Against Embryo Freezing, re-opened the discussion and the Social Affairs Committee was tasked to evaluate egg freezing as an alternative.
During committee meetings, Jean Pierre Farrugia and Michael Farrugia stood solidly behind their report, insisting that, although embryo freezing should not be the rule of thumb, it did not make sense to have a law that was too specific and restrictive.
In submissions to the committee, Mark Brincat, director of gynaecology and obstetrics at Mater Dei Hospital, had said embryo freezing and oocyte vitrification were not mutually exclusive. He insisted that embryo freezing was necessary to reduce the risk of multiple pregnancies and give couples the best possible chance of success.
Prof. Brincat reiterated what he had told the Select Committee last year that the target should be to implant two embryos and reduce the risk of multiple pregnancies.
However, to achieve this, a higher number of eggs had to be fertilised because natural wastage always happened. “If we fertilise four eggs to get two embryos but end up with three fertilised eggs instead, what shall we do with the third one? Shall we discard it or forcefully implant it in the woman? Embryo freezing is a fallback option in this case,” Prof. Brincat had said in a statement that put him on a collision course with the doctors opposing embryo freezing.
Despite their opposition, the doctors admitted that embryo freezing would have to be allowed in certain cases of “a grave nature” but in their final submission last week their legal consultant, Tonio Azzopardi, hinted at a very restrictive law that would not make provisions for the situation cited by Prof. Brincat.
It was this stickling point that remained unresolved and which is now back in the government’s court.
Select Committee recommendations
The Select Committee on medically assisted procreation chaired by Nationalist MP Jean Pierre Farrugia last year made a series of recommendations intended to resolve the main sticking points left open by the 2005 Puli report.
• Heterosexual couples in stable relationships and not just married couples should be eligible for medically assisted procreation treatment. This recommendation may be changed to married heterosexual couples after the passage of a divorce law, according to Jean Pierre Farrugia, although Michael Farrugia insists the wording should remain the same.
• An autonomous authority on the same lines as the Human Fertilisation and Embryology Authority in the UK should be set up to issue licences to clinics, draw up standards of best practice, collect information from clinics and certify the eligibility of couples for IVF treatment.
• Infertile couples should have the possibility of adopting frozen embryos that are unclaimed by their parents.
• The donation of sperm and ova by third parties will not be permitted.
• The law should allow unused embryos to be frozen for future use by the couple. The Health Minister has said egg freezing is a preferred option with embryo freezing only used as a last resort for grave cases, a situation that is yet undefined.
• IVF treatment should be financed by the state to make it accessible to all infertile couples.
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Mr Saliba Francis
Jun 18th 2011, 08:25
I always thought that it is the MPs that form the government!
Jean-pierre Farrugia
Jun 17th 2011, 15:50
Fact File:
1. Sal-Kungress tal-ESHRE f'Ruma fl-ahhar ta' Gunju 2010 il-pozizzjoni kienet li embryo hu ferm aktar rezistenti ghal freezing mill-bajda (Luca Gianaroli, Parlament Malta, April 2010).
2. L-iffrizar tal-isperm qatt ma kien problema ( qed inhalli barra ghal kollox id-donazzjoni ta' gameti li hi indispensabbli fil-kazijiet aktar rari ta' sterilita' - dawn jistghu jintbaghtu barra ).
3. F'dan il-Kungress tressaq studju minn Ana Cobo (Valencia) fejn irrizulta li bl-uzu ta' vitrification ( hafna oghla ) il-bajda saret rezistenti daqs l-embryo. B'hekk jigu ffrizati l-gametes tal-partners ( li la infertili jkollu/ikollha/ikollhom apriori gametes/sistemi riproduttivi difettuzi ), il-bajda tipprova tigi fertilizzata b'ICSI (intra cytoplasmic sperm injection - hafna oghla) u l-embryo/s jigu ffrizati sakemm tigi l-mara ghat-transfer.
4. Bil-ligi kontra l-Abort, Malta ma jistax isir elective Single Embryo Transfer (eSET) bhalma jsir fl-UK u xi 5 pajjizi EU ohra ghax b'dal-mod thalli l-embryos jikbru ftit u mbaghad wara gimgha taghzel l-aktar wahda zviluppata u tittrasferixxi lilha (Dignitas Personae jekwiparixxi dan ma' Abort) b'rata ta' success gholi hafna u minghajr ebda twins.
5. Jekk jigu trasferiti zewg embryos f'salt ir-rata ta' success hu 20% - bhalissa Malta jittrasferixxu 3 jew 4 (sakemm ma toggezzjonax il-koppja) biex jghollu r-rata ta' success b'riskju gholi ta' twins/triplets bhalma kellna f'Jannar ( triplets iwasslu ghal rata gholja ta' cerebral palsy).
6. Il-punt krucjali: biex ikollok ta' lanqas 2 embrijuni trid tipprova tiffertilizza 3-4 bajdiet bl-outcome ikun il-kreazzjoni ta' 0-4 embryos:
0 embryo - tghidilha terga tigi wara li jigi ripetut il-process fuq bajdiet iffrizati ohra taghha;
1 embryo - tittraferrih b'rata ta' success success baxx hafna;
2 embryo - success 20%;
3 jew 4 - il-paediatricians maltin unanimament ma jaqblux li jigu trasferiti izjed minn 2 f'salt. B'hekk f'kaz mhux ippremeditat li jinholqu aktar minn 2 embryos, jigu trasferiti 2 u ffrizati il-1 jew 2 l-ohra. Kienet hasbet esklussivament ghal din id-sitwazzjoni l-Kummissarju tat-Tfal precedenti. L-emfasi hu li l-embryos zejda ma kienux ippjanati b'intenzjoni izda mahluqa inevitabbilment minhabba l-incertezza tal-procedura. Ma dan kien qabel Dr Schembri Wismayer l-uniku espert tal-lobby kontra embryo freezing ( Kumitat Affarijiet Socjali 11 Mejju 2011).
7. Dr Tonio Azzopardi f'isem dan il-lobby ( Kumitat Affarijiet Socjali 8 Gunju 2011 ) rega' bdielu meta stqarr: "l-iffrizar tal-embrijuni jithalla jsir biss u eccezjonalment f'kazijiet gravi u impellenti ta' force majeure li tkun iccertifikata mit-tabib. F'cirkostanzi ohra l-iffrizar tal-embrijuni jkun ipprojbit." Dan jirrispetta c- cirkostanzi kollha tal-mara (indirettament anke tar-ragel), gravi u mhumiex - minn mewt sa "second thoughts" - izda le tal-embrijun b'riskju gholi ta' korriment f'kaz li jigi trasferit 1 embryo u riskju gholi ta' prematurita' f'kaz li jigu trasferiti 3 jew 4.
Fic-cirkostanzi kif zvolgew jien ma kelli ebda diffikulta' li l-proposti originali tal-Kumitat Maghzul isiru aktar restrittivi, imma aktar minn hekk zgur li mhux denju ta' politika serja li taspira ghall-eccellenza fis-sahha. Dan ma hu liberali xejn - kien ikun liberali gamete donation, eligibilita' lil persuni single jew koppji gay, surrogacy, preimplantation genetic diagnosis (ukoll ekwiparat ma' Abort f'Dignitas Personae) - sitwazzjonijiet li eskluda l-Kumitat Maghzul immexxi minni u li ilu xolt 9 xhur.
Mr Marco Cremona
Jun 17th 2011, 14:49
Given that even IVF (without entering the discussion about freezing of embryos) is considered a "grave evil" by the Catholic Church, what is our holier-than-thou MPs position on not only granting free access of IVF to everybody but also deciding between the freezing of embryos or the freezing of eggs?
These are the same MPs who have difficulty voting 'YES' in parliament on a democratic divorce law because of issues of "conscience". How do they feel about being part of a government who has already invested in IVF equipment at Mater Dei? Do they want to be party to the propagation of this "grave evil"? Where is their conscience now?
A question to Mr.P . Vincenti ..... how can you oppose divorce and not oppose IVF - when IVF is the precursor to embryo freezing and therefore abortion - your raison d'etre?
I am completely baffled.
Mr Alfred Baldacchino
Jun 17th 2011, 14:33
If given the choice, would anyone opt to be born by artificial means ?
I certainly would not !
Philip Hili
Jun 18th 2011, 11:12
@Mr Alfred Baldacchino
Ibqa' cert Sur Baldacchino, li hadd, lanqas dawk li qeghdin imexxu din l-agenda ma jkun jridu li jitwieldu bl-"IVF". Jekk huma ONESTI maghom infushom jghidulna jekk jixtiqux li jekk jergghu jitwieldu, jippreferexxux jitwieldu bl-"IVF"!!!
Izda ghax hemm il-boqxiex - flus (L-EUROS) fin-nofs, allura dak isir dritt bhal ma sar dritt id-divorzju. Ara jekk hux l-erba galantomi li jahdmu f'dan il-qasam qeghdin jitkelmu u jmexxu l-agenda.
Hbieb taghna, mhux koppja wahda ta, izda izjed minn koppja li nafu qalulna li kull darba li jmorru ghand il-gynaecologist dan jiccargjhom 70€ kull visit!!!! Fejn hi l-kuxjenza?
Flus, Flus u Flus BISS. Ghalhekk iridu li jmexxu l-agenda tal-IVF issa!!!
Mr Lawrence Fenech
Jun 17th 2011, 13:00
I would not mind another referendum on this matter as long as EFA does not interfere.
Philip Hili
Jun 17th 2011, 14:49
@ Law. Fenech
So long you pay for ALL the expenses incured!!
DR EMMANUEL BEZZINA,MA,MAG.JUR.[EU Law],LL.D.,
Jun 17th 2011, 12:41
Pure or Adulterated waste of time:give the people complete liberty to determine what is best for them,themselves! They are capable of so doing. The people do not require any impositions from nobody or anybody. Let them have adequate and seasoned explainations by all means,but let our representatives stop wasting our resources.Those who want to moralise can do so on their own steam and to their inner selves.
Give the people all possible options. It is not to our House of Representatives to dictate the ultimate choice of each individual.This mentality has to stop or the people will see to it that it is halted.Legislate for IVF now;and secularise this country as the people do not want to hear anymore that farcical quipp that some organisation has the constitutional right to teach what is right or wrong.That situation was created by way of a compromise which has now run into history:Malta is a liberal country,secular in its thoughts and lay in its behaviour. That is all that has to be accepted: now MPs vote in this law,that of divorce,that of a lay constitution,and eliminate all earthly priviliges to those whose kingdom does not appertain to this earth!
Mr Dr Miriam Sciberras
Jun 17th 2011, 12:37
There are a number of inaccuracies in your front page article regarding embryo freezing, which need to be corrected if your newspaper is all about informing the public on the real state of the debate and not on pushing forward someone’s agenda on embryo freezing.
During the debates at the Social Affairs Committee, there where some points of convergence reached mainly that the Laws of Malta should include embryo protection right from fertilization and that the couples undergoing the grueling IVF treatment should have the proper support from qualified fertility councilors. Many couples suffer because they do not have this psychological back up and the informed consent is not really informed as couples are painted a pretty picture and do not really know what they are going in for.
There was never any agreement on embryo freezing as an option of treatment in IVF. In fact the debate was reopened because of this disagreement. The embryo has a right to life and should not be subject to manipulation and freezing.
The “handful of doctors” you refer to were representing the lobby group set up in January, Professionals Against Embryo Freezing(PAEF). This lobby group now numbers over 200 professionals including lawyers, consultants, doctors, nurses and many others. The midwives association is also a member of our group. Since being set up we have worked very hard to raise awareness about the embryo’s value and the embryo’s right to life.
We have also brought forward other issues that where not even being considered as an option. I am referring to the use of oocyte vitrification (freezing of ova) as an alternative to the use of embryo freezing. This technique is now proven to give good results as Dr Eleonora Porcu, head of a fertility hospital in Bologna confirmed. Dr Porcu gave a public lecture on this subject to which your reporters where invited but did not attend. She also answered any questions from the public. Scientific papers back up what Dr Porcu stated which is more than one can say about the many comments being said by others working in the same field. Embryo freezing is not needed as an option of treatment.
Working with oocytes rather than with embryos avoids the legal, ethical, moral and religious issues. This is a very important issue often being overlooked in the local discussion. It avoids the build up of surplus unwanted embryos as well as the legal problems associated with ownership of the embryos in cases of separation or marriage breakdown. This process also avoids the needs for the women to undergo repeated hyper stimulation cycles and avoids multiple pregnancies.
Embryo freezing in the unforeseen grave emergency is different. It means that should something serious happen to the woman that prevents her from having the embryos transferred such as an accident on that day of embryo transfer, the embryos can all be frozen until they can be all be safely transferred again when the woman recovers.
Dr Miriam Sciberras
Co Coordinator PAEF
Philip Hili
Jun 18th 2011, 02:10
@ Dr Miriam Sciberras
Unfortunately the PN is hijacked by members like Dr. Jean Pierre Farrugia.
Time for the party to make a clean sweep, otherwise, the Party is going to face the music. Another agenda in the middle!!! Who is going to make money from these things?
Charles Sammut
Jun 17th 2011, 12:04
Perhaps the Government should pass on the buck to the People by way of another "consultative" referendum and then the MP's will have a discussion with their conscience irrespective of what the People decide by way of the referendum...or better still, why does'nt the Government have a talk to the Archbishop and ask his opinion regarding the introduction of IVF and then the Archbishop can take a trip to Rome and lay this hot potato in the lap of the Holy Father and ask His opinion on this subject ?
....and the beat goes on...and the beat goes on.....
Mr Paul Caruana
Jun 17th 2011, 11:53
It is always important to keep in mind that the health risks associated with multiple pregnancies, especially for the infants and especially when the multiple pregnancy involves more than two children, are significantly higher than for singleton pregnancies.
For this reason, it is completely unethical to produce such multiple pregnancies in humans, and local legislation should make this point clear (i.e. they should be made illegal) once and for all.
Victor Rodenas
Jun 17th 2011, 11:16
But why we did not think about all this before,the IVF apparatus has been at Mater Dei for years now.All important decisions should have been taken before .
Charles Sammut
Jun 17th 2011, 11:14
I suggest to Edwin Vassallo, Laurence Gonzi and the other fervent bible bashers and conscience laden Catholics to contact Bishop Ignacio Carrasco de Paula, President of the Pontifical Academy for Life and ask for his feedback regarding IVF.
Or how about another "Consultative" Referendum??
Below makes interesting reading.....
Vatican official objects to IVF scientist’s Nobel Prize win
by Jenna LylePosted: Tuesday, October 5, 2010, 13:28 (BST)
A Vatican official has voiced anger over the decision to award the Nobel Prize for Medicine to the pioneer of IVF.
Bishop Ignacio Carrasco de Paula, President of the Pontifical Academy for Life, said it was “out of order” to award the prize to Professor Robert Edwards, who produced the first ‘test tube baby’ in 1978.
“Without Edwards, there would be no market for human eggs; without Edwards there would not be freezers full of embryos waiting to be transferred to a uterus, or, more likely, used for research or left to die, abandoned and forgotten about by all,” he said.
...and the beat goes on....and the beat goes on......
P. Vincenti
Jun 17th 2011, 10:24
To be clear, I am not at all interested in the political dimension.
This is all about agreeing on a more ethical solution to this very serious problem.
Egg freezing offers the same success rates as embryo freezing. So why insist on freezing embryos at all? To many in Malta, embryo freezing is just morally unacceptable. If the Government attempts to pass a law that allows for couples to access to IVF on National Health which promotes embryo freezing, there will be a riot as many do not want their taxes to pay for something they can never morally agree to.
Egg freezing allows for the same success rate as with embryo freezing. This will allow for an IVF law that many will be able to accept.
IVF will remain in general wrong for committed and practicing Catholics. But it will still be available for those who may need the procedure.
If we want a regulated IVF, then becoming entrenched in our ideologies will not help.
This is a delicate issue. If we work together, we can arrive at a win –win, for some at least.
P. Vincenti
Jun 17th 2011, 10:10
Dr E Porcu, of Bologna Italy, recently addressed a seminar at MDH organized by the Bioethics committee. Here she demonstrated the excellent success rates of IVF with vitrification (egg freezing) in Italy where embryo freezing is banned except in exceptional circumstances. The success rates are comparable to other European countries that use embryo freezing.
This is a sound solution to allow for a regulated, more ethically sound IVF practice that will in no way affect the success rate of IVF in Malta.
With egg freezing and embryo freezing only as a backup measure, IVF in Malta, if carried out with the same diligence as in the Bologna’s state run clinic will be just as successful.
I do not see why IVF clinics in Malta cannot compete at the same level as the Bologna clinic?
It should be said that key members of the select committee did not even bother to attend the seminar mentioned above. Hon Edwin Vassallo did attend as chairman, but where were the other MPs who form part of the committee?
The piece in the TOM is not fair on the PAEF. There are numerous professionals, including some highly respected scientists who form part of this impressive group. Far from the description afforded to them by Mr Kurt Sansone as being ‘a handful of doctors’
IVF with embryo freezing is just unacceptable even more so when a more ethical alternative, (egg freezing) that will provide the same rates of success is now available.
Maria Zammit
Jun 17th 2011, 09:23
Just some thoughts for consideration. Please excuse my inability to find a way of expressing myself better, I have no intention to offend.
1. How will this "egg / embyro freezing" effect the couple pychologically, if for some reason they cannot "make use of" the "frozen" product.
2. With reference to 1. above will the couple have a right to deny to third parties of the use of the product if they do not wish to "use the product" themselves?
3. With reference to 2. above, for how long will the couple be eligible to "use" the frozen product?
4. Does the product come with an expiry date and if so how will it be disposed?
5. Does "freezing" entail consequences / defects in the child?