Common ground on IVF
Eleanora Porcu, of Bologna, Italy, who has been the director of the Infertility and IVF Centre at the University of Bologna since 1990, recently addressed a seminar organised by the Bioethics Committee.
Dr Porcu demonstrated the very good success rates of IVF treatment with vitrification (egg freezing) in Italy where embryo freezing is banned save in exceptional circumstances. The success rates of this state run clinic are comparable to rates reported by other European countries that use embryo freezing as part of standard IVF treatment.
Dr Porcu has provided solid evidence of the more ethical practice of egg freezing that will now allow for a more ethical solution to the problem of unregulated IVF treatment in Malta.
With egg freezing as the norm and embryo freezing only there as a backup measure, Artificial Reproductive Technology (ART) in Malta may enjoy the same success rates as Dr Porcu’s clinic in Bologna and there is no reason why IVF treatment in Malta cannot perform at the same level of excellence as the Bologna clinic.
Moreover, the financial investment required to run an ART clinic based on either embryo freezing or egg freezing remain relatively similar This means that setting up a clinic to provide egg freezing is not going to present local specialists with insurmountable entry barriers.
Egg freezing removes the need to fertilise more than the exact amount of embryos targeted for implantation and thus removes the necessity to freeze superfluous embryos. Restricting implantation to two embryos will likewise eliminate some of the problems created with current practices predominantly those that result in multiple births and the associated problems that this brings. There remain the other issues to overcome such as the problems that arise from the fact that currently Malta does not have a resident embryologist and clinics here rely on a foreign embryologist who visits the Island once every quarter. This places a strain on the Neonatal Paediatric Intensive Care Unit at Mater Dei Hospital.
This is not a time for individuals to become entrenched in ideology. Neither is it wise to politicise such a delicate issue. There is consensus that IVF in Malta cannot continue unregulated. I believe that we have now arrived at a situation where common ground has been found and it is high time that we close this chapter.
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Jean-pierre Farrugia
Jun 22nd 2011, 09:46
The agenda on the Social Affairs Committee meetings re-IVF in recent weeks was to be restricted to one issue - following the developments in the June 2010 ESHRE (European Society of Human Reproduction & Embryology ) Annual Meeting in Rome, does ova vitrification rule out the necessity of embryo freezing altogether save the obvious to avoid prejudice to the woman’s health?
Put differently does egg vitrification exclude the possibility of creating more than the exact amount of embryos targeted for implantation? In fact creating an “exact number of embryos” as layman Vincenti suggests is fiction.
Prof Mark Brincat, the head of Department at Mater Dei and the University of Malta here, was unequivocal in the May 11th 2011 Social Affairs Committee: “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”.
This middle-of-the-road approach was also advocated by then Commissioner for Children, Ms. Carmen Zammit, backed by the National Council, whereby my Select Committee was advised that “embryo freezing was to be allowed only in urgent circumstances or when more embryos would have been created as an unintended side effect as not more than two embryos should be concomitantly transfered.”
That no more than two embryos should be transferred has been the unanimous decision of all paediatricians here since 2005.
The implantation rate, moreover the pregnancy rate following the transfer of a single unselected cleavage state embryo ( as diametrically opposed to single embryo transfer) in an infertile couple are so low that no ART specialists carry it out – not even Dr Eleanora Porcu, recent guest of local lobby against embryo freezing.
Reacting negatively to the conclusion reached by the Italian Constitutional Court in 2009, deciding against several sub-articles of Article 14 of the law of February 19, 2004, No. 40 and introducing a derogation to the general ban against any freezing of embryos, Porcu stated: “As time went by the number of pregnancies in my patients progressively increased and fertilising less eggs than the maximum number allowed by law, I was able to have approximately the European average rate of triplet pregnancies.”
http://www.ilsussidiario.net/News/Scienze/2009/4/3/LEGGE-40-Eleonora-Porcu-i-paradossi-di-una-bocciatura-ideologica/15633/
Infact European data indicate wide differences in the incidence of triplets between countries, varying between 0% (e.g.Slovenia, Iceland, Lithuania) and 4.4% (Hungary). ( Source: PubMed )
Government's 2015 vision for Health aims for excellence not fiction.
P. Vincenti
Jun 22nd 2011, 11:54
Dr Farrugia. You do not need attack my credibility by pointing out that I am a lay person to garner my respect.
You already have that.
When I refer to the 'exact number of embryos' I am in fact quoting what Dr Eleonora Porcu stated in her presentation.
Unfortunately,you did not attend the presentation as one would have expected and this may explain why you have these unanswered questions.
P. Vincenti
Jun 22nd 2011, 11:54
Dr Farrugia. You do not need attack my credibility by pointing out that I am a lay person to garner my respect.
You already have that.
When I refer to the 'exact number of embryos' I am in fact quoting what Dr Eleonora Porcu stated in her presentation.
Unfortunately,you did not attend the presentation as one would have expected and this may explain why you have these unanswered questions.
Jean-pierre Farrugia
Jun 22nd 2011, 23:41
Does it occur to you that I had another meeting that same evening and that in any case Select Committee I chaired wound up 9 months ago - as long as a full term gestation that is.
And after having reached consensus in Social Affairs Committee on May 11th, just because a lobby invites a specialist - not officially as the Parliamentary Select Committee had invited the head of ESHRE itself - one is expected to reopen and regurgitate ... over and over ... again and again.
Eleven Select Committee meetings were organised from February to June last year and none of you ever attended or showed any interest.
Moreover I am really perplexed how you never ever objected that hundreds of miscarried foetuses upto 22 weeks gestation/ 500 g weight are thrown away in a bin without any documentation. Hon Justyne Caruana and I had to take the initiative to remedy this.
P. Vincenti
Jun 23rd 2011, 17:20
Dear Dr Farrugia,
First of all, I admit to previously using a level of unwarranted sarcasm in my last post. When I reread what I wrote I must admit that this was uncalled for on my part and I apologise for the tone I used.
I am sure that you and your colleagues worked very hard in those months that you chaired the committee. The welfare of human life from conception deserves the best from us all. Because nine months had been spent on the issue should not however imply that we ought to throw our hands up and not continue to seek the best outcome for the embryo and the people seeking treatment. I do recognize how frustrating this must have been for you as chairman of the committee and for your colleagues.
Your work, and that of the other MPs is commendable. I dare say that few appreciate the complexity of the issue and much of your committees work will truly never be fully appreciated.
I do not see the reopening of discussions as has happened here as an indication of failure of your committee's work. I view it as a sign of maturity from all given the importance of this issue.
You say you are perplexed that GOL did not react to the cases of foetuses under 500 grams in the past.
Frankly I do not see what this has to do with the case at hand. I suspect that this may be a reaction to my previous unwarranted tone previously.
I will point out that indeed GOL did publicly support Hon. Justyne Caruana's call at the time. A quick look through the archives on this paper will attest to this. The Times had documented our official support for her noble proposal. We issued a statement to this effect and officially supported both Hon Caruana and Hon Dr M Axiak who was an MP working on her proposal from the government’s side at the time.
We issued a statement when the changes re the issuance of certification facilitating the burial for foetuses had been effected. We thought this was a sensible measure. I will gladly email scanned copies of the newspaper cuttings attesting to all of this from our archives.
GOL have only the utmost respect for you and your colleagues. GOL have one objective. That is to work for all of human life and defend life from its inception.
It is clear that we are all finally close to a win-win outcome. One where the ethical aspects of ART and the needs of local fertility clinics, to assist would be parents safely and successfully, can be met.
This is as a result of the work that the various Social Affairs Committees have done in the last years working with a variety of stakeholders from a wide-range of society.
P. Vincenti
Jun 23rd 2011, 21:14
Dear Dr Farrugia,
First of all, I admit to using a level of unwarranted sarcasm in my last post. When I re-read what I wrote, I confess that the tenor I used was uncalled for and I apologise for this. It lacked respect for both you and your colleagues and it was wholly unnecessary.
I am sure that you and your colleagues worked very hard in those months that you chaired the committee. The welfare of human life from conception deserves only the best from us all. Because so many months were already spent debating the specific issues, this should not therefore imply that we ought all throw our hands up and not continue to seek the best outcome for the embryo and the people seeking treatment.
I do recognize how frustrating this must have been for you as chairman of the committee and for your colleagues. It would of course have been far better had the objections to freezing and the options to it been presented at that time, this is true.
Your work and that of the other MPs is commendable. I dare say that few really appreciate the complexity of the issue and much of your committee’s work will never be fully appreciated.
I do not see the reopening of discussions as has happened with the last committee, as an indication of failure or disrespect to anyone. I view this as a sign of maturity from all given the importance of this issue.
You mentioned you are puzzled that GOL did not react to the case of foetuses under 500 grams and the debate raised by Hon. Justyne Caruana in the past.
I honestly do not see what this has to do with the case at hand. I presume that this may be a reaction to my previous unwarranted tone.
I need to point out that indeed GOL did in fact publicly support Hon. Justyne Caruana's call at the time. A quick look through the archives of this paper will attest to this. The Times had documented our official support for her noble proposal. We issued a statement to this effect and officially supported both Hon Caruana and Hon Dr M Axiak who was an MP working on her proposal from the government’s side at the time.
We issued a statement when the changes re the issuance of certification towards facilitating the burial for miscarried foetuses had been effected. We thought this was a sensible measure. I will gladly email scanned copies of the newspaper cuttings we have filed attesting to all of this.
GOL have only the utmost respect for you and your colleagues even if we may not fully agree on all aspects of the proposed law and policy. GOL have one objective in this affair, to work for the protection of all human life from its inception.
The way I see it, we are all finally close to a win-win conclusion. One where the ethical aspects of ART are catered for through vitrification whilst the needs of local fertility clinics, to assist would be parents safely and successfully, now have converged.
This is as a result of the work that the various Social Affairs Committees have carried out in the last years, including of course, the one that you chaired, whilst all these having worked closely with a variety of stakeholders from a wide-range of society.
Jean-pierre Farrugia
Jun 25th 2011, 01:29
Thanks. Just read through Dr. Porcu's presentations - she and Dr.Gianaroli have both contributed and sincerely it was a privilege to have both of them here. Ova vitrification as Dr. Porcu's ( et al )studies confirm is truly a breakthrough that will prevent apriori embryo freezing & thank heavens drastically reduce it but cannot eliminate it altogether as an exact number of embryos can never be predicted. Pregnancy even naturally is all about mathematical probability after all.
Regarding GOL's stance re foetus disposal, I am sorry not to have been aware of your concern.
No hard feelings - I know you are a genuine person.
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