Now that the divorce issue is virtually over, another pressing issue is looming over our society regarding legislation about in vitro fertilization (IVF).
Newly married couples nowadays have different priorities than they did a few decades ago. While in the past, marriages at a relatively young age were more common, nowadays couples tend to wait a bit longer before they tie the knot. Also, while in the past having children would have been a top priority for newlyweds, today lots of couples prefer to plan a childless period in order to achieve a certain degree of economic stability.
These modern choices mean couples start families later in life. On the other hand, it is a well-known biological fact that a woman’s fertility starts to diminish after the age of 25. These factors are leading to the scenario of increased infertility problems which are bound to get worse. As a result, IVF has always suffered from the perception of being a lifestyle choice.
Infertility is usually borne in secrecy. Couples do not even tell their friends and family of the hardship they are going through but they are ready to spend whatever it takes to achieve their goal.
Assisted reproduction, more commonly known as IVF, is the answer to a good percentage of infertility problems and so the demand for it is bound to increase.
IVF has been available in Malta for the past two decades only in the private health sector. Though many obstetricians still prefer to send their patients for IVF abroad, if it weren’t for the initiative of the private hospital’s infertility team, lots of Maltese couples would have remained childless.
However, in Malta, IVF is being performed outside any legal framework. Lots of questions and dogmas abound.
Should we allow embryo freezing which has been in practice abroad since 1981? How many embryos should be implanted for every attempt? Should the number of embryos implanted be capped? If we decide to freeze embryos, what would happen to the embryos that are not required? Should we consider oocyte freezing?
In my opinion, freezing female eggs (ova or oocytes) is the way forward; it makes a lot of ethical, legal and financial sense.
The first stage of IVF involves the pharmacological stimulation of the female ovaries to produce oocytes. This is a taxing exercise on the woman’s health which is followed up by the most technically difficult component of IVF: the collection of these cells from the ovaries.
These two initial steps in IVF are also the most expensive at around €4,000. The next step is IVF of these oocytes.
Once the embryologist verifies fertilisation has occurred, the embryos are implanted in the womb. Ethical problems arise at this stage as it is decided how many embryos should be implanted to achieve a balance between the woman’s health and improve success – while not discarding embryos .
Should one implant one or two embryos? More? And if one has five fertilised embryos, should one implant them all or freeze some of them for possible future use? If the parents do not use the embryos should one discard them? These are important ethical issues that could be solved by allowing freezing of the ova or, as it’s called, oocyte vitrification, which would control the number of embryos available for implantation.
This technique is relatively inexpensive. However, a professional setup is of paramount importance. The availability of this procedure would imply that female stimulation and pickup be carried out less often.
Also, one would only need minimal female hormonal preparation prior to embryo transfer. Capping the number of oocytes exposed to fertilisation means that a maximum number of embryos can be implanted per session and therefore there is less risk of stillbirths and premature babies while the possibilities of other problems are decreased to a minimum.
Thus, the availability of female egg freezing, apart from decreasing the burden on the woman’s health, also means that future IVF attempts in case of initial failure will cost much less. However, above all, ethically one is on much safer ground as embryos are never discarded.
This could be the way forward within which legislation for IVF can be implemented as soon as possible.
The government should also provide or part finance such a service on the national health scheme, according to a strict protocol, to the needy couples who are not able to afford this expensive way of conceiving.
Mr Mercieca is a consultant ophthalmic surgeon.