Balancing the implications

The regulation of IVF (in vitro fertilisation) in Malta will, in the near future, be tackled by the implementation of a law. The number of couples unable to have children now amounts to about 10 per cent of all couples and this number is constantly on the rise due to the tendency of having children later on in life and an increased prevalence of sexually transmitted diseases, which can damage the reproductive organs. Even the increase in obesity rates tends to raise the rate of infertility.

There are various ways of treating infertility, usually according to the cause. After exhausting the simpler methods of treatment, IVF or other forms of assisted reproductive technology can be used in selected cases. Other forms of ART (assisted reproductive technology) are ZIFT, GIFT and ICSI, which vary, especially where success rates are involved. The technique is chosen by specialists with experience in the field according to the details of the case.

IVF is one of the most common procedures where ART is concerned. This involves the extraction of a number of eggs (ova) from the ovaries that are in turn fertilised in the laboratory by a sperm sample provided by the woman’s partner, which would already have been prepared and washed. When a number of eggs are fertilised, these are reinserted into the uterus and, if these manage to implant in the womb, the woman will become pregnant.

However, a number of ethical questions with regard to this procedure remain. Among these is the question whether all the fertilised eggs (embryos) should be inserted into the uterus that would then carry the risk of multiple pregnancy, which bears a higher rate of complications. Or else the spare fertilised eggs might be thrown away or kept in storage for future use by freezing.

IVF continues to provide additional ethical challenges because the sperm or eggs used can be provided by other persons who are not part of the actual couple as in the situation of surrogate motherhood. All these ethical considerations have to be discussed in the near future when the law on ART is drafted, of course, also covering IVF.

The IVF law must be drafted by MPs who have ideals and moral convictions that reflect today’s realities. Hopefully, they are guided by secular principles and not, as has been shown recently by some, continue to be guided rigidly by the Catholic Church. If this were to take place, IVF would not even be allowed to take place in Malta. Sound ethical principles must continue to prevail and, although differing opinions may lead to long discussions, several important questions need to be addressed properly before the next step is taken. Here is a list of them:

Which couples can undergoe ART treatment? Should they be married? Can they be unmarried, stable couples, gay couples?

Are couples performing the procedure privately entitled to a form of tax rebate on expenses? (Costs amount to at least €5,000 for each cycle.)

Will the government offer the ART procedure for free at Mater Dei Hospital and to whom? Will a form of means testing be introduced?

How will the ethical question of freezing of sperms, ova and embryos be tackled? The freezing of sperm is also useful for those with testicular cancer before undergoing chemotherapy.

How will the procedure be regulated? It is crucial to find the correct balance, especially where ovarian stimulation is concerned, to reduce health risks for mother and baby (especially regarding risks pertaining to multiple births). The procedure is also regulated by making sure it is carried out by trained specialists with the right equipment at hand. Psychological attention has to be part of the treatment as the IVF procedure has a success rate of only about 30 per cent per cycle.

Other questions include what to do with extra embryos, the ethical considerations of surrogate motherhood and the question of donation of ova, sperm and zygotes by third parties.

A woman can become pregnant with an embryo emanating from sperms and ovas from otherpeople!

All these questions need to be thoroughly discussed and addressed if a proper IVF and artificial procreation law is to be implemented.

Dr Grech is a family doctor and a Labour Party electoral candidate.