Experts split over IVF Bill
Hunt for IVF compromise
A draft law regulating IVF treatment locally has kicked up a storm among Malta’s medical community, with opinion split as to whether the fertilisation method to be used will actually work.
The law, which is open for public consultation until September 14, will require all clinics offering IVF to only successfully fertilise a maximum of two eggs per woman at any one time.
Excess eggs will be snap-frozen in vats of liquid nitrogen, allowing doctors to extract, thaw and inject them with sperm one-by-one until they end up with the two fertilised eggs allowed by law.
The snap-freezing process, known as oocyte vitrification, is a relatively new one and has only come into mainstream medical use over the past few years.
And while the government is convinced the procedure will successfully bypass the ethical minefield of embryo freezing, a leading figure in local assisted reproductive technology remains unconvinced.
“All this Bill does is give parents false hope. The technology they’re proposing is only a couple of years old. There are very few pregnancies from eggs which were frozen – you might get embryos, but translating those into pregnancies is a different story,” said Saint James Hospital’s medical laboratory director, Paul Sultana.
Saint James Hospital has been offering IVF privately for a number of years. In the absence of regulation, the hospital implants any successfully fertilised eggs into a woman, to avoid having to destroy or freeze embryos.
The hospital will now have to obtain a licence to continue to offer IVF locally – and doing so will mean having to conduct the procedure using oocyte vitrification.
But Mr Sultana was livid at the government’s decision to adopt the “very experimental” technology which, he said, was still in its infancy.
“I observed a clinical trial of the technology in Germany. And from the 15 women taking part, not a single one got pregnant. Malta has no real experience of IVF, and suddenly we’re meant to successfully implement this experimental technology.”
Mr Sultana’s scepticism was counterbalanced by Pierre Schembri Wismayer, who heads the Anatomy department within the University of Malta’s medical faculty.
“Oocyte vitrification is relatively new, but it is proven and the medical literature supporting it is out there for all to see. Success rates are comparable to other IVF methods and more and more clinics are making use of it,” Prof. Schembri Wismayer said.
“Nine-hundred babies have already been born across the world thanks to oocyte vitrification, which is significant considering the process is still relatively new.”
The two sharply opposing perspectives were balanced out by gynaecologist Donald Felice, who said the process had “enormous potential” but was still in the process of becoming established.
“Its popularity is increasing, but the fact that it’s such a new process means that statistics about the procedure are still thin on the ground,” Dr Felice noted.
Articles about oocyte vitrification published in recent months seem to back up Dr Felice’s caution. A study by the GENERA Centre for Reproductive Medicine in Rome, Italy described vitrification as “efficient and reliable” – a finding supported by the Instituto Valenciano de Infertilidad in Valencia, Spain, which, however, added the caveat “more large controlled clinical trials are needed”.
Researchers at the Royal Women’s hospital in Melbourne, Australia, urged caution. “There are key limitations associated with the available evidence base, including a paucity of randomised controlled trials [and] limited reporting of live birth outcomes,” researchers noted.
The former chairman of the Bioethics Consultative Committee, Maurice Cauchi, said all members of the public could benefit from this long-overdue Bill. The problem with the Bill, he said, was to try to find a reasonable compromise.
“Too many eggs and you end up with multiple pregnancy – considered a medical disaster – too few and the chances of a successful pregnancy are considerably reduced.”
Asked if it was correct to limit IVF to heterosexual couples who are either married or in a stable relationship, Prof. Cauchi said the majority in Malta would probably agree with this proposal.
“In places like Australia, third party donation of sperm or eggs has become standard practice. I do not think Malta is ready for this yet.”
Meanwhile, Health Minister Joe Cassar and Justice Minister Chris Said jointly visited Mater Dei Hospital’s IVF clinic yesterday. Set up in 2004, the clinic has sat unused ever since.
As the ministers were shown around the clinic, Dr Cassar noted that much of the equipment had never been commissioned and was therefore still under guarantee.
He also opened the door to further public-private partnerships, saying private clinics offering IVF could, against payment, decide to start storing frozen eggs at the MDH egg bank.
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M Darmanin
Jul 30th 2012, 13:18
WHY IVF? leave nature to do its job.. God`s nature is Awesome
Peter Simpson
Jul 30th 2012, 14:27
Next? time you have an' appendix'...let nature do its job too !
Nikolai Debono
Jul 31st 2012, 13:37
Awesome?
Are diseases awesome? Are natural disasters awesome?
pat muscat
Jul 30th 2012, 11:12
I think that it is humiliating to us as a Europeans.... why five wise men should decide for a woman whether she'll have the generic IVF procedure or the 'force majeure' one!
Why are we always getting a committee of these freaks control, ..possibly headed by a monsignor... to decide the fate and lives of others?..... whilst in Europe-Italy, Spain, France, UK etc have none of these outdated inquisitorial control?
And why the draconian fines of 70,00 euros and a seven year prison? Why can't we be normal citizens of Europe?
One 'liberal' blogger has been screaming to all its 'learned' fans that GonziPN is the natural home of Maltese liberals: the censorship law, the divorce law and the outdated 'liberal' IVF law is a proof of it!!!!!
The truth is GonziPN is a very much inward looking highly conservative Church dominated Party; it is closing all its doors and windows, so that , once again, the Maltese, instead of going to neighboring countries to buy chocolate, or ( if GonziPN had it) divorce, this time they are going abroad to buy the IVF procedure so common in Europe except ( Church dominated ) Poland?
Joseph Aquilina
Jul 30th 2012, 18:27
Why do you need to bring politics in everything ... The proposd solution is already used in other countries. The proposed solution will not put the future mother in harms way!! So what do you have to complain about? The fact that it is PN in government? The fact that the law bridges the concerns from those who feel morality has a place in this country? What are you complaining about?!?
George Cutajar
Jul 30th 2012, 10:41
The PN Government has taken away the wind from JM's sails by bringing the IVF Law before Parliament. JM must now find a new law to promote as his first law should he become PM.
What is most interesting about JM, his movement and the IVF Law is that they do not have a stand. They want to wait and see what the reaction is going to be and then decide which way to go. This is once more JM's politics of convenience coming to the fore. No policy, no ideas simply staying on the fence, waiting to see and than take the most opportunistic route available. This has become the trade mark of JM and his movement of liberals, progressives and what nots.
Philip Hili
Jul 30th 2012, 00:38
Dr. Muscat, ghidlu lil poplu x'behsiebek taghmel!!
Ghandek programm biex il-poplu ikun jaf ghalfen ghandu jivvutalek?
Minn ser jixtri l-hut fil-bahar?
Ma nghamlux moghod li ser tohrog b'xi affarijiet lejliet l-elezzjoni hux, halli ma jkolniex zmien biex naraw dak li ser twieghed hux kredibbli jew le!!
Charles J. Buttigieg
Jul 30th 2012, 09:47
Philip,f'kull elezzjoni nixtru l-hut fill bahar. Naqqasielek ir rata ta l-income tax Gonzi? Fl-elezzjoni kien qallek li ser izid is salarju tiegh u ta shabu b'600 Euro fil gimgha?
Mr Zeppi Borg
Jul 30th 2012, 10:18
Sur Philip Hili wara li qrajt hafna mil kummenti tieghek fuq din is site, nista najdlek li personalment inti jaghmel x jaghmel JM qatt ma ha tivvutalu. Isaqsix ghal affarijiet li mhux ha taqra jew tikonsidra zgur. Isni jien nixtieq li ikolli cans naqra il manual ta xi Rocket meta qatt xorta ma jien ha nirkbu. :)
Philip Hili
Jul 30th 2012, 11:43
@ Charles J. Buttigieg.
"Naqqasielek ir rata ta l-income tax Gonzi?"
IVA, ghal darba darbtejn! U dak li naqqasli l-ewwel darba, GHADNI INGAWDIEH, U ANKE DAK LI NAQQASLI FIT-TIENI DARBA, WKOLL GHADNI INGAWDIEH.
Allura, meta naqqasli l-ewwel darba u ma regax ziedli ir-rata, dak ghadni ingawdieh. U l-istess japplika ghat-tieni darba.
Qabel tkunu onesti mal-qarreja u mal -poplu, ma ghandkomx cans ghal-Kastilja, ghax il-poplu ikompli jikkonfrma li wara 25 oppozizzjoni MA TGHALLILMU XEJN!!!!!!
Philip Hili
Jul 31st 2012, 00:02
@ Zeppi Borg
Tajjeb!! mela skond int, jien "jaghmel x jaghmel JM qatt ma ha tivvutalu" meta naf x'qieghed joffri. Allura kif tridni nivvutalu jekk dan ma jghidlix fuq x'hix ghandi nafdah bil-futur tieghi!! Mela ma tatinix tort li ma nivvutalux!!
Denis Pace
Jul 29th 2012, 22:59
I am amazed at the number of experts on the subject writing in this blog........................
S.M. Cuschieri
Jul 29th 2012, 22:24
What worries me about IVF is the risks of abnormalities within the embryo. I understand that even with a normal conception this also may occur, but I think it is too experimental and scientifc. IBut there and again, it is a ray of hope for those couples who yearn for a child but cannot have them. But I would not extend it to gay couples. I do not think that raisng a child within a gay lifestyle is at all healthy for the child.
Joseph Grech Attard
Jul 29th 2012, 20:00
If the equipment has been there for 8 years, is it correct to note that some of it could be oudated? Guarantees on equipment that is outdated does not help much, doesit?
And why did one buy the equipment before there were any laws? Why did it take so long to discuss the law? Isn't this bad management?
C Sant
Jul 30th 2012, 09:59
"never been commissioned and was therefore still under guarantee."
This answers your question.
Mary Ann Borg
Jul 29th 2012, 19:28
Ah, mela ghalhekk illum Joseph ma kkommitix ruhu. Ghalhekk qal 'Labour would give its reaction to the IVF bill after looking at it in a realistic manner and listening to the people's reaction to studies the party will be commissioning, leader Joseph Muscat said this morning.'
L-ewwel se joqghod gallarija, umbghad ha jara x'jahseb JPOS, umbghad iressaq il-proposta kif ikun iridha JPOS, biex umbghad jerga jipprova jwaqqa l-gvern.
The end justifies the means. Dak hu l-vera motto tal Lejber taht Joseph, xejn iktar.
Mr Zeppi Borg
Jul 30th 2012, 10:24
Mary Ann Borg, Ma nistax ma nikumentax fuq dan il kumment stupidu li halejt inti.
Joseph Muscat tajjeb u hazin f'dan il kas partikolari ijad itik ic cans tithol sew fis sugget u mhux bhal hafna politikanti jaqbad u jaghmel kif jiftilhom.
Importanti li in nies juru x jahsbu f kull haga li issir malta.
O. Grixti
Jul 29th 2012, 19:23
@ Joseph Aquilina
You surely read the letter of the Bishop or you are one of the authors? I don’t have this letter and I don’t really need it, because in my opinion everyone has his profession and the bishop is no exception. The bishop has all the right to say what he thinks, but with all due respect, he is not a doctor (specialist) in this subject, he is not a couple who is suffering from this problem of not having children, he also is not the parliament who should make this bill correctly following doctors suggestions, with the aim to really help the couples who are suffering and not to be liked by the bishop. So why do we really have to act to please the bishop in every law Malta is trying to do.
Joseph Aquilina
Jul 29th 2012, 20:53
How can do you know that what the Bishops said is wrong if by your admission you did not read what they said? Their letter is available on this website and the website of the church of malta. if you read it you will see how the Bishops have a message of love that thinks for every person including the person that still is to be born. Finally, no I am not one of the authors; when writing such letters the Bisjops consult experts; I am just a person who likes to read something before critize it.
simone spiteri
Jul 29th 2012, 18:45
I think there is something missing in this law. Certainly oocyte vitrification will enable couples to have children without killing any embryos and it might diminish the burden of multiple ovarian stimulation and retrival procedures. However why are only ova frozen ? Should the government offer also sperm freezing. I believe one should be fair also on men !
Mark Cassar
Jul 29th 2012, 17:04
Leaving ALL aside, freezing non-fertilised eggs has to be more ethical than freezing viable (living) embryos that already have the genetic potential to be fully a human being. It must be heart-wrenching to leave your off-spring frozen (on the shelf) for years, until it obviously stops being viable; as even freezing in liquid nitrogen there is a viability life-span. This new and already proven method should help potential parents sleep easier at night.
Mrs Joana Pura
Jul 29th 2012, 15:21
An additional question? Isn't a regulation of the Health World Organization which says that only one egg has to be implanted from IVF? As far as I know the up mentioned organisation is worried as the number of twins and triplets in Malta is way over the average.
On the other hand the board of the health department has all the technical details to take a good decision.
At the end of the day the majority that can have kids in normal condition should not say to many as the matter does not affect them.
And at the end it is not immoral at all to want to have kids of your own. The Church should stap back a bit as they are not asked to provide money for the technology neither to take care of the parents or kids. What does someone who does not have real kids knows about the sacrifices of a normal family? Oh yes, I forgot: in theory they know everything. I am still waiting for a real, constitutional separation of the powers in the Maltese democratic State.
Joseph Aquilina
Jul 29th 2012, 16:02
Clearly you failed to understand the message of the Church on the subject. In the letter of the Bishops (did you read it?) the Church actually encourages scientific research in order to help couples have children of their own. However the Church does not stop (like many) at the rights of the parents, but also considers the rights of the um born child. Who will decide who will be born and who will be frozen ... never given a chance to live a full life like everyone else.
The problem is that here in Malta, like in every other part of the world, we are not going to get the best solution in relation to IVF. On the contrary, we are going to get the most “profitable” solution. For some clinics profit equals money, while for a political part profit means votes. In the end who will suffer? Where will all those frozen embryos go? Who will take responsibility? We flush them and forget all about them? That is the value we give to the miracle of life?
Sam Torp
Jul 29th 2012, 12:39
Why all the worry? Will IVF treatment in Malta cover the cost of the necessary medication / pharma a woman will need? The cost St. James charges is grossly exaggerated. For the same prices, one can travel to an established clinic overseas., deal with experienced staff and enjoy a nice holiday with plenty of change left in your pocket.
To be precise, expect to pay around 5,000 - 7,000 euro on medication in certain cases. Does the new law cover or at least minimize the exaggerated prices the private players take advantage of the situation? If the new law does cover this, then St. James has every reason to worry about the new law.
Joseph Aquilina
Jul 29th 2012, 16:05
I believe that at a minimum first and foremost the new law should also have included A PROGRAM that puts a couple through other less painful and stressful process and only if all other possibilities fail would IVF be considered. I am sure that the number of needed IVF treatments would diminish when other options are considered.
C Sant
Jul 29th 2012, 18:36
@ Joseph Aquilina - agreed but actually the law has made it mandatory for the couple to undergo a fully informed process of counselling and thus presumably be offerred all possibilities and pros and cons of each method, prior to the IVF process.
For those that think that the IVF process is simple and without danger, they are mistaken. There ahave been a number of deaths from the hyperstimulation that is required and most of the time, the mother is not told of such a risk.
Joseph Aquilina
Jul 29th 2012, 20:56
@ C Sant
thank you for highlighting that. its a good thing and something i feel is very important for all those involved.
Victor Rodenas
Jul 29th 2012, 11:22
What happens if a country buys a fleet of airplanes but do not have an airport?
Mr Mike Farrugia
Jul 29th 2012, 10:43
Nixtieq li xi darba, xi hadd, jaghmel inkjesta kemm hemm apparat go mater dei li spiccatlu l-garanzija u li ghadu qatt ma ntuza! Skond informazzjoni li ghandi, intefqu l-miljuni f'apparat li QATT mhu se jintuza.
Joe Fenech
Jul 29th 2012, 11:01
Dizastru state of the art!
Sarah Grech (Zebbug)
Jul 29th 2012, 10:25
Din mhi xejn hlief mod kif il-Gvern iserrah il-kuxjenza.
Jien kontra l-iffrizzar ta l-embrijuni bis-sahha imma din kull ma ser taghmel ser izzid l-ispejjez lil koppji u tnaqqas ir-rata ta success.
Ghal dawn l-affarijiet ma jezistux kompromessi. Meta tikkonsidra l-ispejjez u l-ghafsa tal-qalb li dawn il-koppji jghaddu minnha trid tmur ghal dak li jghatik l-ghola rata ta success. Imma biex tghamel dan ikollok twarrab l-etika, l-principji u t-twemmin tieghek minn nofs.
Joseph Aquilina
Jul 29th 2012, 16:14
"Imma biex tghamel dan ikollok twarrab l-etika, l-principji u t-twemmin tieghek minn nofs."
Wow!! Great message your giving to the future generation; be ready to curb on everyone and everything as long as you get what you want!! We should aim at the very best possible law and having thousand of frozen embryos is not the best possible law. If IVF has become so successful then why worry? Why not try to fertilize one egg and then try another when that fails? It's not as if the woman will pass from several interventions since the law includes the freezing of the eggs. How much human life are we ready to sacrifice in order for one single life? Also one has to also consider the social aspect that IVF will have. One question who no one is answering is the effect that IVF will have on adoptions; which are bound to diminish when such law will be introduced.
Lawrence Fenech
Jul 29th 2012, 10:23
Gonzi during his tenure in office did not manage to get one right, this IVF bill is another half baked effort.
c p agius
Jul 29th 2012, 10:23
The impotant thing is that they bowed to our Bishops's expectations
Joseph Aquilina
Jul 29th 2012, 16:24
If you read the letter of the Bishops (which I strongly recommend if you want to comment on what the Bishops said) then you would realise how wrong you are.
The simple concept that an embryo can be frozen makes the whole law unethical in principal. Who will be responsible to decide which of the two embryos will get frozen? How will they decide? Will the doctor close his eyes and say “this one”!! What will happen to the potentially thousands of embryos that might remain frozen? Who will be responsible for them?
These are very important questions; since one day there will be many legal battles fought on such simple questions.
Alex Falzon
Jul 29th 2012, 10:22
This is abuse to human's nature.
Victor Rodenas
Jul 29th 2012, 10:17
This is as was divorce,if you can afford it make it privatly or get it from abroad.....then it is accepted in Malta,....how funny!
Adriano Spiteri
Jul 29th 2012, 10:16
i) Such a discussion should have been held BEFORE the equipment was purchased. Now it is too late
ii) The equipmnet is already out-dated. Whoever decided to halt its use is a criminal: the taxpayer has been robbed once again
iii) Politicians have no right to dictate what the People should go for. This is not a majority-counts business but something that couples should have a right to decide whether to go for or not. Doctors who do not agree with the procedure should simply refrain from working in such a unit
iv) Is this practice being held in private hospitals already? If so - that explains all the delays
v) A Politician should never mix Politics with Religion. The People have a right to decide. All these acts of delay are simply breaching their right to freedom of decision
vi) It took Malta years to introduce divorce. Maltese people were disadvantaged because only the wealthy were able to afford divorce in another country.
IVF, at present, is likewise.
Ms D. Borg
Jul 29th 2012, 10:06
Can't we just take a look around and adopt the method which has been most successful in countries where IVF has been used for a relatively long time? I hope this is not going to be a repeat of the divorce issue. Imma f'din in-naqra ta gzira kollox ingibu bi kbir! Let's also keep in mind what is best and less painful for the women please.
Mark Grima
Jul 29th 2012, 10:02
So the government is proposing legislation that will constrain physicians to utilise a technology with no history of success. Well, at least Jesus will be happy! Please someone, save this country from the religious loons in charge.
G Schembri
Jul 29th 2012, 11:28
This has nothing to do with religion, it is more a case of ethics, are we prepared to freeze embryos, are prospective parents prepared to have multiple births, if more than two fertilized eggs are implanted there is a chance of triplets or more. At least parents should have the right to choose the method to be used.
Mark Cassar
Jul 29th 2012, 17:14
Mr Grima, the article states that though relatively new the technology has also been proven to be successful. Certain stakeholders may disagree, but we can all come to our own conclusions.
Joe Fenech
Jul 29th 2012, 09:36
Same crap. It's as if IVF has just been invented!
W Cassar
Jul 29th 2012, 09:35
I think the bill as it stands will give false hope and a lot of disappointment to childless couples.
If a system is not proven then why adopt it? Are we not taking people for a ride? ... then again it would not be the first time would it.
Matthew Vella
Jul 29th 2012, 11:52
This affects men as much as it does women.....
Joseph Aquilina
Jul 29th 2012, 16:35
@W. Cassar
With your philosophy mankind would still be in stone age ... if not primates!!
Mark Cassar
Jul 29th 2012, 17:56
Mr/ Ms Cassar, though relatively new technology, it has indeed been proven successful too.
W Cassar
Jul 29th 2012, 18:02
@ Joseph
Your comment does not hold water when there is already a viable alternative. We are not breaking ground here we are appeasing the church, nothing more nothing less!
Joseph Aquilina
Jul 30th 2012, 09:09
@W Cassar
“Oocyte vitrification is relatively new, but it is proven and the medical literature supporting it is out there for all to see"
Vincent Scerri
Jul 29th 2012, 09:17
With all due respect to women...thank God I'm a man!
Sarah Grech (Zebbug)
Jul 29th 2012, 10:14
X'ghandha x'taqsam Sur Scerri li inti ragel u mhux mara?
F'dawn it-tip ta diffikultajiet, anka l-irgiel ikunu ghatxana u mixtieqa ghal tarbija mhux in-nisa biss bid-differenza li n-nisa jghaddu minn tbatija fizika u emozzjonali u l-irgiel minn dik emozzjonali biss.
Gorg Sciberras
Jul 29th 2012, 09:12
Another aspect of the bill means that Malta can focus on an emerging technology and could become a key research centre in the field, which can only be beneficial.
B. Cachia
Jul 29th 2012, 11:33
We can hardly afford to be the world's guinea pigs, Gorg.
ANTHONY PAVIA
Jul 29th 2012, 12:16
Wouldn't being guinea pigs for the smallest country in the world with the worst roads and most populated per square inch be enough research pigging?
Gorg Sciberras
Jul 29th 2012, 12:47
B. Cachia
I see you are all for science and development.
Joseph Aquilina
Jul 29th 2012, 16:34
@Gorg Sciberras
I agree with you 100%!! There are many who because of their inferiority complex believe they're good at nothing. Luckily for Malta there are many of us who are staring to realise that us Maltese are just as good and in many ways even better!!
B. Cachia
Jul 29th 2012, 17:21
You don't get science and development by imposing medieval restrictions on your medical establishment and hoping that somehow they'll find a fix. You get them by creating the conditions for foreign enterprises to set up their R&D units in Malta.
Joseph Aquilina
Jul 29th 2012, 18:26
@B. Cachia
and now enlighten us why the bill in your opinion is of "medieval" quality? I am all ears ...
B. Cachia
Jul 29th 2012, 20:20
Joseph, the bill is not of 'medieval quality', whatever that may mean. What is medieval is the imposition of absurd restrictions on medical science, and on people's lives, on religious grounds.
Joseph Aquilina
Jul 30th 2012, 09:13
@B. Cachia
I am sorry to hear that for you the protection of life is "imposition of absurd restrictions". If you had read the letter of the Bishops you would have found out that the Roman Catholic Church actually encourages research in this field and many like it ... as long as the human life involved is respected as from conception.
Please choose the reason of your report below: