Currently about one in 10 couples will have fertility problems and difficulties starting a family. This is particularly so nowadays, since people are getting married when they are older, and starting a family is often deferred for career or financial reasons.
The draft legislation has been well received since it aims to to uphold the dignity and respect of new life- Karl German, Consultant Urologist, Attard
These subfertile couples will require professional help which may include the need for IVF (as a last resort) or in some instances, IVF may be seen as the only realistic chance for success and as such, it would be recommended as first-line treatment.
The draft legislation has been well-received since in essence it aims to fully uphold the dignity and respect of new life (in the form of the developing embryo). The draft legislation therefore aims to prohibit embryo freezing (except under exceptional circumstances), and also aims to reduce the possibility for multiple pregnancies.
An IVF success is usually defined as a singleton pregnancy. There is, however, a fine line between the success of IVF and the possibility of multiple pregnancies (which is usually considered to be a failure). During a recent TV interview, Dr Josie Muscat said he currently has an overall IVF success rate of 55 per cent, but he also explained that of those women who are successful at getting pregnant, 18 per cent will have multiple pregnancies (usually twins and rarely triplets). The draft legislation proposes to allow only two eggs to be processed for fertilisation. This will almost certainly reduce the overall success rate of IVF but will also reduce the possibility of multiple pregnacies.
While limiting the number of eggs that are prepared for possible fertilisation to two might seem reasonable in situations where there are normal eggs and good quality sperm there will be many instances where more than two eggs will be required in order to ensure a reasonable chance for success. The IVF unit at Saint James Hospital now has over 22 years experience and it is this experience which enables the professional staff to identify the ‘difficult scenarios’ where more than two eggs will usually be required.
The medical conditions of subfertility that result in the need for IVF are diverse and beyond the scope of this article, however I shall give three examples to illustrate the point. Couple A: wife aged 25 years with no fertility problems, husband has a congenital condition where he has normal production of sperm but the absence of the tube to take the sperms out of the testicle. During the IVF procedure, the normal sperm is sucked out of the testicle and injected directly into the normal eggs obtained from the wife (ICSI). Assuming the eggs obtained from the wife are normal, then the chance of success, even with only two eggs is very good.
Couple B: wife aged 25 years with no fertility problems, husband has a very low sperm count and very poor quality sperm. Though it is likely that fertilisation of the eggs will be successful, it is very likely that in this scenario, the resulting embryo will be of poor quality with a reduced chance of success. In this case, therefore, it would usually be recommended that more than two eggs are used to increase the chance of success.
Couple C: wife aged 35 years having already had one failed attempt at IVF during which she was found to have poor quality eggs which failed to fertilise, husband has a normal sperm count. In these circumstances, it would usually be recommended that they should have more than two eggs prepared for fertilisation.
Legislation cannot cater for these complex medical scenarios, and therefore I feel there is a need for a committee to be composed of medical and ethical representatives, to discuss the individual cases and to reach consensus whether more than two eggs can be prepared for fertilisation under certain conditions. The committee’s aim would be to limit the number of eggs allowable for fertilisation to two in the straightforward cases but would have the authority to give permission for the use of more eggs if necessary. In this manner, the process of IVF will remain regulated, but will also cater for circumstances where the preparation of more than two eggs will be necessary.