IVF law ‘not good clinical practice’

Egg freezing is not an efficient alternative to embryo freezing, according to Italian in-vitro fertilisation expert Luca Gianaroli.

Running an IVF programme in which oocyte freezing replaces embryo freezing will double the costs and reduce pregnancy rates

The former head of the European Society of Human Reproduction and Embryology said the IVF Bill presented by Justice Minister Chris Said was restrictive and did not advocate good clinical practice.

An expert in the field, Dr Gianaroli was consulted by the parliamentary select committee run by Nationalist MP Jean Pierre Farrugia in 2010, which proposed embryo freezing as a solution to reduce the chance of multiple pregnancies.

“Running an IVF programme in which oocyte freezing replaces embryo freezing will double the costs and reduce pregnancy rates by 30 per cent,” Dr Gianaroli said.

He rubbished claims by fellow Italian doctor Eleonora Porcu, who recently told a Maltese audience she achieved high pregnancy rates at her Bologna clinic using frozen eggs.

Dr Porcu was brought to Malta by the government as evidence that egg freezing is a proven science with good success rates.

But Dr Gianaroli said Dr Porcu’s data was based on young patients who were likely to have higher pregnancy rates anyway.

“Since 50 per cent of the patients that we are treating in Europe, and I suppose in Malta as well, are older than 35, half of your patients will not benefit from oocyte freezing.”

He pointed out that data from the Italian national registry showed a statistically significant choice in favour of embryo freezing.

“When the restrictive Italian law was reversed in May 2009 the majority of IVF cases involving frozen cycles used embryos not oocytes. If egg freezing works so nicely why do the majority of clinics still choose embryo freezing?”

The Bill published by the government bans embryo freezing except when it is not possible to transfer the embryo from the petri-dish to the woman because of some accident or serious illness.

The Bill allows only two fertilised eggs to be created and transferred to the womb, in a bid to reduce multiple pregnancies occuring.

Dr Gianaroli believes this limit can lead to disappointment. He explained his point using the example of a woman who would have produced seven eggs after stimulation.

“If I try to fertilise all seven I may end up having between one and seven embryos but very rarely will I have zero, one or two or six and seven. What’s likely is that I will have three, four or five embryos.

“With the new law, if the woman produces seven eggs, I have to randomly choose two eggs for fertilisation and the morning after I can have two embryos, which will be fine, one, not so fine or zero embryos.

“The woman would have gone through the whole procedure and gone home with zero chances.”

Freezing the extra embryos, rather than the unfertilised eggs, he added, made more sense, especially for women of a certain age since embryos were more viable when thawed.

He believes oocyte freezing can be used under some circumstances such as preventing infertility in young women who want to postpone having children. In this case, the eggs must be frozen when the woman is still young.

Dr Gianaroli cautioned against the restrictions imposed by the law and insisted it would put Maltese patients at a disadvantage.

Those with money would go abroad and clinicians may not accept to work under this law, he added.

“I would refuse to work under such legislation for two reasons: I want the best for my patients and secondly, especially if I work for a public body, I would think that I am throwing away taxpayers’ money.”

ksansone@timesofmalta.com