In vitro fertilisation could be a thing of the past in Malta if a law comes into force restricting to two the number of embryos that can be transferred to the womb, Paul Sultana, medical laboratory director at Saint James Hospital, said.
The private hospital, which offers the procedure, would have to "close shop" if such a restriction is applied, he added.
A draft law, which aims to protect the embryo, has been drawn up and is waiting to be discussed by Cabinet. Although no details about the draft law have been divulged, Mr Sultana expressed concern that the law would eventually impose very strict restrictions on the procedure.
His main concern is that the law would restrict the number of embryos that can be transferred into the mother's womb to two, something which Mr Sultana said would give the patient "absolutely no chance" of having a baby.
It is important for guidelines to be put in place, he said, adding, however, that each case is unique and no law should draw a straight line.
"A 25-year-old who has had her tubes removed because of a past ectopic pregnancy has a good chance of getting pregnant, so we do not expose more than three eggs to sperm. It is very rare that all three eggs get fertilised, but if they do, we have three embryos to transfer into the womb.
"But if we have a 40-year-old who has already tried IVF several times unsuccessfully, we would risk transferring up to four embryos and, therefore, expose four or five eggs to sperm," he said.
Showing pictures of three of "his babies", whom he referred to as his "pride and joy", Mr Sultana said extreme caution has been exercised since IVF started being carried out in Malta 17 years ago. "We have always been conservative. We never wanted to freeze embryos because of the risk that the parents would not come for them," he said, adding that abroad, when this happens, the embryos are either given up for adoption, used for research purposes or destroyed.
If two embryos can be transferred, attempts to fertilise only two eggs can be made. There is a high probability that none of them gets fertilised, and the whole procedure ends up as a "complete failure", he said.
The local success rate of IVF treatment stands between 25 and 30 per cent. Mr Sultana explained that not all embryos are viable, with some of them failing to grow. The hospital's policy is to transfer them all in the uterus.
"Even if we believe that an embryo is not viable, we still transfer it because one can never be sure."
Despite reluctance to freeze embryos, Mr Sultana recognises that the ideal IVF scenario includes freezing.
"If after stimulation, a woman has 10 eggs, ideally all should be fertilised but only two transferred the first time, with the rest being frozen. If the first treatment is unsuccessful, more eggs can be transferred."
This is how things are done abroad, and Mr Sultana and the hospital tells patients about this option which some parents opt for. If only two embryos can be transferred and the team can only expose two eggs to sperm, the authorities have to allow for freezing to take place, he said.
Every time a woman is stimulated to produce more eggs, she has to be operated upon to have the ova collected. There is also the risk of hyper stimulation, which can cause the ovaries to become enlarged, and lead to hospitalisation.
Being able to freeze ova would do away with a number of the ethical difficulties associated with IVF. But although this has started being done in some countries, the success rate is not good yet. Mr Sultana said this might be possible in three to four years' time.