The first IVF baby born in Malta will turn 18 on Tuesday. His parents tell Cynthia Busuttil he was their best ever Christmas present. The teenager says the way he was conceived does not really make a difference.

Louise* and Robert* had been married for five years. But their house in Iklin felt empty. Despite their attempts, they could not have children.

The five years were fraught with complications. Louise had two miscarriages, leading to an infection in one of her fallopian tubes which started deteriorating as a result.

"I had a flurry of visits to the doctor, until I was told I had a 50 per cent chance of getting pregnant," Louise said.

Sitting on a sofa surrounded by her family, she recounted how, despite the couple's attempts and regular tests, the prospect of motherhood seemed distant.

"We were not getting any younger and could see the chances of having a child shrinking," Robert said.

Then, sometime towards the end of 1990, Louise was talking to a friend and heard about the new technology at Saint James Hospital.

"I did not even know anything about in vitro fertilisation (IVF) at the time," she said.

The couple were prepared to do anything to have a child, and made an appointment to see hospital head Josie Muscat, full of hope that finally they would become parents.

"Dr Muscat said if we did not manage to get in through the door, we could try to get in through the window," Robert said.

The couple turned a blind eye to the expenses - more than €9,000 - including all the tests. But looking at his son, who is sitting on the sofa listening to the story, he quickly added: "But it was well worth it."

The couple reminisce about the day they found out Louise was pregnant. "Dr Muscat barely wanted to believe the tests. We did four, and he was only convinced when he heard the baby's heart," Robert said.

Although she was careful, Louise said she did not live her pregnant life wrapped "in cotton wool", continuing to work as a sales assistant until her fourth month.

The pregnancy went on without a hitch and on December 14, 1991, Louise's waters broke. The couple rushed to the Żabbar hospital and Chris* was born the next morning, making headlines.

Leafing through stacks of photo albums, Louise journeys down memory lane, recalling how they kept their newborn close to the heater to protect him against the cold that struck that winter. But the weather could not dampen the family's joy at finally having a child.

"That first Christmas was very special. It was our first one with a baby," Louise said.

Soon after Chris was born, Louise was in for another surprise. She missed her period, but considering the problems she faced to get pregnant with her firstborn, did not think much of it - until she did a pregnancy test and it turned out positive. Just 16 months after having her first baby, she gave birth to another son.

Chris is immune to the fuss surrounding his birth. "It's just a story," the aspiring computer technician, who loves to eat lasagne and listen to trance and house music, said.

He opts to keep a low profile, preferring to keep his identity under wraps. "Sometimes people joke about test tube babies, and even though they do not know I was born through IVF, it still hurts me," he said.

Yet his parents are full of encouraging words for couples who are having problems conceiving. "They should not give up and do whatever they can to succeed," they said.

* Names have been changed.

Three men and a baby

Louise managed to get pregnant the first time she went through IVF process, even though back then the success rate was only between 15 and 25 per cent.

But today, things have changed, and Paul Sultana, Saint James Hospital laboratory director, said the success rate has shot up to between 40 and 45 per cent.

"It feels good to help a couple have a baby," Mr Sultana said.

Mark Brincat, head of Mater Dei Hospital's Obstetrics and Gynaecology Department, said: "When I broke the news that we had our first IVF pregnancy during a medical conference, I was very emotional," he said.

He estimates around 400 children have been born following IVF performed in Malta. The procedure might sound simple enough - put the ova and sperm in a Petri dish and let them do the work. But it is not as easy as that.

The IVF story started in Malta in the late 1980s, when Dr Muscat quit politics and went to Glasgow's Royal Infirmary University to attend IVF sessions. When he returned, he started building an IVF laboratory and an Artificial Reproductive Technology Clinic.

"At that time, assisted reproduction was almost nonexistent," Dr Muscat said, adding that he wanted to help women with childbearing problems.

"At that time, the only way sub-fertile women could have children was by going abroad for treatment. It was extremely expensive and affordable only for the few."

At the same time, Mr Sultana went to Cambridge - where Louise Brown, the world's first IVF baby, was conceived in November 1977 - to learn about the procedure.

Before the fertilisation takes place, the mother has to undergo hormone treatment. "We use medication to switch off the ovaries for two weeks and then stimulate them for another two weeks, all the time keeping an eye on the mother through regular ultrasounds and blood tests," Prof. Brincat said.

After around 12 days, all the ova follicles are picked up with a needle inserted through the vagina. What follows is an exercise in precision and patience, where follicles are drained one by one, the eggs found, and the best ones chosen. It is only then that these are put in a Petri dish with thousands of sperm to allow fertilisation to take place.

The following day, the experts will know whether fertilisation has taken place, but they have to wait another day, when the embryo starts splitting, to know how successful the procedure was. It is only then that the embryos are transferred into the woman's womb, and the waiting game begins.

But even knowing how many eggs to fertilise is not an easy decision. Because Malta does not allow embryo freezing, all the fertilised eggs are injected back into the woman's womb, and if too many are implanted, there could be complications during pregnancy and for the babies.

Back in the early 1990s, the procedure was carried out very much in the dark, since lab technicians would not know how many of the extracted eggs were fully developed. Nowadays, most cases involve intracytoplasmic sperm injection, where the cells on the outside of the egg are cleaned and the sperm is injected directly into the egg.

"This gives us more control on the outcome," Mr Sultana said.

Prof. Brincat said nowadays couples who would never have been able to have a child some years ago were enjoying success. He said the procedure was the end of the line for many couples who went through other fertility treatments beforehand.

While infertility has always been around, today there are added pressures, such as couples having a baby later in life.

Although the success rate is high, there are disadvantages, including the emotional blows for unsuccessful parents, the high cost of treatment, which could rise to well over €1,500, and the length of each trial.

"Probably the most difficult part for the couple is the 10-day wait between undergoing embryo transfer to the day when the pregnancy test is carried out and the couple find out whether the treatment was successful or not,"

Dr Muscat said. He was present when Chris was born. "It was highly emotional for me to watch the proud parents hugging the baby and each other with such joy, knowing such a moment could have never been made possible without IVF. The scene of happiness is just indescribable. Every birth is a moment of great happiness, but when one delivers a baby which, nine months before, had seemed impossible to conceive, then one is truly lost for words."