The in-vitro fertilisation success rate almost halved after new rules limited to two the number of eggs that could be fertilised, Times of Malta has learnt.
In 2013, the first full year the sector was regulated by law, 28 per cent of IVF procedures led to pregnancy, according to the annual report released by the Embryo Protection Authority.
All 100 treatments last year were done in the private sector since Mater Dei Hospital, the State hospital, only started offering the service at the start of this year – pregnancy resulted in 28 cases.
The 2013 success rate contrasts sharply with the 50 per cent success rate claimed by St James Hospital, the only private clinic that does IVF procedures, in 2012.
Josie Muscat, the doctor who owns St James and pioneered IVF in Malta 20 years ago, attributed the significant drop to the rules.
“Since the law does not allow us to try and fertilise more than two eggs, except in certain circumstances, the pregnancy success rate has dropped because the chances to obtain viable embryos have been reduced,” he said.
The law introduced in 2012 binds doctors to try and fer-tilise only two eggs in a bid to cut down on the number of multiple pregnancies.
The law does allow three eggs to be fertilised in exceptional cases that take into consideration the woman’s age and previous failures to get pregnant.
According to the authority that regulates the sector, in 2013 it received 23 requests from doctors to fertilise three eggs instead of two but permission was only granted in 14 cases.
In the national debate that preceded the enactment of the IVF law, specialists in the field had warned that putting a limit of two could prove problematic. They had argued that giving doctors the option to fertilise more than two eggs would increase the chances of success in obtaining viable embryos. But with MPs intent on curbing the number of higher risk multiple pregnancies – caused by the implantation of more than one embryo – the question that had to be tackled was what would happen to the extra embryos if only two were transferred to the woman.
Doctors wanted the option to freeze the extra embryos, an ethically contentious stand rejected by legislators. The law does not allow embryo freezing except in grave circumstances such as if the woman has an accident just before implantation or changes her mind half way through the process.
However, the law does allow the freezing of eggs and sperm, which is not ethically contentious. Expert opinion is split on whether frozen eggs are more suitable than frozen embryos – fertilised eggs – to give a higher success rate.
The annual report showed that until May this year 83 couples chose to freeze the extra eggs, which amounted to 338 oocytes. Three couples froze sperm.
Dr Muscat explained that stimulation to harvest a woman’s eggs could produce more than the required number and so extra oocytes are frozen.
This means that in subsequent treatments the woman would not have to undergo the uncomfortable and risky stimulation process to produce eggs.
Dr Muscat said there were medical reasons for the freezing of sperm such as when the man had a very low sperm count and substantial volume was needed to have enough viable sperm for use in the treatment.
There were no recorded cases of couples freezing their gametes as a preventive measure such as when the individuals require cancer treatment that could potentially render them infertile.
The authority’s annual report, which was handed to Health Parliamentary Secretary Chris Fearne, gave a breakdown of figures since it started regulating the sector in May last year. From May 2013 to May 2014 the authority received 142 requests for IVF procedures in the private and public sectors, granting approval in 138 cases.
Three requests were declined because the women were aged over 42, the upper limit set out in the guidelines, and one case was denied because the woman was under 25, the lower limit.
The authority also received 52 requests from doctors to be able to fertilise three eggs instead of two. Approval was granted in 38 cases.
In January this year Mater Dei Hospital started its IVF treatment programme and from 27 couples who underwent the procedure, six resulted in pregnancy.
The report also showed that 21 non-resident foreigners specifically sought IVF treatment in Malta over the year in review.