Issue link: https://maltatoday.uberflip.com/i/1367395
12 maltatoday | SUNDAY • 2 MAY 2021 NEWS KURT SANSONE THE sweeping changes to the Embryo Protection Act in 2018 enabled in-vitro fertilisation to be unshackled from some of the constraints introduced six years earlier. The changes allowed doctors to be able to fertilise up to five eggs instead of only two, increasing the chances of success. They also made embryo freezing an in- tegral part of the treatment process. But government was very careful back then to steer clear from introducing pre-implantation genetic diagnosis (PGD) on embryos in those cases where prospective parents carry the risk of transmitting a hereditary disease or ge- netic disorder to their child. In parliament, several government MPs at the time made it a point to em- phasise that PGD will not be on offer. However, there was the lone voice of Rosianne Cutajar, who subsequently called for a mature discussion on IVF- linked treatments not offered in Malta such as PGD. Health Minister Chris Fearne a fort- night ago said government will be draft- ing changes to the IVF law to make PGD possible. He did not give details and his statements were made in the context of criticism from the Opposition that although the IVF process is free on the national health service, the expensive medication required to stimulate the woman is not. PGD can help prospective parents who have known genetic disorders or diseas- es to have a better chance at conceiving healthy babies. But the matter is not without its ethical considerations. What is PGD? PGD stands for pre-implantation ge- netic diagnosis. In a nutshell, it is when genetic tests are carried out on embry- os formed through in-vitro fertilisation (IVF) before these are implanted in the womb. What is the purpose of PGD? PGD is used to determine whether the embryos are at risk of genetic disease. The test is normally offered when one or both biological parents have, or are car- riers of, a known genetic abnormality. Is this available in Malta? Not quite. The IVF law does allow doc- tors to carry out "clinical interventions" on embryos, however these have to be "exclusively diagnostic or therapeutic". The law also makes it a condition that any such interventions are "in the in- terests of the health and development of the embryo itself". So, any diagnostic test could theoretically be carried out, however in practice these are not done because the law imposes other limita- tions. What happens if the PGD test flags a genetic abnormality? In jurisdictions where PGD testing is allowed, the embryo with a genetic ab- normality is normally discarded or kept frozen and given up for scientific re- search. Only healthy embryos are trans- ferred to the womb. Can embryos be discarded in Malta? Malta's law prohibits embryos from being discarded. It also prohibits em- bryo use for scientific research. If PGD testing is done and a genetic disorder is flagged, the most that can be done is freeze the embryo. However, Maltese law does not allow the woman to un- dergo a new cycle of IVF until all frozen embryos from a previous cycle are used up. These limitations make PGD useless and impractical. Which genetic defects are tested for? In theory, tests can be carried out for Testing embryos for genetic disorder before implantation Health Minister Chris Fearne says government will put forward changes to the law regulating in- vitro fertilisation so that pre-implantation genetic testing of embryos will be possible. Kurt Sansone explores the ins and outs of PGD What Malta's current law prohibits No sex selection • Sperm cells to be used in ar- tificial fertilisation cannot be selected for the sex chromosome they contain • However, doctors can select particular sperm cells to prevent the child from falling ill with a sex-linked genetic illness Improper use of human embryo • Human embryos have to be created solely for the purpose of im- plantation in a prospective parent • Embryos cannot be disposed, handed over or acquired, or removed from a prospective parent before the implantation in the womb is complete No cloning or research • Any intervention seeking to create a human being genetically identical to another embryo, foetus, or human being, whether living or dead, is prohibited • Altering the genetic informa- tion of a human germ line cell in an artificial way is illegal • Any experimentation on hu- man embryos is prohibited • The formation of chimera and hybrids is also banned