Issue link: https://maltatoday.uberflip.com/i/1467182
11 maltatoday | SUNDAY • 8 MAY 2022 NEWS fertilise them in batches, you can still get a good enough out- come and I don't think you're decreasing your chance of suc- cess substantially," Schembri Deguara said. Sultana said that Malta had come a long way in the IVF field but was still lagging behind other countries in many aspects due to several legal restrictions. "Permission to use all the oo- cytes retrieved during an IVF cycle in order to identify and choose the best-quality em- bryos for transfer is one of the procedures which would give couples a better chance of con- ceiving through IVF, in the process increasing Malta's IVF success rate," he argued. Should pre-implantation embryo genetic testing be ntroduced? PGD is a controversial topic in Malta because of its ethical im- plications. PGD allows doctors to test embryos in couples who risk transmitting certain genet- ic disorders to their offspring. The tests are done before the embryos are implanted in the woman. The genetic diagnosis is cur- rently not carried out in Malta since the law does not allow doctors to discard defective em- bryos or give them up for scien- tific research, which is normal- ly what happens in countries where PGD is allowed. Schembri Deguara agreed that PGD testing should be intro- duced but cautioned that it is normally only used when there is a known hereditary disease in the family and which the parents would not want to be transferred to the embryo. "When you are biopsying an embryo even in good hands, there is a chance of damage to that embryo, so I wouldn't go about randomly biopsying for women under 35, assuming they have not had recurrent miscarriages or I suspect a ge- netic condition," she said. Schembri Deguara said that even when PGD is available in the future, there are benefits to specific cases, but it's not some- thing that would apply across the board. "It's always a matter of benefit over risk," she said. Likewise, Sultana said that introducing PGD testing into Malta's IVF law must be "fa- vourably considered." "One can still regulate its ap- plicability depending on each individual," he said. PGD test- ing should be used in cases in- volving women who have had two or more failed assisted re- productive cycles or have suf- fered two or more miscarriages due to unknown causes. Sultana added that another example of when PGD testing should be used is where women have been through a pregnancy that involved chromosomal ab- normalities, especially in assist- ed reproductive cycles, or when the man's sperm reveals errors during meiosis or a low sperm count. Sultana said that the benefits of using PGD testing include a lower risk of miscarriage and increased chances of having a healthy baby, and a lower prob- ability of going through several IVF cycles. What should the role of the Embryo Protection Authority be? The law regulating IVF is actually called the Embryo Protection Act, which also in- cludes the setting up of the Embryo Protection Authority. This authority is tasked with overseeing the sector, issuing guidelines and protocols and carrying out checks on IVF fa- cilities. Sultana said the authority in Malta has been a key player to ensure that in an area that is very sensitive, the highest lev- els of standards are adhered to. The EPA has done this job well, he added. However, Sultana said the EPA should have the flexibility to adapt treatment options ac- cording to the different scenar- ios and varying needs and diffi- culties encountered by couples. "Finding the right balance be- tween ethical considerations, medical advancements, and the interests of the patients is never easy but identifying the best international IVF practices and adapting them to the local context is the least we can do to give couples in Malta the best chance of conceiving through IVF," he said. Schembri Deguara said the EPA's role is to make sure that protocols are adhered to prop- erly to ensure patient safety above all else. "At the end of the day, any controlling legis- lative body aims to ensure that treatments are done according to the law." She added that the EPA had ranked highly in the EU. "From our perspective, having opened a fertility clinic, the EPA has been helpful and meticulous." MaltaToday spoke to Dr Christine Schembri Deguara from Hope Fertility & IVF, who specialises in IVF and fertility issues, and senior embryologist Paul Sultana, a laboratory director at MLS Advanced Ltd, to gauge their views