Issue link: https://maltatoday.uberflip.com/i/1545896
FEW pieces of legislation have transformed lives in Malta quite like IVF legislation. Thousands of couples who once had little hope have been given the opportunity to experience the joy of parent- hood, thanks to political courage and successive reforms that have steadily expanded access to fertil- ity treatment. A Labour government deserves recognition for the progress made over the past decade. Public in- vestment has increased, free treat- ment has expanded, medication is now being financed and, once again, government is discussing a fourth amendment to further strengthen the law. This progress matters. It should be acknowledged and appreciated. But gratitude should never pre- vent us from asking what comes next. For many couples, the greatest obstacle today is no longer finan- cial. More free cycles, greater in- vestment in medication and addi- tional resources for the public IVF service are all welcome measures. They will undoubtedly make treat- ment more accessible for many families. Yet accessibility is only one side of the equation. The oth- er is whether our legislation gives couples every reasonable medical opportunity to succeed. Today, it does not. I do not believe that having chil- dren is a right. No legislation can promise that outcome. What the State can and should guarantee is access to the best medical ad- vancements available within an ethical and regulated framework. No Maltese family should have to leave home, and leave behind their support network, simply to access treatments that could help them grow their family. If we genuinely believe in re- productive healthcare, then our legislation must evolve alongside science. One such area concerns genetic testing. Government's proposal to expand the list of diseases that may be tested through Preim- plantation Genetic Testing for Monogenic disorders (PGT-M) is certainly welcome. However, it remains only a fraction of what modern reproductive medicine can now achieve. Hundreds of ge- netic conditions can now be iden- tified internationally, yet Maltese couples continue to have access to only a limited number. Equally important is the conver- sation around Preimplantation Genetic Testing for Aneuploidy (PGT-A). This remains unavail- able in Malta despite being an important clinical tool for par- ticular categories of patients. It is certainly not a test that should be used routinely, nor is it suitable for every couple. Like every medical intervention, it has limitations and should always remain a decision between patients and their fertility specialists. However, for some couples, PGT-A can identify embryos that have virtually no chance of result- ing in a healthy pregnancy before implantation even takes place. In some cases, this can help avoid the physical pain of repeated failed transfers, the emotional trauma of preventable miscarriages and the uncertainty that follows every pregnancy loss. Anyone who has experienced miscarriage knows that it is never "just part of the process". It leaves an emotion- al and physical scar that can last long after treatment has ended. If modern medicine can reduce even a fraction of that heartbreak for carefully selected patients, should Maltese families not have access to that option? Surely we owe Maltese women every reasonable opportunity to maximise their chances of success while reducing avoidable physical strain and emotional heartbreak. These are not simply political arguments. They reflect concerns that continue to be raised by pro- fessionals working in reproduc- tive medicine. Fertility specialist Christine Schembri Deguara re- cently called for discussions to be reopened on aspects of Malta's IVF framework, including surro- gacy, while highlighting the lim- itations of the current legislative framework. Whether one agrees with every proposal is beside the point. Scientific expertise should help shape public policy, and diffi- cult conversations should never be avoided simply because they are politically or ethically sensitive. Surrogacy and unused embryos This naturally brings us to surro- gacy. I fully appreciate that many women's organisations and femi- nist voices remain opposed to its introduction, raising legitimate concerns regarding exploitation, commercialisation and the pro- tection of vulnerable women. Those concerns deserve respect and should never be dismissed lightly. Yet, I also believe that a ma- ture society should be capable of holding a healthy, respectful and non-partisan debate on wheth- er altruistic surrogacy, governed by one of the strictest regulatory frameworks in Europe, could of- fer hope to women who simply cannot carry a pregnancy. Dis- cussing an issue does not prede- termine its outcome. It simply demonstrates our willingness to listen, evaluate the evidence and legislate responsibly. Another issue that deserves equally careful consideration is the fate of unused embryos. Our legislation effectively leaves prospective parents with very limited long-term options, prin- cipally continued freezing or em- bryo adoption. For many families, neither option reflects their wish- es once they have completed their family. Many countries now provide additional alternatives, including donation for approved medical research or compassionate trans- fer. These are deeply personal decisions involving ethical, emo- tional and moral considerations. But surely the role of the State is not to prescribe a single accept- able outcome. The State should legislate responsibly and provide options, allowing each family to decide according to its own con- science and beliefs. The same principle applies to equality. Malta's IVF legislation was en- acted before our country made its remarkable advances in LG- BTIQ+ rights. Since then, Malta has rightly become internation- ally recognised for promoting equality and inclusion. It is there- fore timely to review the legisla- tion carefully to ensure that no unnecessary discrimination, even if unintentional, continues to ex- ist for same-sex couples wishing to build a family. Ultimately, this debate is not about compelling anyone to un- dergo a particular treatment or embrace a particular ethical po- sition. It is about recognising that the State's responsibility is to pro- vide a safe, ethical and medically regulated framework that offers the widest possible range of evi- dence-based options. Couples re- main entirely free to decide which treatments they wish to pursue and which they do not. Expand- ing choice does not oblige anyone to use it. Restricting choice sim- ply obliges some Maltese couples to board a plane. Choosing to grow your family is one of life's most remarkable jour- neys. Yet for many, it is far from straightforward. Behind every IVF cycle is a story of infertility— sometimes female, sometimes male, and often a combination of both. While we have become more comfortable speaking about women's fertility, male infertility remains far less discussed, despite affecting countless couples. That silence is another barrier we must begin to break. Families come in all shapes and sizes, and advances in medicine continue to create possibilities that previous generations could scarcely have imagined. The role of lawmakers is not to decide which of those possibilities every family should embrace, but to ensure they exist within a safe, ethical and compassionate legal framework. We should be proud of how far Malta has come. But progress should never become an excuse to stop progressing. It is time to stop exporting our problems, start trusting Maltese families with informed choices, and begin opening up the con- versations—and the possibili- ties—that modern medicine can responsibly offer. Because infer- tility does not discriminate, and neither should opportunity. 11 maltatoday | SUNDAY • 19JULY 2026 OPINION Nikita Zammit Alamango President Nisa Laburisti IVF reform: Progress achieved should never become an excuse to stand still It is time to stop exporting our problems, start trusting Maltese families with informed choices, and begin opening up the conversations—and the possibilities— that modern medicine can responsibly offer. Because infertility does not discriminate, and neither should opportunity