Issue link: https://maltatoday.uberflip.com/i/969423
17 maltatoday SUNDAY 15 APRIL 2018 News KEY TERMS Surrogacy This is when a woman offers her womb to carry somebody else's baby. It can be done against payment or on an altruistic basis, depending on the country's legislation. Sterility There are cases where the man or the woman or both do not have gametes, or these are inadequate to conceive. IVF is useless for these couples unless they can benefit from gamete donation, embryo adoption or surrogacy. Oocyte This is the scientific name of the eggs produced by the woman. Eggs and oocytes are used interchangeably. Embryo An embryo forms when a female egg is fertilised by sperm. The resultant union provides the first human cells with a potential to develop into a baby. The new law uses embryo and fertilised egg interchangeably. PGD Preimplantation genetic diagnosis is used to screen embryos for any genetic defects before they are implanted. Embryos that are found to be defective are discarded. This is often used in cases where the prospective parents have a hereditary disease, which can be transferred to their children. THE IVF PROCESS How does the IVF process start? IVF starts with a course of hormone therapy for the woman, which is taken as pills and injections. This stimulates the development of eggs. Is it painful? It is uncomfortable and can pose the risk of hyper stimulation if the eggs grow too much. To avoid this, doctors normally ask the woman to have regular ultrasounds towards the end of the cycle to monitor egg growth. This adds to the anxiety. What happens when the eggs are of the right size? The woman undergoes a minor operation by which the eggs are harvested from her body and placed in a petri-dish. On the same day, sperm is collected from the partner or retrieved from a donor. In some instances, extra eggs can be frozen for future use, without the need to undergo the stimulation process. What happens next? At this stage doctors try to fertilise the eggs by putting the sperm in the same petri-dish in the hope that fertilisation occurs, normally within 24 hours. If fertilisation does occur, an embryo is formed. In some cases, a sperm is actually injected into the egg to aid the process. This is called ICSI. The embryos are left for three or four days in the petri-dish before being transferred to the woman. Under the new law doctors can try to fertilise more than two eggs and so the extra embryos can be frozen for future use. How are frozen embryos used? They first have to be thawed before being implanted in the womb. If they remain unclaimed the authority can give them up for adoption. If nobody adopts them they will remain frozen and likely to deteriorate naturally over time. Does this mean that all embryos transferred to the woman will result in live births? No. The take-home baby rate for IVF treatment in 2016 stood at 20%. This is why doctors prefer treatment options that allow embryo freezing, because this gives the prospective parent a greater chance to become pregnant without having to go through the trauma of stimulation at every cycle. Why are doctors prevented from implanting more than two embryos? Paediatricians have often raised concerns about the health risks associated with multiple pregnancies as a result of IVF processes. The transfer of two embryos, which at the most can lead to twins, seems to be a widely-accepted protocol. Transferring two embryos does not automatically translate into twins because either both or one of the embryos may be rejected by the body. ETHICAL AND LEGAL IMPLICATIONS Why is embryo freezing contentious? Objections to embryo freezing stem from the core argument as to whether an embryo has a distinct right to life, over which there are oppos- ing scientific, moral and religious views. For those who believe the embryo is a human being vested with rights, any attempt at destroy- ing or freezing it, is construed as a breach of the embryo's right to life. However, there are those who argue that freezing is not equivalent to ter- mination because life is being preserved. Others contend that the embryo is only a group of cells, which cannot be vested with rights nor- mally assigned to a person and so no ethical con- siderations should arise. But the dilemma is not only whether to freeze embryos but what will happen to them if they re- main unclaimed. Frozen embryos can be allowed to perish naturally or be given up for research apart from adoption. The new law retains the ban on embryo research and by obliging parents to give up unclaimed embryos for adoption, tries to minimise the number that will remain frozen. Does egg freezing come with the same ethical dilemma? No. Unfertilised eggs do not carry the same ethical and moral implications as embryos. But most experts contend that the success of an IVF programme depends on the judicious use of both egg and embryo freezing. Can gamete donation and embryo adoption lead to people unwittingly marrying their sibling in the future? Anonymous gamete donation may lead to such a circumstance but the new law has an inbuilt safeguard that limits the number of donations a person can make to one time. This zeroes the chances of having two people born in different families from the same sperm. However, the chances of siblings getting married because they do not know they were conceived from the same parents, are higher with embryo adoption. But according to the Health Minister, international studies have shown that this risk is less than what it is in ordinary circumstances. What are the ethical implications of surrogacy? The principle concern is the dignity of the woman that will carry someone else's baby and the implications of what some believe is the com- modification of the womb. Others believe surro- gacy is a noble act of altruism that is no different from someone offering a kidney to someone in need. However, some argue that surrogacy will intentionally deny the baby from the maternal bond that would have developed throughout the pregnancy. Other ethical issues concern multiple parent babies, whereby the child is conceived by a surrogate mother from donor gametes. The new law only bars surrogacy against payment but the rules laying out what is permissible and not will have to be defined at a later stage by the minister. Are there legal implications with donation and surrogacy? The legal standing of the third party donating the gametes or offering her womb to carry the baby are one set of complications. The new law makes it clear that any child conceived by ei- ther of the two methods will be legally bound to the prospective parents. But a more significant stumbling block may be the child's right to know who his biological parent or parents are in the case of gamete donation. Anonymous donations were stopped in the UK after a woman, con- ceived through donor gametes, won a court case that determined it was her right to know about her identity. The new law in Malta tries to miti- gate the problem by ensuring the child will get access to important information on the donor but it stops at that. It will probably have to be tested in a court of law to determine whether this will be enough.