Issue link: https://maltatoday.uberflip.com/i/981272
| SUNDAY • 13 MAY 2018 maltatoday 16 INTERVIEW There has been a lot of controversy surrounding the proposed amendments to IVF legislation. First off, however: is it necessary to amend this law in the first place? What needs to be changed? It is necessary, and how. The aim behind IVF Is that infertile women will go home [after treat- ment] and have a baby. But the law that we have now is extreme- ly restrictive, and in quite a few cases does not allow us to reach our aim. The current law allows us to attempt to fertilise two eggs; which is very different from hav- ing two embryos. In exceptional circumstances, the law allows a concession to try to fertilise three eggs. Now: what happens in the rest of Europe? Usually, you col- lect all the eggs – in a normal cycle, between eight and 15 – and attempt to fertilise them all. Why? Because when you attempt to fertilise 15 eggs, you will get 10 to 12 that will actually fertilise; and these will then have to devel- op. Also, abroad they are allowed to go up to five days [before im- plantation] instead of only three [as is the case here]. By the end of that process, from 15 eggs, you will end up with five or six. One will be implanted, and the rest are frozen. But what are we doing [in Malta]? We are attempting to fertilise only two eggs – which sometimes gives you two em- bryos – and we have to [implant] them both by the third day. We don't allow them to go up to the fifth day... What is significant in the difference between implanting after three or five days? By the fifth day, the embryo will have shifted from its mother's infrastructure, to its own. This gives more opportunity to iden- tify genetically abnormal embry- os – and by 'genetic abnormali- ties', I'm not referring to Down's Syndrome, or abnormalities that will still give rise to a live birth. I'm talking about problems that will lead to failed implantation, or miscarriages. So, by leaving implantation to the fifth day, it will give you a way to at least try to weed out the really bad ones. Those will not be replaced [back in the womb]... what's the point of replacing an embryo that is destined to fail? In our case, how- ever, if we had to wait until day five, in many cases we will not be implanting anything at all. [...] in reality, we are very often replac- ing embryos that are destined to fail. Is that right? Is that going to help us achieve our objective? And yet, the law as it stands is called the 'Embryo Protection Act'... It's a very big misnomer... ... so it seems, as from what you're saying it doesn't seem to be offering much protection to embryos at all... It's even worse. What I've been talking about so far are embryos that are destined to fail... which haven't really had anything done to them. But we are in a worse situation than that. Today, we know that, if you measure one of the hormones at the time of actually triggering ovulation... basically, if the progesterone lev- el is over 1.5 – that reduces the chances of an embryo implanting by around 20%. Abroad, in those cases they would freeze the em- bryo, and replace it later [when the hormone levels are lower]. What do we do? We put it in anyway. So what are we doing? We're sending at least one fifth of our embryos to certain death, if you want to look at it that way. You call that embryo protection? It's embryo destruction... Another effect is to raise the hopes of expectant mothers, in cases where chances of success are minimal. Do you encounter cases like that? Unfortunately, as I tell my pa- tients all the time: we are going to do our best, you are doing your best... but this is like a lot- tery. When you buy a lottery ticket, you don't commit your- self to buying a new house or car... because, in most cases, you are not going to win the lottery. With IVF, it's the same. Even in the best scenarios, two-thirds of the people we are going to start the process on, are going to re- main empty-handed... Is this because our law is faulty... or is it a statistic about IVF in general? If you take IVF in general: on the first cycle – what we call the 'fresh' cycle – without subdivid- ing by age, or any other factor... you are looking at a 33-35% chance of [success]. Abroad, it is slightly different... they can freeze embryos, and can at- tempt to fertilise all a woman's eggs... so if you have four or five embryos, you will implant one to begin with; and if it doesn't work, then you take one of the remaining [frozen] embryos, thaw it, and put it back in. That process is much, much simpler: you do not have to stimulate the woman with all those injections; you don't have to give her anaes- thetic to collect her eggs... be- cause everything's already been done. So then, there is what we call the cumulative success rate, per cycle that you have stimulat- ed. With freezing, one stimula- tion gives you four, five chances. That pushes up the cumulative successive rate to between 60 and 70%. In our case, without freezing... you only have one chance. If that fails, you have to start the process again. Basically, you have to stimulate the patient every time... One aspect that is rarely discussed is how all this affects the patient. What does a woman undergoing IVF treatment actually go through? When we do IVF, we take over the cycle. We shut down her own cycle, and stimulate everything afresh. [...] The process involves two weeks of multiple injections; and when the eggs have matured enough, we administer a light an- aesthetic to retrieve those eggs, using a trans-vaginal ultrasound with a needle on it. We puncture the ovaries, and aspirate those eggs. The eggs are then sent to the lab, where, currently, any two are taken for an attempt at fertili- sation. The rest are frozen, using oocyte vitrification... And the success rate is not satisfactory... No. [...] The latest European statistics show that for a woman The ongoing IVF debate has sparked a wave of pro-life concern; but for obstetrician MARK SANT, that is a case of missing the baby for the test-tube. Infertility is a medical condition, he argues... and should be approached as such This is about medicine, not theology Raphael Vassallo I think it's ridiculous that people who have had four, f ive, nine children feel empowered enough to impose on the childless, and tell them: 'Lump it. You're not going to have babies...' rvassallo@mediatoday.com.mt [With the present law] we're sending at least one f ifth of our embryos to certain death. You call that embryo protection? It's embryo destruction...