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maltatoday | WEDNESDAY • 20 JUNE 2018 7 NEWS ANALYSIS IVF could only be provided to adult heterosexual couples who are either married or in a stable relationship. Lesbians were ex- cluded despite the introduction of same-sex marriage last year and civil unions three years earlier. Single women were also ex- cluded. The law prohibited the fertilisation of more than two eggs. It did allow an exception for three eggs to be fertilised, if this was medically necessary in some cases and doctors would first have to seek the authority's consent. Statistics show that in 40% of cases doctors had asked for permission to fertilise three eggs. All embryos produced had to be transferred to the womb. The principle legislation made no provisions for sperm and egg banks but regulations drawn up by the authority do allow the freezing of unfertilised eggs that are harvested from the woman who will make use of them. There have been IVF processes at Mater Dei that used frozen oocytes. Pre-implantation genetic diagnosis (PGD) and research using embryos are both illegal. It was illegal to freeze embryos as part of the IVF treatment. The only exception was in cases – referred to in the law as force majeure – where implantation of embryos could not take place because of something that happened to the woman. So far, there has only been one case where this has happened and two em- bryos had to be frozen because the mother fell ill before the im- plantation process. Although the authority could put up frozen embryos for adop- tion, the law did not give a detailed outline of how this should be done. There was a one-year time frame from when the embryo was frozen by which the authority could proceed with adoption but made it incumbent on the authority to consult with the pro- spective parents before proceeding with the process. Sperm and egg donations were illegal. Only gametes from the prospective parents could be used to produce embryos that would then be implanted in the same woman from which the eggs were harvested. The definition of prospective parent has changed to cover any adult person, irrespective of gender or sexual orientation. This will make IVF available to all women, including singles and les- bians. Doctors will be able to fertilise up to five eggs in any cycle. How- ever, if the prospective parents do not consent to embryo freezing and the subsequent adoption of any unclaimed embryos, doctors will only be able to fertilise up to two eggs in all cycles of the treat- ment. In all instances, the maximum number of fertilised eggs that can be transferred to the womb in any one cycle will be two. Any extra embryos will have to be frozen. The law proper makes provisions for the creation of regulated sperm and egg banks, where gametes can be frozen for future use. Sperm can be preserved throughout the lifetime of the person from which it originates, while oocytes will have to come from women with a maximum age of 36. Eggs cannot continue to be preserved after the death of the woman from whom they origi- nate. However, the law will allow the use of sperm and eggs of people who die but would have previously made a direct dona- tion of their gametes. PGD and research using embryos will remain illegal. Embryo freezing will be allowed, subject to an agreement be- tween the prospective parent or parents and the authority. The authority can issue a five-year permit to the prospective parents allowing them to freeze extra embryos if they agree to give up any unclaimed embryos for adoption. The permit can be extended every five years until the woman is 48. Given that the law allows the fertilisation of a maximum of five eggs, of which only two can be implanted in the womb, embryo freezing becomes an integral part of the IVF process. The authority can give up unclaimed frozen embryos for adop- tion, in a process that is better defined. The authority can pro- ceed with adoption if the parents of the embryo decide not to renew the five-year certificate granted them to freeze embryos, or if the prospective mother reaches 48 years of age. The law makes it clear that the person adopting frozen embryos cannot have embryos originating from different couples, implanted into the womb at the same time. Sperm and egg donations are legal. Prospective parents can identify the donors or donor, in which case, the identity of the person will be known to them. The donor or donors cannot be next of kin. However, prospective parents can also benefit from gamete donations by using sperm and oocyte banks. In this case, the donor is anonymous. A child conceived from anonymous do- nors has the right to know who the biological parent or parents are, upon reaching 18. Surrogacy An original proposal to legal- ise altruistic surrogacy was re- moved from the Bill after public pressure. Surrogacy would have allowed women unable to carry a child in their womb, the possibility to become mothers. It also meant that the whole spectrum of the LGBTI community could use surrogacy as an option to be- come parents. None of this was included in the final amendments to the Embryo Protection Act, with the government pledging to pro- pose surrogacy as a separate Bill. As things stand, surrogacy of all types remains illegal and the doctor performing the IVF or embryo transfer can be pun- ished by a fine ranging between €5,000 and €15,000 and a maxi- mum three-year prison sen- tence. The surrogate mother's punishment is decreased by one or two degrees. KEY EXPLAINERS Surrogacy This is when a woman of- fers her womb to carry some- body else's baby. It can be done against payment or on an al- truistic 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 wom- an. Eggs and oocytes are used interchangeably. Embryo An embryo forms when a fe- male egg is fertilised by sperm. The resultant union provides the first human cells with a po- tential to develop into a baby. PGD Pre-implantation genetic diag- nosis 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 dis- ease, which can be transferred to their children. How the IVF law has changed THE OLD LAW THE NEW LAW ELIGIBILITY FOR IVF EGG FERTILISATION EMBRYO FREEZING ADOPTED EMBRYOS SPERM AND EGG DONATION SPERM AND OOCYTE BANKS EMBRYO RESEARCH