An imperfect IVF law, undermined by party-politics

A minor ‘spat’ between Health Minister Chris Fearne and Opposition leader Bernard Grech, over proposed amendments to IVF legislation, has once again highlighted how even the most delicate, sensitive issues end up being used as weapons in a political war.

The subject now, if the government does forge ahead with its bold move, is PGD testing, which is employed in in vitro fertilisation to test embryos for hereditary diseases. The marvellous science helps prospective parents avoid the hereditary transmission of incurable diseases. Already, the prospect is being foolishly weaponised by lobbies such as ‘pro life’ doctors: in a shameful statement this week Doctors For Life had the gall to reassure sufferers of cystic fibrosis that they could look forward to a life expectancy of 50... so ignore the science that reduces suffering!

Indeed, the tragedy of Malta’s fertility ‘policy’ (had there been one) is that it remains at the mercy of our politicians, and the sway of our main political parties. To wit, in 2011, the Gonzi administration had dismembered Malta’s semi-regulated IVF regime with a system which, in the words of the then prime minister, “helped us overcome difficulties of conscience”.

It was the Byzantine technology to freeze eggs, rather than embryos, despite a committee of doctor-MPs clearing the way for both sides to consider embryo freezing rules in 2009. In bid to spike that push, Gonzi tasked the conservative MP Edwin Vassallo, who chaired the social affairs committee, to reopen the debate on embryo freezing in 2011: at the suggestion of a pro-life ‘lobby’ called Professionals Against Embryo Freezing (the same members are now part of Life Network Foundation).

The move was clearly designed to contradict the committee findings of Nationalist MP Jean-Pierre Farrugia.  And the resulting legislation was aimed more at assuaging the conscience of pro-life politicians… than to address the health needs of a small and vulnerable minority.

When elected in 2013, Labour was slow to use its parliamentary weight to reverse the damage of the Nationalist administration’s conscientious objections: which then limited IVF to just a maximum of two fertilised eggs, by banning any form of embryo freezing (and therefore any excess of embryos beyond two fertilised eggs).

With its amendments in 2018, any adult person, irrespective of gender or sexual orientation, could qualify for IVF – namely all women, including singles and lesbians. Additionally, up to five embryos could be fertilised, with a maximum of two implanted in any cycle. Embryo freezing allowed prospective parents to have more embryos from the same cycle of harvesting to be implanted.

However, pre-implantation genetic diagnosis (PGD) as well as research using embryos, remained illegal. And now, the change mooted by Fearne sets the stage for a tricky legislative debate on introducing PGD into what is already an imperfect IVF law, limited as it is by faith-based consciences of lawmakers, when it should be serving couples seeking full fertility treatment.

The reason is simple: PGD opens up a scenario for more eggs to be fertilised, and for embryos to be discarded or used for research and training. So Labour must tweak the IVF law and bring it up to modern standards, if it also wants to include PGD testing for those couples who want to have children free of rare, incurable, hereditary diseases.

In such cases, there must perforce be allowed a substantial over-stimulation of ova. After harvesting, it will be from those fertilised eggs that doctors will have to make an important choice: keeping ‘best quality’ embryos for implantation, which are free from the hereditary disease.

That in itself will mandate discarding the embryos carrying the disease, or freezing them indefinitely.

It is a prospect that is expected to raise opposition from conservative quarters in parliament, as well as external lobbies. But PGD testing is the reason why certain IVF couples in Malta must take recourse to fertility treatment abroad: carrying out over-stimulation in Malta, before harvesting, fertilising, testing and implanting in a facility overseas.

As “challenged” by Chris Fearne, the Opposition would have to walk its talk by accepting that, just as it complained about IVF couples paying for their expensive medication before getting state-paid fertility treatment… then by the same reasoning, it should accept that no Maltese couple should be forced to go abroad for PGD testing, and therefore for IVF treatment.

But the challenge to government will be the forced prospect of creating more frozen embryos, as well as the discarding of unwanted embryos. Yes, MPs will be faced with the ethics of what to do with unwanted frozen embryos; (though even detractors of sound IVF science are aware that freezing unwanted embryos indefinitely, will ultimately lead to their death anyway.)

At this stage, the Labour administration must take a good hard look at its IVF law, and bring it up to the same legislative gold-plated standard it achieved with various civil rights. In short, it must guarantee that the same level of safety and security accorded to so many other citizens, is offered to prospective parents who want top-notch, science-based fertility treatment with PGD testing: without the conscientious hang-ups of MPs who jump through hoops to create ‘Malta-style’ laws, attempting to square the circle of science.

This is, ultimately, a medical issue; and it should be discussed in medical – not political – terms.