It is indeed sad that Italian Luca Gianaroli (August 27) has put in his two pence worth again in the IVF issue as his performance before of the ad hoc Parliamentary Committee on IVF left much to be desired ethically.
At that committee, he never mentioned the possibility of egg freezing as a viable alternative and was highly in favour of regular embryo freezing with the resultant disposal of the unused embryos given over for research purposes or adoption. In a newspaper interview he even advocated the eugenic selection of embryos in a process called pre-implantation genetic diagnosis, by which embryos with the best genetic and physical characteristics are chosen and the rest discarded.
It is quite obvious that he does not think early human life worthy of any ethical respect. I remember Eleonora Porcu adding very attentively at one of her lectures that in centres where the eggs are not carefully selected the results of egg freezing techniques are poor compared with those where embryo freezing takes place. However, in centres such as hers at Bologna, where the eggs were carefully selected for their quality, the success rate of IVF was as successful with frozen eggs as with frozen embryos. Not only that, but the success rate with frozen eggs even equalled that of fresh human eggs!
The Italian Register of Assisted Reproduction shows that the results achieved by oocyte freezing appear comparable to that with embryo crypreservation (17.1 per cent vs 18.7 per cent). The pregnancy rate per transfer in oocyte vitrification cycles varies between 32 per cent (Ubaldi 2010) and 65 per cent (Cobo 2008, Noyes 2010).
Oktay et al (2006) performed a meta-analysis showing 51 per cent pregnancy rate per transfer in cycles of oocyte vitrification while pregnancy rate per transfer in embryo cryopreservation was 36.9 per cent in the USA and 21.6 per cent in Europe (Mouzon 2012). The most important parameter is the cumulative pregnancy rate, which is 50 per cent with embryo freezing and 47.4 per cent in oocyte freezing (Borini 2008). So the results, especially in Italy, speak for themselves!
In his definition of “good clinical practice”, Dr Gianaroli obviously does not regard the safeguarding of the life of human beings in developing embryonic form as having any merit in the IVF medical equation! Where exactly does primum non nocere enter into the spheres of “good clinical practice” here?
It is also unprofessional the way that he is trying to discredit a professional colleague of his, Dr Porcu, who, in line with new trends, is offering IVF using only frozen eggs, with the result that no human life is discarded in the process.
That IVF using human egg freezing is possible and produces equitable results however, is not only attested to Dr Porcu but also to other renowned doctors such as Ana Cobo who presented the evidence at one of the meetings by the European Society of Human Reproduction and Embryology, of which he was formerly president, and Nicole Noyes of the New York University. There are, of course, others.
If these people are having success with now about 1,000 children born using egg freezing worldwide, why cannot we?
The regular freezing of embryos in IVF is not ethically acceptable because it presents a grave danger to the lives of the human embryos themselves and turns them into a commercial commodity.
Nobody today ever suggests that egg freezing should be systematically carried out for those women who want to postpone having children until later in life unless there are strong contingent strictly medical reasons for doing so, as any accident with the freezing processes, which are not unheard of, would destroy all the stored eggs forever.
Since Dr Gianaroli cautions that IVF within the present legal restrictions imposed by the proposed law (Am I assuming textually that he is referring to IVF done without the regular freezing of embryos?) would put Maltese patients at a disadvantage and thinks it would be a wasting of taxpayer’s money to do so, could he be so kind as to illuminate us how he would rate the very successful abilities of the two Maltese doctors, Josie Muscat and Mark Brincat, who, to their credit, have been privately spearheading IVF in Malta for the past 20 years or so without any freezing of embryos?
Have I also often heard that many patients choose to finish the rest of their IVF commenced pregnancy at state hospitals? I most definitely would not think that they were in any such way taking any advantage of their patients or wasting taxpayer’s money just because they were appropriately not freezing embryos!
I sincerely think that the new Embryo Protection Bill is a step in the right direction in that it seeks to preserve human life in a manner respecting the absolute right of all innocent human life. It also preserves the bonds of Maltese families in the process. Notwithstanding some necessary tweaking, it is most definitely a step in the right direction by the Government.
The author is chairman of the Bioethics Committee.