The news that five sets of triplets have found themselves in the special care neonatology unit of Mater Dei in the space of one month left me aghast and surprised! I have looked at the number of triplets recorded at hospital since the year 2000 when there was one set. In 2001 there was also one set, two in 2002, three in 2003, four in 2004, three in 2006, one in 2007, four in 2008 and three in 2009 (National Obstetric Information System – NOIS). This means an average of 2.5 triplets per year in the last 10 years. Not to mention the quadruplets in 2004 (two sets) and in 2007 (one set). How do we now end up with five sets in one month? The results previously mentioned include triplets from artificial insemination, hyperstimulation and IVF procedures and not just from IVF alone, as is alleged to be the case in this instance. The questions to be asked are various. How come these fertilizations and transfers are occurring in batches that overload the special care units and are not staggered throughout the year? How many embryos are being inserted by the operators to achieve these results? More than three embryos transferred are surely circumspect. Are the parents being counselled about the outcomes and circumstances of the medical procedures? Who is the medical practitioner responsible for the procedures? Not that these are illegal but there are certain ethical issues involved here which need to be ironed out and people need to talk about these issues as many staff and equipment in the special care neonatal unit are being strained to capacity and human beings are being expended! I hope at least that everybody is worried about the human beings!
The ad hoc committee of the House on human fertilization procedures immediately came forth and used this case as proof to drive the point home that freezing of embryos is an unavoidable evil if we want a humane IVF process. What a downturn! The freezing of embryos issue is itself fraught with hazards to human life. I would like to ask the committee a question here. Do they believe that human life at the embryonic stage, with an ontological potency to develop, merits the same respect that a newborn child or adult does? I strongly suspect that the answer might not be a straightforward yes. Why would they suggest the necessary expendability of so many human lives to save some others, which are probably contingently fewer in number and mostly deal with morbidity rather than mortality? They would probably quote the much maligned lesser evil here. But where is this lesser evil when so many human lives are being wasted? Besides the principle of lesser evil or perplexity as it is called, only holds water when the evils are being created by others independent of oneself, not by the one carrying out the procedure. That would be the principle of utility! Not a very Christian or even humane approach for that matter.
Could it be that the ad hoc committee was misled into rushing to believe that embryo freezing was the golden solution to the paradigms of IVF procedures? Did they really examine what other ways could be used to lessen the impact on human life without the freezing option? Did they bother to see what other countries that do not allow embryo freezing actually do? Did they bother to look into other ethical avenues such as the recent breakthroughs these last couple of years in the scientific techniques of the freezing of ova called vitrification? I have many scientific papers that attest to the efficiency of these new techniques. Just to mention one by a certain Dr Ana Cobo PhD, put forward in the recent 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome, where she showed that “the on-going pregnancy rate in women who had received vitrified oocytes (ova) was 43.7 per cent as opposed to 41.7 per cent in the fresh oocyte group”. A very good percentage! And even if the efficiency here were not to be so high but lower than that of the freezing of embryos, as I may imagine some others might suggest, it would still be an interesting and viable preposition. Do they know that in the UK alone there are nine clinics authorized by the Human Fertilisation and Embryology Authority (HFEA) to carry out egg freezing? One sees here that one is not selling tomatoes at the market, with the buy a dozen and get one free option. The issue of scientific efficiency is secondary to the issue of humanity. Not all things that can be done, ought to be done. The main aim of the ad hoc committee should be along the lines that IVF is controlled in as ethical manner as possible in order to reduce as much as possible the dangers to human life and dignity, while trying to help couples to have children. We should not produce human life in the laboratory and then proceed to destroy it expediently. There is no justice or humanity in that!
If the ad hoc committee is ready to meet and re-examine these issues anew, taking into consideration the new scientific and ethical angles that they may not have previously considered, that is a positive sign and should be encouraged. An opportunity not to be missed I would say for those who believe in an objective truth!
Michael Asciak MD
BIRKIRKARA