I write this letter in the early hours of the summer solstice, the longest day of the year when the Sun throws its light equally on both the northern and southern hemispheres, one of only two days of the year when this happens. But the spheres I have in mind today are not of the celestial kind, but rather the ones that constitute the female gamete or ova. Much hype is being printed and verbally disseminated on the IVF issue. I am writing this letter as chairman of the Bioethics Consultative Committee which has discussed this issue for at least the last eight years. I have taken a professional interest in this subject for the last 15 years. I spent the last five years of my tenure in parliament trying to raise public awareness on these issues (bioethics − for which I was jokingly dubbed ‘embryo man’ by my colleagues, better than Batman I suppose). There are issues here that need an approach that is both scientific and ethical. There are so many that I would prefer to put them in point form.

It is essential that whereas actors in the field are actually heard, one should keep in mind that there really may exist a conflict of interest and the position of the regulator remains one of seeking solely the common good, which includes preserving the life of the mother and that of the embryo. The right to life of the innocent is an absolute right and it has to be borne in mind that in Maltese culture, and in scientific human embryology, a human life begins at fertilisation or conception. I am stating this, because from what I’ve heard till now, not everyone seems to attest to this fact in principle if not in practice.

When the parliamentary ad hoc committee finalised its work last year, it published a report which showed that the majority of professionals interviewed about the freezing of extranumerary embryos were actually against this freezing process. How the final report end up supporting embryo freezing beats me. Unfortunately, the foreign gynaecologist brought over as an adviser, Dr Luca Gianaroli, is quoted in the report as saying that the ‘left over’ frozen embryos should be disposed of in ways that do not uphold the dignity of human beings. Many countries use these frozen embryos, thousands of them for research, experimentation for cosmetics or vaccines, sources of stem cells, while others just let them die then pour them down the sink. The real problem is that there are thousands of these everywhere IVF with embryo freezing is practised as a routine procedure. The freezing process of embryos itself involves a 30 to 40 per cent risk of causing serious damage or death to the embryos themselves. Some ethicists object to the routine freezing of embryos as evil in itself. They ask whether one would freeze one’s grandmother if she had a particular physical problem especially if there was a 35 per cent chance of dying while defrosting.

In a recent sitting of the Parliamentary Social Affairs Committee, Professor Mark Brincat states, and I quote, that in order for the woman to have the best possible chance to become pregnant, given the state of today’s medical practices and scenario, one has to try to fertilise at least four ova, hope for three embryos and transfer two into the uterus, as it is dangerous to transfer three. The danger here refers to multiple pregnancies such as triplets, which increase perinatal morbidity. Obviously, this implies that the other one or possibly two left over embryos need to be frozen as a routine procedure! Can somebody please tell me how many embryos have been transferred per cycle over the last 20 years and even today, since embryo freezing was and is not yet an option?

A recent state of the art scientific breakthrough of the last two years has offered the selection and freezing of ova (eggs) as an equitable option to embryo freezing. The success rate for transferring two fertilised selected ova is equitable for both fresh and frozen ova as the one for both fresh and frozen embryos. The Bioethics Committee held a conference on this subject last month, which was addressed by an expert, Dr Eleonora Porcu, a gynaecologist from Bologna University, who showed that the success rates using this new system were equitable to embryo freezing if the proper eggs are selected. A copy of this lecture was laid on the table of the Parliamentary Social Affairs Committee of the House, so it is available to anyone interested to check the facts. Incidentally, 50 odd people, to their credit, turned up for the conference at the university, only one of which was a gynaecologist who was a member of the Bioethics Committee itself. None of the ad hoc parliamentary committee members turned up, nor those from the Social Affairs Committee, except for the chairman, the Hon. Edwin Vassallo. It seems that interest to learn new things is not so extant!

Some are arguing that both embryo freezing and the freezing of ova should co-exist side by side. I cannot understand however why one ought to opt for a system that squanders human life needlessly when there is one that can protect human life effectively. Is it a case that some are unwilling to abandon medical practices they are used to and are unwilling to take up new challenges that are ethically superior? Dr Josie Muscat, himself a practitioner in the field, has declared in the Social Affairs Committee that ova freezing means that embryo freezing per se need no longer continue and that it can revolutionize IVF.

In very rare circumstances where the mother is too ill to receive her fertilised ova, it might be necessary as a contingency, to freeze these embryos temporarily until the mother is well again. There is no disagreement on this. However, this will only be done in the case of an unforeseen emergency, which is very rare. Purposely fertilising four embryos in order to transfer two is not an emergency, by any stretch of the imagination or philosophical definition, as it is foreseen and created by the practitioner. It is simply a routine procedure that can be avoided with the availability of an embryologist round the clock if the freezing of ova is practised. Currently, the embryologist comes over to Malta only once every three months to fertilise the ova in vitro, as the patients are ‘batched’. Could this be the reason that some are still seeking to maintain embryo freezing on the statute books?

It is wise for political parties and individuals to tread carefully here. The issues involved are not analogous to the ones on divorce, or individual liberty but deal with the fundamental dignity of the human being albeit at the embryonic stage. The issues involve the restriction of fundamental rights which pertain to human life and which the State has a duty to protect irrespective of the wishes of the parents or the medical choices of the medical practitioners involved, or of any politician. If the life of a human innocent individual is made subject to the relative choices of others, then we will precipitate into a rights chasm that has no bottom and which negates the a priori natural rights of the human individual. Positive law based on the negation of natural law is a travesty of law. According to the Maltese Constitution, the State has the obligation to protect innocent human life. Medical practices that have developed in other cultures that do not respect the right of human life from conception should not be superimposed willy-nilly on Maltese culture. Besides, there is an old medical axiom which states that ‘one should not be the first to use the new nor the last to leave the old practices’. The new is already with us! Often it is not the law which is restrictive but some of our mentalities.

Michael Asciak MD

BIRKIRKARA