I make it no secret that I am part of the professional group which has pronounced itself against the freezing of embryos. This group, among others, has proposed a possible way forward in the form of freezing of ova. However we are at a delicate stage of the game and one has to sit back and evaluate the situation.

We risk slipping from the sublime to the ridiculous if we simply think that we have solved the problem in this way. Let us summarise a few facts:

The moral weight of freezing embryos was on grounds that there is no guarantee that they will not remain frozen indefinitely – it was not about freezing per se, which was accepted already in certain circumstances, such as when the potential mother falls ill during the process. Moreover it is an accepted fact that many countries remain with thousands of frozen embryos because the fertilisation of eggs up till a point in time was unlimited; that changed. Moreover they had no moral questions about frozen embryos. Numbers of embryos remaining frozen started to fall even in these secular countries once the problem was given value.

Secondly when one pronounces oneself against freezing, one is not taking an absolute position against the ‘freezer’. It is the good of the embryo which counts at the end of the day. One solution was to fertilise only a small number of eggs; but this would have required the woman to undergo the hyper-stimulation and extraction process more than once.

Position papers of freezing ova, as presented by the group to the parliamentary committee, suggested freezing of ova as an alternative to some women who are ill or undergoing radiation. But it is also feasible for those who have a moral objection. When the country seems to have a moral objection, then it is a whole different ball-game. One has to ask whether we are being realistic. Let us consider some other facts.

How many ova are you going to thaw and fertilise at one go? How many are you going to take in the first place when you know they will not all be fertilised? Is the ovum without moral significance? And will this not be imposing again high-risk pregnancies with the possibility of multiple births? Was not our discussion also about the Child Intensive Care Unit being overloaded? Surely we cannot feel at ease simply because we think we have bypassed embryo freezing, while at the same time increasing the burdens.

On the other hand, if you fertilise only one or two, then you are faced with a situation where, to treat one couple, a technician must repeat the procedure a number of times. When one multiplies this by the amount of people who will now seek a solution (those who before could not afford), we will have an analogous situation that we have with hospital beds – we thought we had enough; but we did not take into consideration the increased work load which a new hospital was to bring about. When every infertile couple will make legitimate use of the service, and we now propose a service which besides being more expensive will create more congestion, what are we really solving? Will couples have to wait their turn?

I think responsible freezing should remain an option to parliament. Freezing a small amount of fertilised eggs and holding couples responsible is feasible. People should be held responsible to pay for keeping embryos frozen; should they default after a stipulated time, the government can take custody. This imposes a responsibility and one will guarantee no left over frozen embryos.

We have not considered freezing a fertilised egg at the stage when the two pro-nuclei have not yet met; thus not as yet having an embryo, but which still carries a moral burden of allowing it to develop as the process of fertilisation has started.

But one may ask, why? If it is only a matter of cost and time, perhaps the morality of freezing an egg should trump over freezing an embryo. What we are overlooking is the fact that just as an embryo is not a commodity, neither is an ovum – which after all is a gamete, the donation of which, for example, the Church prohibits (and rightly so). Granted that allowing an embryo to be frozen indefinitely does not carry the same moral weight as allowing an egg to remain frozen indefinitely, one cannot brush aside the moral significance, especially when this is to be used on the masses. Quantitatively you will end up with a greater moral problem than if you had responsible embryo freezing which guarantees the life of that embryo. There may be less moral weight when one considers donating an embryo in order to save its life, than donating eggs simply because there are many left over. One is done for the embryo, the other is done for the mother.

It is as if we are saying, so what if we have 50,000 frozen ova, say, after 10 years? So what if men have to manually give samples of their sperm 10 times instead of once? So what if the chances of an ovum being fertilised is less after freezing, due to thawing and the necessity of ICSI?

ICSI and cryopreservation of ova are developments on IVF and were never intended to replace a whole process. While it is an option, one cannot in truth believe it is the solution. We have known about it all along; we are simply turning a blind eye to the problems. Using this system on a mass scale has never been proved to work. It has moral implications which can be far worse than freezing embryos for a stipulated time only. Women are born with a stipulated number. Who owns these ova? Can a woman who delivered successfully with IVF use her ova whenever she wants to in the future – even 10 years later? Are we obliged to keep them indefinitely? Who owns them?

Pierre Mallia is Associate Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta; he is also Ethics Advisor to the Medical Council of Malta. He is also former president of the Malta College of Family Doctors