Last week a colleague called me to say that I was quoted as saying somewhere that we are not concerned about the impact that IVF babies have on the Special Child Care Unit (SCBU). I do not know where this was said but it is understandable that in a complicated field as this one may be misquoted. However it is an important area and I wish, more than to correct what I was quoted as having set, to state the reality of the situation.
When I said something to this effect it was said in the context of natural procreation methods. Recently we had the discussion on naprotechnology and this method uses, as many patients before being channelled to IVF, a method which stimulates the ovaries of the woman so that she may have a better chance of fertilization. This method of course is not for all but many couples manage to have children this way. The flaw with this method, although supported by Catholic Church and all, is that it poses a substantial risk of the woman getting pregnant with twins, triplets and even quadruplets. Those who remember the recent series of documentaries of that American couple who had eight children, twins and sextuplets, were the result of such therapy. Although sextuplets are rare, quadruplets and triplets are not.
These are indeed high risk pregnancies not only to the mother but also to the children and many of these children die in the uterus. Moreover it puts a strains on the SCBU, which is paid from our tax money.
The same holds for IVF when the lab used to put more than four fertilized eggs; however there was the impression that it is only IVF that produces these high-risk pregnancies and that it was only IVF that posed a burden on SCBU. Whilst I understand the plight of paediatricians working in this unit, which has a limited number of incubators, one cannot blame only IVF. In fact if we now, with the proposed legislation, limit the number of eggs which can be fertilized and inserted into the uterus, we should technically not have more than twins. Usually, with IVF it is only one baby. The SCBU see only those were there are multiple pregnancies. But some IVF technicians are saying that it is difficult to guarantee only fertilizing two, and without freezing they may end up with three and therefore have to insert all three into the uterus as they are doing up till now.
The point is however that many couples will not arrive to IVF and get pregnant with this ovary stimulation (a drug called clomiphene, or similar, is used). Therefore the threat to SCBU remains, and it is not the fault of IVF this time. SO if and when I was quoted as saying this, what was obviously implied, as I explained to my colleague, was not that IVF is not a problem with SCBU but that the problem will remain irrespective of whether we have IVF or not. MY colleague is very right indeed to be concerned with SCBU; we are still not looking at IVF holistically. All reproductive technologies, whether with clomiphene or those who go on to have IVF, pose s risk of multiple pregnancies. Besides, as we said the risk on both babies and mother, there is the added burden on the SCBU, with added burdens on our tax money and indeed with the risk that some baby who urgently needs an incubator does not find one available if we happen to have babies from two or more couples.
If we succeed in being able to fertilize only two eggs, then the risk of multiple pregnancies from IVF will be less than that of natural procreative methods which use ovary stimulation. This is indeed a paradox when, to avoid babies without sex we promote sex with more babies that ‘nature’ has intended women to have in one cycle. Although this was the reality with IVF as well in the past, IVF never claimed to be a ‘natural’ method. One may also make a controversial argument here - and for those who like to quote or misquote, I am not saying that we should – that given the high risk of multiple pregnancies, if on average the use of clomiphene proves to have more numbers in multiple pregnancies than IVF, then given the risk to babies, mothers, and SCBU, we should perhaps contemplate IVF as morally more viable than the natural method of ovary stimulation.
Two things: we still do not know whether this will be true; and naprotechnology does not use ovary stimulation only. It is one of the methods. Nevertheless all this is food for thought which I believe is not being addressed in the current bill; as issue which has given rise to litigation in the past.
Professor Pierre Mallia teaches Patients’ Rights, Bioethics and Family Medicine at the University of Malta. He is Chairman to the Health Ethics Committee and Ethics Advisor to the Medical Council of Malta. He is also former president of the Malta College of Family Doctors.