Welcome (back) to the jungle…

Perhaps it's a little early to start the GonziPN post-mortem. But if you ask me, the recent announcement of 'fine-tuning' to the IVF regulatory bill - and above all, the decision to increase the number of eggs that may be fertilized from two to three - places its finger squarely on everything that has ever been wrong with the present administration.

Those who have followed the issue since its conception will know that the so-called 'Protection of Embryo Bill' was originally touted as a means of addressing what Prime Minister Lawrence Gonzi once described as a 'jungle': i.e., the lack of any framework regulation to ensure that assisted reproduction therapy is carried out safely for all concerned.

From day one, however, there was small snag. The Catholic Church (which enjoys a certain influence on Gonzi, to put it mildly) frowns upon the entire practice - having branded IVF as 'sinful' because it seeks to supplant the conjugal act altogether.

The same Church is also deeply concerned with the life, dignity and ultimate fate of any human embryos artificially fertilized, ex utero, as part of the process.

But for almost 30 years, people have been free to make up their own minds on the issue: some availed of the service provided (without a regulatory framework) by St James Hospital; others presumably paid heed to the Church's warnings, and chose not to.

Exactly why it was suddenly deemed urgent to regulate this 'jungle' only now - after 30 years of unregulated service - is admittedly something of a mystery. But let's agree that regulation was in fact needed, and take the matter from there.

No sooner did Gonzi announce his intention to regulate IVF, than suddenly objections started multiplying exponentially in all directions. Church exponents such as Rev. Prof. Emmanuel Agius (who had never spoken out in public before) suddenly described the same therapy in terms almost akin to genocide. At one point he even told parliament that there were more frozen embryos than living people in the USA... only to later admit that he was somewhat slightly exaggerating. Meanwhile Gift of Life did its usual thing and hopped onto its soapbox... so that from one second to the next, the same medical practice we had all accepted without batting an eyelid for 30 years became a cause for national hysteria.

And that's before the proposed regulatory framework even saw the light of day. When government finally unveiled its proposals, it became obvious that the law was not at all concerned with the medical aspect of the issue at hand. It said nothing about patients, for instance: their health, their rights, their options, etc. Instead it had clearly been cooked up with the specific aim of reinventing the whole practice to make it more palatable to the Church (and more importantly, to assuage Lawrence Gonzi's all-important Catholic conscience).

The result was a law which banned embryo freezing altogether, while limiting maximum number of embryos to be fertilised to only two. And as an alternative to embryo freezing, the law proposed "oocyte vitrification"... a lesser known (and arguably much more expensive) process which freezes unfertilized eggs instead of human embryos.

Immediately a chorus of objections arose from professionals in the field. Dr Josie Muscat (director of St James) warned that the proposed law was too restrictive, and that local patients would be forced to seek treatment abroad as a result. Dr Jean Pierre Farrugia, whose recommendations as bio-ethics committee chairman had earlier been thrown out of the window altogether, echoed this warning... as did other gynaecologists and specialists.

I need hardly add that the Church's reaction was simply to stick to its guns, with a pastoral letter denouncing as 'immoral' the entire concept of assisted reproduction therapy, regardless of the new legislation which was supposed to address all the objectionable bits and bobs.

That was the situation until yesterday. Now, it seems government has finally conceded that the proposed law needed some revision to bring it in line with medical reality. So what did they do? Simple: they upped the number of legally fertilizable eggs from two to three... forgetting in the process all about their initial reservations about the 'jungle' they had originally set out to civilise.

This is strange, because the entire controversy regarding embryo freezing has all along revolved around the safety or otherwise of implanting more than one embryo. In the absence of embryo-freezing, establishing a limit of only two embryos to be fertilised will (according to professionals who already offer the service) make the success rate so low that the therapy would be impracticable.

At the same time, global medical consensus is that implanting more than two fertilised ova carries risks to the health of the mother... and for obvious reasons, the risk increases in direct proportion to the number of embryos implanted.

This is where embryo freezing comes into the equation. The idea was to be able to fertilize multiple embryos, but only implant a maximum of two at a time. Any extra fertilised ova would be cryo-preserved (to use the proper term), and only used at all if the original implanted embryos fail to survive... or if the same mother in future would want to go through the process again, without undergoing unnecessary ovary stimulation.

Now look at the newly amended law again. By allowing three eggs to be fertilized, all we have done is revert to the original dilemma of what to do with the fertilised eggs you don't implant. For though it seems to have escaped the government's notice this time round... a fertilised egg, by definition, is a human embryo.

Herein lies the rub. The same law they have revised to allow the fertilization of three eggs, also bans the freezing of any of those resulting human embryos. As a result, we are left with no choice whatsoever but to implant all three embryos - against all accepted notions of best medical practice. For let's face it: what else can you do, if you've pre-emptively closed the door to the only existing alternative?

Incredibly, then, with this new amendment we have performed the mother (literally) of all 360-degree turns... and are now right back to exactly where we were before this whole controversy began. Actually, worse: for patients will now be exposed to exactly the same risks as they were exposed to before... only without the same options at their disposal as to how these risks can be minimized.

And what is that, exactly, if not a return to the selfsame 'jungle' we were supposed to try and regulate? So welcome back to the jungle, folks. Take a break, have a banana, etc