Mater Dei’s multi-million IVF unit waiting for Gonzi’s conscience to clear up

Gonzi and Health Minister Joe Cassar are pronouncing themselves in favour of a more expensive technology to freeze eggs – partly because Mater Dei already has what was once a state-of-the-art IVF unit installed by Skanska back in 2004, equipped with two Planer freezers and nitrogen tanks that can freeze both eggs and human embryos. The unit was never set up.

The scene appears to be set for policymakers to turn down embryo freezing: since a select committee chaired by Nationalist MP and doctor Jean-Pierre Farrugia advised government to go for the freezing of embryos, Lawrence Gonzi – who set up the committee in 2009 – kicked the ball in the court of Nationalist MP Edwin Vassallo. Vassallo used his social affairs committee to reopen the debate on embryo freezing in 2011 “on suggestion” of a newly formed lobby called Professionals Against Embryo Freezing, composed of Faculty of Theology students studying bioethics led by dentist Miriam Sciberras.

Together with anti-abortionists Gift of Life, PAEM are vehemently opposing the Farrugia committee’s proposalsto freeze embryos that would allow women to go through less cycles of stimulation and encourage sterile couples to adopt frozen embryos. Even the Maltese bishops have sounded a pastoral warning to MPs on embryo freezing.

But while Gonzi is clutching onto the debatable science of egg freezing to bypass the science of embryo freezing, even if the spectre of religious conscience is at work here – the Catholic Church is already against all forms of IVF – egg freezing included.

The Catholic Church’s Dignitas Personae maps out the position against IVF because it substitutes the personal act of procreation between husband and wife. The Church says there is “no morally licit solution regarding the human destiny of the thousands and thousands of ‘frozen’ embryos which are and remain the subjects of essential rights and should therefore be protected by law as human persons”.

But it goes further: because even the freezing of oocytes, or eggs, so that it can be fertilised with the sperm and implanted as and when necessary, is “morally unacceptable” in Dignitas Personae.

The costs of egg freezing also pile up upon those incurred in a normal IVF procedure: there is first the cost of egg retrieval, the annual storage costs, and of course the fertilisation and implantation – done once over for each egg.

Why freeze?

On Saturday, Jean-Pierre Farrugia declared in The Times that hopes that egg freezing would exclude the possibility of creating more than the exact embryos to be implanted in a woman’s body was “fiction”.

In comments to MaltaToday, Prof Mark Brincat – chairman of the Gynaecology and Obstetrics Department at Mater Dei Hostpial – said that even if four frozen eggs are thawed to be fertilised with the aim of getting two embryos, it is possible that doctors end up with three embryos instead.

“What should we do the third one? If we don’t discard it, it has to be forcefully implanted in the woman, which we don’t want... so even supporters of egg freezing rely on the safety net of human freezing if they don’t want to discard embryos. Egg freezing does not obviate from the need to freeze embryos, even from a conservative viewpoint.”

Brincat added that the laboratory work involved in freezing eggs, thawing them and fertilizing them was riskier and more expensive. “If you freeze an embryo there is less laboratory work because it is already fertilized.”

The reason freezing of embryos is necessary is because an excess amount of eggs must be extracted from a woman to be then fertilized by human sperm. The resulting zygote (a cell that is produced when sperm fuses with the egg) begins to sub-divide over the next 2-4 days until it becomes an embryo that can be implanted into the woman.

But not all of the embryos survive this natural process, leaving less good-quality embryos that can be implanted.

And it is not granted that implanting one or two embryos leads to pregnancy: implanting more than two can be risky for the mother, and IVF is a very expensive procedure that is financially and emotionally taxing on infertile couples.

So freezing the ‘excess’ embryos offers them a chance at success: both in terms of second chances if the first attempt at pregnancy fails; or even the opportunity at having another child in the near future without undergoing the burdensome procedures of hyper-stimulation.

The ethical problem is what to do with unwanted frozen embryos if parents don’t thaw the remaining embryos for another pregnancy. The options are to freeze them indefinitely – which eventually means they will die due to the long exposure to low temperatures; discard them or use the ‘live’ embryos for research that can be of immense benefit to humankind.

Even detractors of sound IVF science are aware that freezing unwanted embryos indefinitely leads to their death: because long-term freezing undermines the chances of an embryo to become a foetus.

While Gonzi contemplates a new ethical problem for MPs to deal with, the human realities of infertile couples and those with inheritable diseases who need PGD testing (pre-implantation genetic diagnosis) on embryos, have been the last to be heard out in the parliamentary committees.