Paediatricians call on government to limit embryo transfer to two

Paediatricians are calling for a restrictive egg freezing protocol, in a resolution to MPs ahead of a parliamentary debate on the Embryo Protection Bill.

In an extraordinary general meeting of the Maltese Paediatric Association, which includes doctors who also work at Mater Dei hospital and will now be offering in vitro fertilisation services, the association said the government should limit the number of embryos transferred in any single IVF procedure to a maximum of two fertilised oocytes [embryos] in order to minimise the risk of medical complications in the woman and new-born infants.

The MPA pointed out that worldwide, multifoetal pregnancies were associated with increased neonatal deaths and brain damage in children. Referring to the previously unregulated IVF industry, which due to its practice of not freezing supernumerary embryos often led to the implantation of even three embryos, the MPA said this practice had resulted in an excessive number of multifoetal pregnancies and excessively high rate of neonatal deaths, "disabling impairment in children and human suffering."

The MPA made no mention of whether it supported the ban on embryo freezing, which has determined government's decision to go for the novel science of oocyte vitrification.

The government's proposed law outlaws embryo freezing, which means that all the eggs harvested from a mother will be frozen, save for the first two which will be fertilised and if they successfully develop into an embryo, transferred inside the womb.

The MPA had previously in 2005 urged the government to effectively regulate the practice of IVF and limit the number of embryos transferred in any single IVF procedure to a maximum of two - a position which implicitly demands the practice of embryo freezing.

The MPA said that multiple births are the single biggest risk to the health and welfare of children born following fertility treatment.

"The health risks for twins and triplets are greatly increased compared with those for singletons, mostly because multiples tend to be born prematurely and underweight. Premature and underweight babies account for half of all neonatal deaths. The risk of early and late miscarriage is also higher for twins than for singleton pregnancies," the MPA said in its resolution.

A recent study estimated that if all IVF babies born in the UK in 2003 had been singletons, the deaths of 126 babies could have been avoided. Singleton babies are usually carried for about 40 weeks and tend to have normal birth weights. But many twins and triplets are born prematurely, before the normal time for healthy singletons. Prematurity can cause many problems and may even result in the death of the baby.

The problems caused by prematurity can range from those that, although serious, affect only the early stages of the child's life, to those that have a devastating and lifelong impact.

In Malta, between 1990 and 2011, of the 176 premature triplets and quadruplets that were admitted to Special Car Baby Unit, 45 of them died. This represents a mortality of 25%.

In the UK, around half of all twins and 90% of triplets are born prematurely or with a low birth weight. The risk of a baby dying in the first week of life is five times higher for twins than for a single baby. For triplets, the risk is nine times higher.