IVF twist: Poland to fund unregulated IVF services

As Malta wrestles with a highly restrictive IVF law which effectively bans embryo freezing, Poland's centre-right Prime Minister Donald Tusk has circumvented conservatives in his parliament pushing for a ban on embryo freezing or an outright ban on IVF, by announcing State funding for IVF without imposing any restrictions on embryo freezing.

On 21 October, Polish Prime Minister Donald Tusk announced that funding for IVF will be made available without a change in law, as part of a Health Ministry three-year programme.

Tusk said the parliamentary conflict made it even more important for the government to take a stance.

"We have a kind of blockage in parliament, with diverging views, and this risks lasting a long time. The aim of the new programme is to guarantee the security of the patients and embryos, and enable an equal access for highly expensive procedures," he said.

Donald Tusk's decision to issue a funding scheme for IVF despite the absence of any law regulating the procedure has rocked the conservative establishment in one of Europe's most Catholic countries.

Under the Health Ministry's programme, IVF will be listed and standardised as an ordinary medical procedure, meaning that funds can be freed up for the treatment without passing a bill in parliament on the matter.

Tusk has promised 100 million zloty (€24.3 million) in State funding each year, channelled via the National Health Fund (IVF), and he has claimed that the treatment will reach some 15,000 couples over the next three years.

Advocates of State funding had argued that the current situation favoured the wealthy, but excluded thousands of prospective parents who could not afford to go private.

The IVF divide in Poland

Ultimately the IVF issue highlights the contrasts between two Prime Ministers of two profoundly Catholic countries and both members of the European People's Party, which have taken two different approaches to a divisive issue. While Gonzi has managed to impose a conservative line now backed by the Labour opposition which effectively bans embryo freezing-the mainstream procedure used to ensure higher rates of success without risking multiple pregnancies by having to increase the number of implanted cells, Tusk has used the IVF issue to boost his credentials as a liberal reformer.

As in Malta in the absence of any legislation, IVF is legal in Poland - but it has to be performed in a private clinic, and the practice is still unregulated and not available for free in public hospitals.

A further similarity to Malta is that discussion on IVF has been going on for years. Campaigning against the arch conservative Jaroslaw Kaczynski, Tusk pledged in his 2006 election campaign to ensure availability and universal access to IVF, which is provided by approximately 40 centres throughout Poland.

But while in Malta the conservative line seems to have prevailed with government - presenting a law which rules out embryo freezing - in Poland, ruling centre-right Civic Platform party is split, with the prime minister favouring a law which allows embryo freezing and his justice minister Jaoslaw Gowin favouring a ban on freezing.

Gowin is proposing a law which would limit IVF to married couples and outlaw the freezing of embryos, which makes the technique considerably more effective and cheaper.

Gowin's draft law is even more conservative than that being proposed in Malta, which would allow heterosexual cohabiting couples to resort to IVF and allows freezing in exceptional circumstances.

On his part, Tusk is supporting the more liberal law presented by Malgorzata Kidawa-Blonska.

Unlike the Maltese law, Malgorzata Kidawa-Blonska's draft law permits IVF and associated procedures, including embryo freezing.

But as in Malta and unlike the more conservative draft championed by Poland's justice minister, it does not limit IVF to married couples but would make it available for all those in a heterosexual relationship.

The problem for Tusk was that the law would not have passed if a sizeable chunk of its members voted with the opposition law and justice party, the main opposition party in Poland, which like Labour MP Adrian Vassallo but unlike the rest of the Maltese opposition oppose IVF on principle.

On its part, the conservative law and justice party has called for prison sentences for doctors carrying out IVF procedures. But the party has already hinted at its willingness to compromise with conservatives in Civic Platform to block the more liberal proposal.

What makes compromise difficult in civic platform are the diametrically divergent views on freezing embryos, which makes the two rival bills irreconcilable.

Thawing the freezing issue

While in Poland the row on freezing has split the ruling party, in Malta, a compromise based on the availability of a new technology has been reached.

Nationalist MP Jean Pierre Farrugia had chaired the IVF parliamentary committee which favoured embryo freezing. But now, the MP says that this issue has been superseded by scientific developments in oocyte vitrification, a process that involves the freezing of a woman's ova instead of embryos. Although promising, the new technology is more expensive and is still in the process of being developed. It was only two weeks ago that the American Society of Reproductive Medicine concluded that egg freezing - the only option which will be available to Maltese couples - is no longer an "experimental" procedure. But although the procedure has gained scientific acceptance it is still widely regarded as less successful than mainstream IVF technology involving the freezing of fertilised cells.

Italian IVF expert Luca Gianaroli contends that oocyte vitrification is an expensive procedure that will "reduce pregnancy rates by 30%".

"Since 50% of the patients that we are treating in Europe, and I suppose in Malta as well, are older than 35, half of your patients will not benefit from oocyte freezing."

But despite these concerns, the Labour Party which has criticised other aspects of the bill namely the power given to regulatory authority to decide who can be a suitable parent or not has accepted the ban on freezing except in exceptional cases as proposed in the law. Neither has it criticised the ban on IVF for single parents - a silence that was questioned by Alternattiva Demokratika, who also favour lifting the ban on freezing proposed in the law.