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Problems arising from new Italian fertility law

4 June 2004
By BioNews
Appeared in BioNews 261

An infertile Italian couple has been told by a court that they must transplant all embryos they created during IVF treatment, even though it is known that they both carry the gene for thalassaemia, a recessive genetic condition, and that some of their embryos may be affected. The decision of the court followed the letter of the controversial new fertility legislation passed last year, said to be the most restrictive in Europe.

The couple, from Lecce in South-east Italy, wanted to be able to use PGD (pre-implantation genetic diagnosis) to find out if any of their embryos would have thalassaemia, and then only implant embryos free from the condition. They had been unsuccessful in previous attempts at IVF with PGD, carried out before the new Italian fertility law came into force in February. The new law stipulates that all embryos that are created - to a maximum of three - must be transferred to the womb. It prohibits the freezing and storage of embryos and would not permit embryos found to be affected by a genetic condition to be destroyed. Nino Guglielmino, the doctor treating the couple, said 'when the law came into effect, I told them I would be obliged to transfer all embryos'.

The couple, said Dr Guglielmino, 'couldn't stand the idea of starting a pregnancy with a thalassaemic embryo, which she would abort, so we agreed to appeal this part of the law in a court'. The judge hearing the case, however, ordered that all the embryos had to be transferred, despite the fact the couple said they would abort a thalassaemic child. He told the woman that, according to the provisions of the new law, she did not have the right to choose a healthy baby. The new law did not affect the law on abortion, which is allowed in Italy during the first six months of pregnancy if a serious illness is detected in the foetus. The woman, who is 35, gave a radio interview to talk about the court's decision and the effects it had on her. 'Less than one month after the court's decision and the embryo transfer, I was hospitalised for a gastric haemorrhage, likely to have been caused by stress, and the pregnancy ended', she said, adding that tests showed that the embryo that implanted was, by luck, a healthy one.

Girolamo Sirchia, the Italian Health Minister, said that guidelines on how to apply the new law were in the process of being drawn up, in order to prevent further cases such as this. But, he said, other effects of the law are also beginning to emerge, including an increase in 'reproductive tourism', where couples travel outside of Italy to seek fertility treatments in more permissive countries, to minimise the risk of having children with genetic conditions. Ironically, the new law was drafted as a response to concerns that Italy had come to be seen as the 'Wild West of assisted reproduction' because, in the past, people have been able to travel to the country for many controversial treatments not available in their own countries.  In addition, Sirchia said, the initial impact of the new law seems to confirm the worst case scenarios that opponents of the law anticipated. Critics of the legislation, including many liberal and female members of the Italian parliament, said during its passage that it was too restrictive, particularly in comparison with other European countries, and that it would place women's health at risk. Now, fertility centres have reported a decrease in IVF success rates for women older than 35, and a sharp increase in multiple pregnancies in those younger than 35, who are often implanted with three embryos.

SOURCES & REFERENCES
Italians fight fertility law in hospitals and courts
Reuters |  4 June 2004
New law forces Italian couple with genetic disease to implant all their IVF embryos
British Medical Journal |  4 June 2004
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