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Restrictive fertility law forces Italian patients abroad

11 December 2006
Appeared in BioNews 388

Thousands of Italians are being forced to travel abroad for assisted reproduction or PGD treatment, because of Italy's highly restrictive legislation. The results of a new survey carried out by the Reproductive Tourism Observatory show that the number of couples travelling to other countries for such procedures has increased four-fold since the law was passed three years ago. The ban on PGD - testing embryos to identify those free from serious genetic disorders- was challenged unsuccessfully in a court case held earlier this year.

Italy's new law, said to be the most restrictive in Europe, was passed in December 2003 to counter the country's reputation for being the 'Wild West' of fertility treatments. The law restricts the provision of fertility treatments to 'stable heterosexual couples' who live together and are of childbearing age, and who are shown to be clinically infertile. Research using human embryos is prohibited, as is embryo freezing, gamete donation, surrogacy, and the provision of any fertility treatments for single women or same-sex couples. The law also says that no more than three eggs can be fertilised at any one time, and that any eggs fertilised must all be transferred to the uterus simultaneously. Italians are also banned from using PGD for any purpose.

The new survey, which gathered data from 27 centres in nine European countries and the US, compared the number of Italian couples who used the centres before and after the law came into effect. It revealed that the number of Italians seeking treatment rose from 1066 in 2003 to 4173 in 2005, with Spain the most popular destination. Data from seven Spanish clinics showed that the number of Italian couples they treated had jumped from 60 to 1365 - representing between 10-50 per cent of their patients. Other popular countries for treatment were Belgium and Switzerland, particularly the Italian-speaking canton of Ticino.

The Reproductive Tourism Observatory was set up by Cecos, an association of private Italian fertility clinics. Its chairman, gynaecologist Andrea Borini, said that the law had also affected the outcomes of fertility treatment carried out in Italy: 'Compared with years before the new law, the number of cycles of treatment remained stable in 2005, as did success rates, except in women aged older than 40 years [in whom it fell], because of the limit of three fertilisable oocytes', he told the British Medical Journal (BMJ). 'On the other hand, among younger women we recorded an increase of multiple pregnancies, which have risen from 16 to 21 per cent of the total, while triplets have increased from 1.8 to 4.3 per cent, since the law insists that all fertilised embryos must be implanted in the womb', he added.

Last month, the Italian Constitutional Court turned down an appeal from a couple at high risk of having a child with thalassaemia, who wanted to use PGD to ensure they did not implant an embryo affected by the genetic blood disorder. Gynaecologist Giovanni Monni told the BMJ that the woman being treated was 'so shocked about the law' that she didn't agree to have the embryo implanted without knowing whether it was affected by thalassaemia. 'She had already had two abortions in the past, after positive results for thalassaemia from chorionic villus sampling', he said.

In court, the couple argued that the law put womens' health in danger, because without PGD they are often exposed to the mental stress of prenatal diagnosis and abortion. After losing their case, the couple now plan to travel abroad to restart their treatment. The law does not set a penalty for women who refuse to have their embryos implanted - under these circumstances, doctors are allowed to freeze embryos for potential use in the treatment of another infertile couple. 'Sadly, the ban of preimplantation testing is favouring procreative tourism among the wealthiest and abortions among the poorest couples', Dr Monni said.

Italian court upholds ban on pre-implantation diagnosis
BMJ |  4 November 2006
Italians are forced to go abroad for assisted reproduction
British Medical Journal |  9 December 2006
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