We must question the efficacy – not just ‘ideology’ – of IVF treatment

In a nutshell, it is time to finally put this essential service – which taxpayers proudly finance out of communitarian solidarity – to a general review, so that we can improve what matters most: its success rate for the prospective parents who need it

On Sunday, this newspaper revealed that Mater Dei Hospital’s current IVF licensee – the pharmaceutical company Cherubino – will have its sojourn at the national hospital curtailed, after spending the last two years “running” the unit without an official government contract.  

Cherubino won a tender in 2014 for the capital spend into MDH’s assisted reproduction unit; and over the past eight years, the company has also been paid by the State for each step of the IVF programme – the service, the freezing of embryos, the transfer of embryos, the freezing of eggs (as licensee it pays a portion of that expense to the regulator, the Embryo Protection Authority); but it is the State that pays for the human resources and medical personnel at the unit.  

What is worrying, however, are the MDH’s success rates for pregnancies: which fall well below the standard identified globally (and in Europe by ESHRE, the European Society for Human Reproduction). 

In fact, an analysis of annual embryology data, and the fees charged to the health department by the Cherubino PPP, suggests that our national IVF programme has struggled to achieve positive results for the last two years: despite an annual €1.5 million financing by the government.

Additionally, the high “risk” rate of ovarian hyperstimulation (OHSS), declared in the 2020 annual report to the EPA, continues to be alarming. Women are either being incorrectly over-stimulated (IVF requires the creation of excess, or supernumerary oocytes – eggs – which are then harvested from the woman, fertilised with sperm to become embryos, and later transferred back); or else, there is excess freezing of embryos.  

Either way, Malta’s state-funded IVF service must be audited by the National Audit Office. Because with a prospective €2.5 million spend for 2022, as the hospital prepares to change its public-private partnership set-up, the taxpayer should be ascertained that: 

(1) the IVF unit is properly staffed and equipped to deliver a substantial amount of cycles for women seeking fertility treatment; 

(2) that state-of-the-art equipment is being invested in, so as to guarantee proper outcomes for parents; 

(3) that the 50% risk rate of OHSS is properly investigated; and that this is not linked to any financial gain derived from the excessive freezing of embryos.  

Meanwhile, the data presented suggests that the large degree of unsuccessful pregnancies cannot be simply put down to some exceptional quality of infertility in Maltese people. That same canard has often been employed by authorities when asked (for instance) to explain Malta’s high degree of Caesarian sections: again, well above international standards. 

The answer to that, somewhat anecdotally, was that private hospital obstetricians were keen on scheduling births on days that caused them the least inconvenience; hence induced C-sections, that allowed them to control the arrival of newborns.  

Elsewhere, the data itself also requires improved presentation: if the EPA insists that this 50% “risk” rate does not actually indicate “incidence”, it must explain what kind of risk was identified; and it must also explain at what stage in the embryo’s five-day development, the freezing took place (good quality blastocysts can appear on Day 5; so a freeze-all on Day 3 might alter outcomes.)  

Far from assuming any sort of scientific authority on the subject, this newspaper feels that politicians should be vocal about the quality of treatment at Mater Dei Hospital. But in terms of their contribution to the assisted reproduction debate: both sides of the House have constantly quibbled about simplistic ideological points instead. 

The PN, for instance, protested that - despite being entirely paid by the State -some couples had to put up the cash for IVF medication themselves. Meanwhile, the PL’s justified push to introduce pre-implantation genetic diagnosis (a battle the PN should not endeavour to oppose, for faith-based reasons...) is being used to paint the PN into its usual ‘exceptionalist corner’.  

None of this, however, seems to have anything to do with the practicalities of the issue at ground-level. Clearly, the time has come to look at IVF in terms of the raw data. And from this perspective, the questions we should be asking ourselves include: are the national health service’s success rates positive? And if not, why?

Moreover, is the high-risk rate of OHSS worthy of investigation by the Public Health Superintendence and the EPA? Should the National Audit Office undertake a proper review of practices employed at the Mater Dei unit and by the PPP licensee? 

In a nutshell, it is time to finally put this essential service – which taxpayers proudly finance out of communitarian solidarity – to a general review, so that we can improve what matters most: its success rate for the prospective parents who need it.