Clinical concerns with the new Finnish fertility law

Merja Tuomi-Nikula, specialist in Obstetrics and Gynaecology

Felicitas Clinic, Helsinki, Finland.

Progress Educational Trust

08 March 2006

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[BioNews, London]

It has taken almost two decades to establish a legal basis for fertility treatment in Finland. Two years ago, most of the Parliamentary Legal Affairs Committee wanted to limit treatments to heterosexual couples. However, there was no agreement on the rights of egg and sperm donors to choose anonymity. So the government withdrew the proposal, and it went back to the Ministry of Justice for review. Now, a new version of the Fertility Law is before the Legal Affairs Committee of the Parliament.

The key features of the proposed new legislation are:

1) Fertility treatment will be provided for single women and to lesbian couples, as well as to heterosexual couples.

2) There will be no age limit for treating women or men. The law says that it will be down to a patient's doctor to evaluate the medical risks or benefits of the possible treatment and/or the pregnancy for the woman, before starting treatment.

3) All egg and sperm donors will be identifiable and registered. At the age of 18, a donor-conceived child will be able to apply to the registry for information concerning their donor's identity.

6) Any embryos already created using anonymous egg or sperm donations, currently in frozen storage, will have to be used or destroyed within six months of Parliament enacting the new law.

5) Surrogacy will not be allowed.

6) Only fertility clinics authorised by the Ministry of Health will be allowed to perform fertility treatments.

FERTILITY TREATMENTS IN FINLAND: CURRENT PRACTICE

To date, fertility treatments in Finland have been carried out to a high ethical and medical standard, despite the absence of legislation. We are one of the leading countries for single embryo transfer in IVF treatment, and we have successfully minimised the rate of multiple pregnancies. We transfer one, or at most two embryos, and still obtain high pregnancy rates. The accepted highest age for treating women is about 45 years in all private clinics, and up to 40 years in publicly-funded clinics.

Up until now, egg and sperm donors have been able to choose between anonymous or known donation, with most opting to remain anonymous. In our clinic, Felicitas, only healthy women under 35 can donate eggs, and all recipient couples must see a consultant before starting the treatment. The waiting time for fertility treatment with donated eggs is approximately one year, and there is constant need for more egg donors. Last year there were approximately 800 treatment cycles using donated eggs in Finland, with the numbers rising every year.

The practice of surrogacy in Finland is currently only permitted using the commissioning mother's own egg [full surrogacy]. A few single women and lesbian couples have used surrogacy, treatment that is always provided with help of a consultant.

CONCERNS WITH THE PROPOSED NEW LAW

Clinicians have raised concerns about some aspects of the new Finnish law. First, with respect to the proposed surrogacy ban, we think it is unfair that women without a uterus will be denied access to infertility treatment. If the woman's ovaries are functioning, we do not see why she should be penalised, as this is a medical condition. This also seems inconsistent with the proposal to treat single women and lesbian couples.

Secondly, we are afraid that if only known egg or sperm donors are permitted, we might lose many donors, making such treatments even more difficult to carry out. It will mean that many couples will travel abroad, and we feel that so-called 'fertility tourism' is not the proper way of helping couples who need treatment with donated gametes. In the original law proposed two years ago, this problem was elegantly solved, in my opinion. Donors could have chosen to be known or not, and in the case of anonymity, the donor would have given a description of themselves to be given to the child after the donor's death (should the parents have informed the child about the circumstances of their conception). This could be a useful compromise for the present law proposal as well, and a solution for this very difficult problem.

Thirdly, we are concerned about the fate of existing frozen embryos belonging to couples who have been treated using anonymously donated gametes. There are currently many ongoing donor assisted treatments and pregnancies in various clinics, and hundreds of embryos stored in Finland. Those embryos belong to the treated couples and I believe nobody else should have the right to decide what to do with them. Many of the couples want to have genetic siblings for their children, a possibility that will be destroyed by the new law.

However, as a clinician working at the biggest private fertility clinic in Finland, I also feel there are positive aspects to the proposed new law - for example, the fact that all clinics will have to meet certain standards set by the authorities. This will help us, as well as the patients. The final decision on the law will be made by Parliament this spring, after MPs have heard from infertility specialists. About half of all MPs are still against the new law, mainly because it advocates the treatment of single women and lesbian couples. It seems likely that this issue will trigger a lively discussion in Parliament, as well as amongst Finnish citizens.