ICSI success rates have declined in Italy since new law
Dr. Kirsty Horsey
Progress Educational Trust27 June 2005
BioNews reporting from ESHRE conference, Copenhagen: A presentation given at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) shows what clinical effects restrictive Italian fertility laws, which came into force on 10 March 2004, have had on success rates - both in the laboratory and the clinic - of treatment by intracytoplasmic sperm injection (ICSI).
Italy's laws, said to be the most restrictive in Europe, were 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 well as 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, increasing the risk of multiple births. Preimplantation genetic diagnosis and prenatal screening for genetic disorders are banned.
Italian citizens were given the opportunity earlier this month to abrogate some of the parts of this law, in a referendum held on 12 and 13 June. They were asked to vote on four elements of the law, including language that gives embryos full legal recognition as persons, the three embryo limit, and rules governing embryo research and gamete donation. The Catholic Church encouraged abstention on moral grounds, while the 'yes' campaign has based its message on choice and safety, particularly for women. A 'yes' vote would have repealed the four provisions, but for the results of the referendum to be legitimated, a 50 per cent turnout was required - only 25.9 per cent of Italians voted, although the results showed that for all four questions, about 80 per cent of those who did vote wanted the law to be overturned.
Dr Laura Rienzi, from the Reproductive Medicine department of the European Hospital, Rome, reported results on the comparison of ICSI cycles in the four months directly after the new legislation came into force and the corresponding period of the previous year. The results of the study showed that the cumulative pregnancy rate (taking into account the use of both fresh and frozen embryos) was 38.7 per cent in the pre-law period compared to 30.2 per cent in the post-law period. This difference became even more obvious in younger patients with good ovarian response: 48.9 per cent compared to 26.6 per cent. Dr Rienzi said that the difference in success rates is probably down to the different qualities of the embryos being transferred - when embryos could be frozen, and more than three could be created in any one time, doctors were able to choose the best to implant. The new law's 'requirement to transfer all the embryos obtained, without any selection, has reduced the chances of obtaining a full term pregnancy', she said.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.