Three Monkeys Online

A Curious, Alternative Magazine

Trust the Stork. Reflections on the law to regulate Assisted Reproduction in Italy.

Among the points to underline, because it's fundamental both from a scientific and moral view point, is the ovarian hyperstimulation syndrome (OHSS), characterised by the formation in the ovaries of large cists that can, in the most severe cases, cause serious thromboembolic complications; on the other hand, the hormonal stimulation of the production of follicles is per se an extremely delicate process: if the aim of the stimulation is the normal rapport or the artificial insemination, one obviously wants to get one well formed follicle, that can release a fertilisable egg. The risk otherwise is that of a multiple pregnancy, with all the complications that this can imply for the pregnancy and the health of both the mother and the foetuses. If, though, the stimulation comes before IVF-ET, the aim is that to produce numerous follicles, to have the maximum chances to succeed in the in vitro fertilization phase.

Neither is IVF-ET without the risks of a multiple pregnancy, because at the moment of transfer of the embryos to the mother's uterus a balance has to be found between the numerous factors that influence the implanting and eventual pregnancy. In other words, if too few embryos are implanted there's less chance of success, but if too many are implanted there's the possibility of a multiple pregnancy, and there's no mathematical algorithm to define what constitutes too few or too many, in so far as it is very subjective and depends upon factors such as age, cause of infertility, number of previous attempts…

Another important consideration is that of the continuous monitoring needed while undergoing ART, starting with preliminary blood tests, ultrasounds, and sperm analysis, through to the complex bio-genetic exams which are carried out on the ova, sperm and embryos during the process. For someone like me who feels faint at the simple sight of blood, just thinking about these procedures is terrifying. The benefits though must be (or must have been, see below) immeasurable for those couples affected by hereditary illnesses, in so much as the pre-implant diagnosis is one of the diagnosis that can avoid having to learn at the start of a pregnancy that the foetus has genetic anomalies, and thus can save couples the trauma of having to choose between continuing a pregnancy where the child is destined to suffer, or falling back on the option of abortion.

The third thing to take into account is the opportunity, through medically assisted procreation, to be able to reproduce also in the cases of total and irreversible infertility of one of the partners: if, for example, the man has to undergo chemotherapy, there is the possibility to cryoconserve (i.e. to freeze) his sperm, which can then be used later for artificial or in vitro insemination, with a high success rate providing the sperm were healthy and fertile at the moment of freezing. Neither do cryopreserved embryos seem 'ruined' and, if they survive the unfreezing, they can be transferred into the uterus without lessening the chances of success of the ART. It's a different case however for the female oocytes, where clinical data is too scarce to guarantee the safety from a genetic point of view for the cryoconservation techniques.

It's not within the scope of this article to delve too deeply into the technical details: there are plenty of far more authoritative sources, easily accessible on the net. Apart from anything, the techniques vary, sensibly, from centre to centre. Or perhaps it's more correct to say 'varied', because recently the famous/infamous 40/2004 law came into force, with, according to its promulgators, the aim of regulating ART.

Law 40/2004 on ART

The law 40/2004 came into force on the 10th of March 2004.

The passage of the law started in may 2001, when a Lega Nord deputy presented proposals to the Parliament for a law to regulate medically assisted procreation. To this proposal would be added other proposals, and all were examined by the Social Affairs commission of the Parliament, which approved a single text, which became the basis for political debate.

The single text approved by Parliament went for examination in the Senate, by the XII Commission on Hygiene and Health, which, after almost a year of examinations, postponements, expert witnesses auditions, re-examinations, approved the original text, without modification.

In December 2003 the Senate, in turn, approved the original text, with the exception of one amendment, held by many to be a mere technicality, which then had to pass to the Lower House for approval.

The law finally was approved the 10th of February 2004 and as mentioned previously came into force the following month.

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