The fate of frozen embryos under the Italian fertility law

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 effects restrictive Italian fertility laws, which came into force on 10 March 2004, have had on people's choices about their frozen embryos.

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. PGD 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 A 'yes' vote would have repealed the four provisions, but for the results of the referendum to be legitimated, a 50 per cent turnout was required - only 25.9 per cent of Italians voted,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.

In the first presentation, Dr Monica Cattoli, from a fertility clinic in Bologna, presented the results of a study of 849 couples whose embryos had been in frozen storage for more than two years before the new law came into force. The object of the study was to 'find out whether the imminent introduction of the new legislation would influence couples towards making a hurried decision on what to do with these embryos', she said. The results showed that 66 per cent of couples wanted their embryos to be disposed of; 4.3 per cent wished them to be used for research; 7.4 per cent wanted to donate them to others; and 21.8 per cent wished for the storage to be extended. Couples who had not had a pregnancy were more likely to favour disposal over donation than others, and the request to extend storage was more uncommon among those who had already conceived spontaneously, said Dr Cattoli.

More interesting was the fact that within the first two months of 2004, 46 couples 'instructed the clinic to dispose of or donate their embryos even if the two year period was not ended, in order to have the right to decide themselves about the fate of their embryos', said Dr Cattoli. 'Over the entire period of our study, 77.7 per cent of couples opted for disposal, donation, or use of embryos for research, and none of these options is available to them under the new law', she added, commenting that the new law had taken away freedom of choice 'on a matter that fundamentally affects personal beliefs and ethics'. She added that the Italian government 'should not allow the dictatorship of the Catholic church to impose a law on all citizens'.

Under the new law, embryos produced by couples undergoing fertility treatments cannot be frozen, so it creates problems for those couples who have embryos that were frozen before it came into force. 'What will happen to these embryos?', Dr Cattoli asked.