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The battle on assisted reproduction and prenatal diagnosis in Italy took a new turn last week, when the gynaecologist Giovanni Monni, head of the obstetrics and gynaecology department in the Ospedale Microcitemico in Cagliari, Sardinia, was ordered by the local court to provide preimplantation genetic testing to a couple carrying the gene for β thalassaemia, which is common on the island.
Dr Monni, the current president of the Italian Association of Hospital Gynaecologists, had unwillingly obeyed the controversial law approved in 2004, which, through guidelines, forbids preimplantation genetic diagnosis, even though he personally supported the couple's request for it (BMJ 2004;328:9, doi: 10.1136/bmj.328.7430.9). “I am very glad of the court's decision,” he told the BMJ.
The law contains several points that have been opposed from the beginning by almost all gynaecologists. These include the stipulations that assisted reproduction techniques can be used only by sterile heterosexual couples in a “stable relationship”; that embryos cannot be frozen, which means that a maximum of three fertilised eggs must be immediately implanted in the womb; and that sperm and eggs cannot be donated. In addition only the non-invasive “observation at the microscope” is allowed as a form of preimplantation testing.
The constitutional court had rejected in November 2006 a similar request for preimplantation genetic diagnosis by the same couple. The ban on genetic testing, the court argued, was contained in the guidelines defined by the health ministry and not in the law itself. Consequently the law itself was not at variance with the constitutional right to health. After that pronouncement the couple went back to the lower court and sued Dr Monni and the hospital and received the recent favourable judgment.
Meanwhile, the couple at the centre of the controversy started treatment for in vitro fertilisation and preimplantation diagnosis at a private centre in Istanbul, with expenses paid for by two anonymous donors. Now the woman, Simona, who had two abortions in the past, is already pregnant, but she has said that she will implant the embryos frozen in Italy as soon as possible, after the end of her present pregnancy, if they do not carry the genes for β thalassaemia.
Many specialists have predicted that the law would have several adverse consequences. They said it would reduce success rates, increase the number of multiple pregnancies, and result in many Italian couples travelling abroad for treatment. The first official data support these predictions (BMJ 2007;335:62 doi: 10.1136/bmj.39272.373634.DB).
Moreover, many couples seem to be circumventing the ban on the freezing of embryos. According to journalistic reports, more and more couples are being allowed to freeze their embryos by refusing to implant them all in a written statement to the hospital.
With the theme of abortion in the background, the law remained unchanged even after the centre-left coalition led by Romano Prodi was elected in 2006, because of the many, strong interventions by the Catholic hierarchies.
The secretary general of the Italian Catholic bishops' conference, Giuseppe Betori, has spoken out publicly against the recent court's decision, and the daily newspaper Avvenire, which is closely aligned with the Vatican, had on its front page an editorial that compared preimplantation diagnosis to eugenics and cited Hitler's myth of the purity of the race (26 Sep, pp 1-2, www.avvenire.it).
The next step will be the publication of new guidelines. The law states that the guidelines have to be updated every three years by the health ministry, and the first revision is due by the end of 2007. “I expect the new rules will take the court's decision into account,” said Dr Monni.