Children wanted, but Greek couples face some difficulties

Around 6,500 children were born through in vitro fertilization (IVF) in Greece between 1989 and 1998. In most cases, the couple’s desire for a child is so great that they keep trying, even if it takes years. Scientific progress in the sector of IVF has made having children possible for thousands of men and women who once would never have had a chance. In Greece alone, about 300,000 couples of reproductive age face fertility problems. However, several ethical problems have arisen around the various methods of assisted reproduction. IVF has been used in Greece since 1985 at about 50 specialized clinics from Alexandroupolis to Crete, most of them private. Even today, however, there is no legislative framework determining scientific conditions in these centers, nor is there any system of recording the results at a national level. So the recent draft bill setting out conditions for IVF submitted to Justice Minister Philippos Petsalnikos by the head of the legislative committee, Professor Giorgos Koumandos, was greeted with enthusiasm by experts. A Health Ministry committee is processing a relevant draft law providing for a national record of results. Until now, data collection has been carried out on a voluntary basis by Associate Professor of Obstetrics and Gynecology Vassilis Tarlatzis of Thessaloniki University. Fertility centers are not required to report results (only half of them do so on an annual basis). According to the data available, between 1989 and 1998 about 48,000 IVF cases have been reported, of which 35,000 resulted in the transplant of an embryo. There were 8,310 pregnancies, and 6,442 live births registered. «This is not a realistic picture,» Tarlatzis told Kathimerini. «It is estimated that about 10,000 IVF procedures are carried out every year.» About 1,500 children are believed to be born every year as a result of IVF. «In about 60 percent of couples with fertility problems, the problem lies with the man,» said Themis Matzavinos, associate professor of obstetrics and gynecology. Matzavinos was on the team which brought the first «test tube» baby into the world. In his office are dozens of photographs of children he has helped to draw their first breath. «The situation has been reversed. In recent years spermatozoa have become very weak. About 50 years ago they were twice as strong. Environmental pollution, the dioxins and chemical additives we eat, along with smoking and stress, have led to considerable problems for men,» he said. «However, while in the past the couple usually needed a sperm donor, nowadays fertilization can take place with whatever sperm the man may have,» he added. (The latest methods of micro-fertilization allow fertilization even when no sperm are present.) In Greece, all modern IVF methods are used with results comparable to those in other European countries. There are a larger number of multiple births (38 percent, compared to 25-30 percent in the rest of Europe), although these numbers are dropping off. Multiple births put both the mother and the embryos at risk, and there is a high infant mortality rate. Abroad, no more then two fertilized ova may be implanted in each woman. «The more embryos one implants, the more chances of success there are. However, it is a dangerous pregnancy. I had two sets of quads that have now grown and are fine,» said Matzavinos. «There is a procedure which allows one to halt two of them in the third month, which is even more barbaric than an abortion. In both cases I had warned the parents of the risk of losing them. One of the women was a Jehovah’s Witness and the other decided to take the risk. Now when I see the children doing well, I wonder which ones we would have ‘stopped’ back then.» Tarlatzis said that one explanation for the high rate of multiple births is that while in other countries there is full insurance cover and couples are able to try again, in Greece there is only partial insurance cover. It was only a year ago that the two main funds, IKA and TEBE, decided to fully cover the pharmaceutical costs of IVF, which amount to at least 1,500 – 1,700 euros. A bonus of 350 euros is paid for each attempt. «This covers about 60 percent of the total cost,» said Tarlatzis. In countries where there is full insurance cover, such as Germany, Sweden and the Netherlands, about 3 percent of all annual births are via IVF.» This is a considerable percentage, particularly for countries with a low birth rate such as Greece. Everywhere, and not only in Greece, there is a surplus of embryos, due to the possibility of freezing them. In Britain, for example, it was decided to destroy embryos after a period of five years because of the cost involved. «I know of cases where four fertilized ova were implanted and a child born, and then four years later, we used embryos from the same ‘batch’ and the woman fell pregnant again,» said Matzavinos. «That is, twins born four years apart.» There are several problems inherent in this procedure, such as when a couple that has frozen embryos decides to divorce. To whom do the embryos belong? If the father dies, can the wife use them? From the first IVF births, legal problems arose that the law was not prepared to deal with. Some of these issues are dealt with in a draft bill recently tabled and which is considered progressive, as it gives legal status to the substitute mother. «Many young women may have excellent ovaries but for some reason have had their uterus removed. The woman has ova and her husband has sperm. In cases such as these, the woman’s sister has often born the child,» said Matzavinos. Naturally all those involved in the pregnancy require legal protection. Otherwise women would offer to carry another couple’s child for purely economic reasons, without taking the necessary precautions, such as not smoking or drinking.