The unregulated and completely privatised administration of infertility treatment has led to an increase in the birth of triplets and quadruplets, and in turn a greater health risk to newborns, a study published in the Malta Medical Journal shows.
The study is recommending the introduction of state-funded fertility treatment to put an end to the anarchy reigning in this sector.
It also says infertility treatment “must be tempered by good adequate advice” and that the stimulation of ova in women “must be regulated and restricted only to accredited specialists”.
Doctors found that while the use of fertility pills and in vitro fertilisation (IVF) treatment was used in just 0.7% of singleton births, reproductive technology was responsible for 28% of births involving triplets and 50% involving quadruplets.
The study population included a total of 20,215 deliveries between 2000-2004, which included a total of 242 twin births, 11 triplets, and two quadruplet births.
The report’s authors said that the number of twins and higher multiple births had increased by 19% since the 1960s, mainly due to the increasing use of fertility treatment.
But the study highlights how multiple births face a greater risk of premature delivery, low birth weight, and complications like respiratory distress.
“The occurrence of multiple pregnancies remains fraught with adverse outcomes in spite of the advances in obstetric antenatal surveillance,” the report warns.
The mortality rate in multiple births remains 7.5 times higher than that registered for singleton births.
And while 85% of multiple pregnancies are born prematurely, this only happens among 4% of single births.
The report concludes it would be more financially viable for government to offer infertility services, rather than to continue treating “sick premature low-weight children” which result from unregulated fertility treatments in the private sector.
But since infertility treatment is only offered by the private sector, it is very difficult for any regulatory body to ensure adherence of any regulations, the report warns.
One of the regulations proposed by the study is that no more than two fertilised ova are implanted in each fertility cycle during IVF treatment.
MaltaToday is informed that since there are no facilities to store fertilised ova in Malta, it is common practice that more than two fertilised ova are implanted in the mother. This increases the possibility of multiple births.
The report calls for regulations to ensure that “only accredited specialists” should administer infertility treatments. “The uncontrolled use of ovulatory agents known to be directly responsible for stimulating over ovulation must be regulated and restricted to accredited specialists in the field,” the report states.
The report denounces that medications used to stimulate fertility “continued to be used by non-specialist” physicians despite a circular calling on their use by specialists issued by the department of health in 1992.
Dr Charles Savona Ventura, one of the authors of the study, told MaltaToday that the “inestimable psychological cost” of parents whose children are born sick must be taken into consideration. “We should regulate what is happening in the artificial reproductive technology sector within the moral and ethical parameters of the country. In my opinion the best way to go is to have a state controlled service,” Ventura Savona told MaltaToday.
The study shows that multiple births increased significantly in 40 years: from 1.04% between 1960-69, to 1.3% between 1990-99; an increase of 19%, which the study attributes to “the increasing use of pharmacological and technological reproductive aids.”
Medication aimed at stimulating fertility were introduced in the 1970s and 1980s. The 1990s saw advances with the arrival of IVF, which the study claims has led to a “a rise in multiple pregnancy rates by a further 10.2% for twins and 83.3% for higher order births.”
Altogether, only 0.7% of women having single births were reported to have resorted to artificial reproductive technologies; 9.1% had twin births, and 30.8% had triplets or quadruplets. The real figures may well be higher because a proportion of couples may be unwilling or reluctant to report having resorted to infertility treatment.
The study was conducted by Dr Charles Savona Ventura, Dr Katya Vella and Dr Stephen Grima from the Obstetrics-Gynaecology Department at Mater Dei, and by Dr Miriam Gatt from the Department of Health Information.

jdebono@mediatoday.com.mt