Fertility's closed Italian frontier

Determined to end its reputation as the 'Wild West" of fertility treatment, Italy is severely curtailing the ability of couples who cannot conceive to seek alternative routes to becoming biological parents.

The Medically Assisted Reproduction Law, which takes effect Wednesday, gives embryos the same rights as their would-be parents and makes it illegal for sterile or gay couples, as well as single adults, to use donors or surrogate mothers. It also bans all forms of embryo research and limits the treatments that "stable" couples - married or living together - can resort to for assistance in conceiving.

The move reverses what critics charge are lawless, market-driven practices in a country where doctors have in the past helped a 63-year-old woman become pregnant. After more than 20 years of debate, the law is seen as a victory for traditional Catholics who argue against all forms of technological assistance - or "playing God" - for infertile or sterile adults.

Health Minister Girolamo Sirchia has called the law "a good starting point" for protecting the embryo. "Research should be carried out on animals,

not Christians," he told Corriere della Sera when the law was approved last month.

But opponents warn that the ban's restrictions could simply drive those trying desperately to have children - in a country where family life revolves around bambini - to take unnecessary risks. It could also, they say, be a first step toward banning abortion, which is legal in Italy. At the very least, the ban may move a variety of procedures beyond Italy's borders, limiting their access just to the wealthy.

"It is as if we have gone back to the Dark Ages," said Federica Casadei, who runs a Rome-based organization for couples with fertility problems called "Cercounbimbo" (Lookingforachild). "The embryo is so sacred now that you cannot touch it - not even to help it be born."

Italy has the oldest population and one of the lowest birth rates in Europe. The government is so keen for a baby boom that it is offering cash incentives for every naturally born second child.

Yet the law, approved by Catholic politicians from across the political spectrum, has thrown an estimated 250,000 couples seeking fertility treatment each year into despair and left doctors and researchers with their hands tied.

"This law is made by people who have no idea what it is like not to be able to have children," said Cristina Zuppa, whose attempts at in-vitro fertilization since last September have failed. "They are dictating to the nation on the most private of things. It's like being told what clothes you are allowed to wear."

The plan has put medical experts in Italy and Europe in an uproar. "Some of these bans are astonishing from a scientific point of view and disgusting from a moral point of view," said an open letter by fertility expert Carlo Flamigni and Rita Levi-Montalcini, winner of the 1986 Nobel Prize for Medicine.

Doctors who continue to provide the banned forms of fertility treatment face fines of up to 400,000 euros and a temporary suspension. Anyone who attempts to clone a human being faces up to 20 years in jail and is struck from the professional register of physicians.

Experts warn that the law raises the risk of multiple births,as women seeking fertility treatments must have three embryos - the maximum the law allows - implanted at the same time. In the past, couples have created frozen banks of embryos for future implant attempts. Now, the three-embryo ceiling means the same invasive treatment as before but with much low chances of success. According to experts, chances of successful fertility under the new law will drop from 30 percent to just 8 percent.

Others are worried about the precedent Italy's actions set for others. "We are afraid it will become a model for conservative Catholic countries," said Arne Sunde, the president of the European Society for Human Reproduction and Embryology. "It is a disaster and it will inevitably lead to 'fertility tourism' as couples seek to get better treatment outside Italy."

Female politicians across the board have slammed the law. "There is no law like this anywhere else in Europe," said leftwing member of the European Parliament Emma Bonino. Alessandra Mussolini, granddaughter of Italy's wartime fascist dictator, said: "Anyone who wants fertility treatment will travel across the border to get it. It will become a luxury for the rich."

Ms. Casadei, who is on her seventh attempt to have an assisted pregnancy, says the law may mean she has to give up.

"It costs about 7,000 euros for treatment abroad," she says. "At my age, the chances of it working are low. To go through all that with a foreign doctor in a foreign language and then fail is not worth it."

Italian doctors plan to set up clinics in neighboring countries. Marco Gergolet will open one in the fall just yards inside the Slovenian side of the frontier in Gorizia. He has received hundreds of requests from couples. "Our services will be 20 percent cheaper than in Italy," he says. "For us it is a great business opportunity."

At the same time, there are fears that bogus doctors will run black-market fertility businesses in Italy for those who cannot afford to travel.

Meanwhile, the government faces a dilemma: What to do with around 26,000 embryos already frozen in fertility clinics aroundthe country.

Mr. Sirchia has proposed that the embryos be transferred to a central "embryo house" in Milan "for safety." A date must be set by which the "owners" of the frozen embryos must use them. Those unclaimed - likely to be around 30 percent - may be put up for "adoption" despite the fact that this amounts to "donating," which the new law officially bans.

"I am sure lots of embryos will be thrown away," said Emilio Mordini, a bioethics expert at Rome's Psychoanalytic Institute for Social Research. "No one will talk about it. It will be done very quietly."