Looking at the research that’s being presented here, one of the first things to strike me is the number of papers from Italian teams trying to get round their country’s restrictions on the use of in vitro fertilisation (IVF).

Italy is a strongly Catholic country of course, and in 2004 a law was passed saying that embryos cannot be frozen, that no more than three embryos can be created at once, and that no embryos can be destroyed (unless clearly already dead). Jail terms could face anyone breaking the rules. The problem is that creating more embryos than needed then picking the ones that look to have the highest chance of producing a healthy baby is a key element of IVF – how best to do that is the subject of a separate raft of papers here.

The law has clearly affected the success of IVF in Italy. Anna Pia Ferraretti of the SISMER reproductive medicine unit in Bologna, Italy, told me that in her clinic, the pregnancy rate for each IVF cycle has dropped from 35% to 24% (for 35-37 year olds at least, the drop is still present but less significant for other age groups) and the miscarriage rate has risen from 16% to 29% (in the same age group). So researchers are having to be pretty creative about improving the success rate again without falling foul of the law.

It has led to some interesting advances, that could benefit IVF more generally. Several groups are freezing any extra eggs that are collected, for example, so that if a woman doesn’t become pregnant after a first cycle of IVF, she can have another round without having to donate more eggs. It’s pretty routine these days to freeze semen, and embryos, but eggs are another matter — the rate of pregnancy from eggs that have been frozen is extremely low. If you could manage it routinely though, cancer patients could freeze eggs before undergoing treatment that would damage their ovaries, or (more controversially) healthy women facing declining fertility as they age could freeze eggs for use in later life. I’ll hopefully write a bit more on egg freezing in a future blog entry.

Ferraretti is working on screening eggs for chromosomal abnormalities, so that the best eggs can be selected before they’re even fertilised. You can’t check the chromosomes of the egg itself without destroying it so in Ferraretti’s study, the chromosomes of the “polar body” were screened instead. The polar body is a structure formed as an immature egg divides in two. One half goes on to become the mature egg, the other half — the polar body — has the same chromosomes but simply degenerates. The egg has to be inseminated within 6 hours of this division, so for Ferraretti and her colleagues it was a race to complete the chromosome analysis in time. The screen didn’t improve the number of women getting pregnant, but the subsequent miscarriage rate was reduced to 14%, roughly what it was before the restrictions were brought in.

Ferraretti is delighted with the result, and hopes that as techniques for analysing the chromosomes in the polar body get better, it may be possible to improve the pregnancy rate as well. And although she admits that such results will be beneficial for fertility treatment, she’s keen to avoid any suggestion that the Italian restrictions have been good news. “I am afraid people will look at the results and think the law is OK,” she told me. “But it’s not at all!” It’s the patients that lose out, she says, as they are forced into using experimental techniques (unless they go abroad for treatment).

There could be another downside too — loss of the expertise that IVF patients in Italy are so reliant on. Ferraretti says she has considered leaving Italy to work somewhere the laws are less restrictive. “I’m so depressed to have such limitations,” she says. “I would like to be more free to adapt the best technique to each couple. I have the experience, I have the skills, and I would like to be able to do that.” By putting together the latest techniques she believes it is possible to minimise the number of embryos used, “with respect for the patient and the embryo”.