ESHRE 2016

2. I declare that I have no commercial or financial
interests pertaining to the subject of this
presentation or its content.
Conflict of interest

3. Some most recognizable Polish
specialities

4. Short summary of ART history in
Poland
1987 – the first successful IVF
2015 – the first legal Act on Infertility
During 28 years of performance the ART procedures:
1. 31% - pregnancy rate in National Programme of Reimbursement (2013-2016)
2. App. 50 ART centres
3. „What’s not forbidden is allowed”:
•.
Open acces to ART for heterosexual couples, single individuals and lesbians
•.
No public system of certification or State’s control over ART centres
•.
PGD, oocyte donations, sperm donations, embryo donations
•.
No public databases: rate of success, number of cycles, children’s outcome,
offspring limitation in case of Third Party Reproduction
Neoliberal paradise without State involvement’s inducing deep
debate on ethical issues and patients’ rights

5. The embryo battle
Anti-IVF piquet in front of ART centre. „Mary –
frozen”, „Martin – frozen”, „Alex – frozen”, „Ola –
frozen”, „Matthew - he only succeeded”
Anti-abortion piquet

6. How has the embryo become the main
actor in Polish IVF debate?
Restrictive anti-abortion law since 1993 (Law on
family planning, protection of human fetuses and the conditions
under which pregnancy termination is permissible, 7th January
1993)
Cultural and linguistic shift
•
„the unborn child” instead of „embryo”
•
„a mother” instead of „a pregnant woman”
"I can almost hear the cry of despair of those
tens of thousands of frozen embryos”
(Jarosław Gowin, the former Minister of Justice)
Legislators: We care about all embryos and we
will prove it

7. Kliknij ikonę, aby dodać obraz
Map of stakeholders'
influence on legislative
process’s shape
•
The Government's belief that compromise
with the Catholic Church is unavoidable
•
ART centres’ experts support
•
None of representatives of patients in a
legislative committee
•
„Better worse than nothing” approach in
NGOs environment („we will aim at
liberalising the Act later on”)
•
76% of Poles supported the access to IVF for
marital and (62%) non-marital couples
(Public Opinion Research Centre, March
2015)

8. So how exactly
„the embryo-
compromise”
was politically
reached?

9. Results
Art. 21.3. states that the embryos will be
mandatory given for donation in the
following cases:
„1. the expiry of the contractual
deadline for the storage of embryos, but
not longer than 20 years from the
date on which the embryos were
transferred to the bank of reproductive
cells and embryos
or
2. the death of both donors or - if the
embryo was created as a result of gamete
donation - the death of female recipient
and her husband or partner"

10. Unexpected (?) results
•
Infertility defined as medical
condition (male and female partners)
•
Both partners' official consents
requested
Single women and lesbian couples
were excluded
Question: What should have
been done with embryos created
before Act coming into the
force?

11. Kliknij ikonę, aby dodać obraz•
Poland’s Ombudsman has requested
the constitutional court to review the
text: law discriminates against single
women, depriving them of access to
the procedure
•
Possible violation of Art. 8 of
Convention on Human Rights
•
Possible violation on Tissue Directive:
donations shall not be compulsory
•
Lack of deep insight in psychosocial
effect of compulsory donations, i.e.
disruption of family life and
chronological continuity of
generations, abuse on the individual's
privacy, some individuals may treat
embryo donation as embryo adoption
and feel it as „forced abandonment of
the child”

12. •
Even so restrictive Act was considered "too liberal" by new rulling party Law and Justice and new
amendments to the Act are being prepared: ban on embryo freezing, only one oocyte may be
fertilized and the period of "compulsory embryo donation" will be probably shortened to 3 years
instead of 20
•
Ministry of Health cancelled the National Programme of IVF Reimbursement
•
Ministry of Health announced preparation the brand new programme titled "National Programme
on Procreation" costed the same amount of money:
Vice - Minister of Health, Jarosław Pinkas, commented on content of the new programme:
"As far as educations is concerned, which we are lacking at the moment. One should know what to
do to avoid fertility problems(…). I mean a disastrous life style, inappropriate clothing like too
tight underwear and disobeying some rational rules of how one should look after themselves”
•
Local municipalities have started to prepare their own programmes of IVF reimbursement to help
their citizens to deal with the lack of the governmental support
conclusions

13. Thank you for your attention
„I have a brother thanks to IVF.
Please, remember that other children
are waiting for their siblings too.
Matylda, Poland”

14. How ART centres used
the lack of the Law
•
Patients’ monitoring over ART centres in
Poland (n=37 ART centres)
•
SET policy treated freely
•
Information given to patients treated freely
(i.e. bHCG pregnancy factor; cycles with ET
only)
•
Strong biomedical approach locating
„IVF-issues” on medical experts’ side
to avoid ideological entanglement