Octuplet Fertility Doctor Has Low Success Rate, Considered Controversial In Field

Main Category: Fertility
Also Included In: Women's Health / Gynecology;  Primary Care / General Practice
Article Date: 12 Feb 2009 - 3:00 PDT

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The Beverly Hills, Calif., physician who provided the fertility treatments that resulted in the birth of octuplets to 33-year-old Nadya Suleman has one of the lowest success rates of any fertility specialist in the country, according to federal records, the Los Angeles Times reports. According to the Times, Suleman's octuplets and her six previous children -- all of whom were conceived through in vitro fertilization from the same clinic -- represent a significant portion of the specialist's pregnancy rate over the last several years. In an interview on NBC's "Today Show" this week, Suleman identified physician Michael Kamrava of the West Coast IVF Clinic as the doctor responsible for the IVF treatments that resulted in all of her children. Federal records show that of the 61 procedures Kamrava's clinic conducted in 2006 -- the most recent data available -- five resulted in pregnancies and two resulted in live births, including the birth of twins to Suleman. Mark Surrey, another fertility specialist in Beverly Hills, called Kamrava's rates "absurdly low" and the "worst numbers I've ever seen."

According to the Times, Kamrava has a "history of poor results" despite his controversial practice of placing more embryos per procedure in patients younger than age 35 than the national average. Kamrava implanted an average of 3.5 embryos per IVF treatment in patients younger than age 35, compared with a national average of 2.3 embryos, and he implanted more embryos per procedure than all but 10 of the 426 fertility clinics in the U.S. that treat women of the same age. The Times reports that fertility specialists say implanting high numbers of embryos is a "common way that poorly performing clinics try to boost their pregnancy rates," but the practice also increases the risk of multiple births and dangers to the infants and women (Zarembo et al., Los Angeles Times, 2/10). Suleman has said she had six embryos implanted with each pregnancy; the octuplet pregnancy resulted when two embryos split. The AP/Yahoo! News reports that national guidelines recommend implanting two to three embryos for a woman of Suleman's age (Tayefe Mohajer, AP/Yahoo! News, 2/9). The Times reports that other physicians have "strongly condemned" the decision to implant six embryos, particularly because of Suleman's history of successful pregnancies (Los Angeles Times, 2/10). John Jain, founder of Santa Monica Fertility Specialists, said Kamrava "really stepped outside the guidelines in a very extreme manner, and as such, put both mother and children at extra high risk of disability and even death." The Medical Board of California is currently investigating Suleman's case to see if there was a "violation of the standard of care" (AP/Yahoo! News, 2/9).

Suleman's case has "evoked fascination and fury among the public and the medical community, with many wondering how she will care for 14 children," the Times reports. Suleman receives at least $490 in food stamps, and she receives federal benefits for three of her first children, who are disabled. Care for the octuplets, who are still in the hospital, is expected to run into at least the hundreds of thousands of dollars. Kaiser Permanente Bellflower Medical Center, where the infants were born, has requested Medicaid reimbursement for their care, three sources told the Times (Los Angeles Times, 2/10).

According to the AP/Yahoo! News, Kamrava is viewed as a controversial figure within the fertility field. Jain said Kamrava has "tried some novel techniques, and some of those methods have been controversial." One such method, according to Jeffrey Steinberg -- a professional acquaintance of Kamrava's -- involves implanting an embryo directly into the uterine lining. He said there is no evidence that the technique improves success rates. Richard Paulson, head of the fertility program at the University of Southern California, said that "those of us who are the scientists in the field do not feel [Kamrava's technique] is a significant improvement" and that some physicians will advertise the technique as "a way of making patients feel that they are trying something new" (AP/Yahoo! News, 2/9).

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