Fertility Specialists Defend Ethics Of Field In Wake Of Octuplet Case

Main Category: Fertility
Article Date: 06 Mar 2009 - 5:00 PDT

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The birth of 33-year-old Los Angeles resident Nadya Suleman's octuplets, who were conceived through in vitro fertilization, has created concern among reproductive endocrinologists about "how a profession that has highly refined the art and science of helping women who have struggled to get pregnant could be so misused," the Washington Times reports. Suheil Muasher, medical director of the Muasher Center for Fertility and IVF in Fairfax, Va., said that Suleman's doctor "reflects badly" on fertility specialists, adding, "While we don't really know the exact facts of the case, whatever was done here was outside the guidelines" of the American Society for Reproductive Medicine. ASRM's guidelines limit the number of embryos implanted in a woman depending on her age and health history. Muasher said the guidelines are recommendations, rather than requirements, because each case must take into account several factors, including age, fertility problems and previous pregnancies. For a woman younger than age 35 "with a favorable prognosis," ASRM recommends the transfer of no more than one embryo; for women the same age with a "more complicated case," ASRM calls for the transfer of no more than two embryos, the Times reports. For women ages 38 to 40, the society recommends no more than three embryos, and for women older than age 40, no more than five embryos.

Dale McClure, president of ASRM, said he is pleased that the California Medical Board is investigating the Suleman case. Suleman has said that her procedure involved six embryos. McClure said, "Physicians have known for many years about the dangers of multiple pregnancies," adding, "ASRM and its affiliate, the Society for Assisted Reproductive Medicine, have worked steadily to formulate evidence-based guidelines for the number of embryos to transfer in assisted reproductive technology cycles." He noted that the percentage of triplet births from ART procedures has declined, with 2% reported in 2005, down from 7% in 1996. The success rate for fertility doctors improved from 28% to 34% during the same period. Stephen Lincoln, a reproductive endocrinologist with the Genetics and IVF Institute in Fairfax, said that aside from Suleman's case of octuplets, "we have seen a significant reduction in higher-order births of triplets or more. We can do better and we are trying." He added, "There are a lot of factors that pressure people to transfer more." Muasher said he is concerned that the publicity surrounding Suleman's case will lead some infertile couples to fear conceiving high-order multiples if they undergo IVF. In reality, the majority of reproductive endocrinologists follow ASRM guidelines, he said.

Another concern among fertility doctors is that an increased scrutiny of the field will lead to regulations, similar to those in some European countries, that regulate the number of embryos that can be implanted. Lincoln said that regulations on the number of embryos that could be implanted would affect the success rate for many doctors and patients. He explained, "We have to be careful that we don't make laws that hurt success rates and deter patients from getting the best treatment possible," adding, "We are always cautious when the government wants to impose restrictions. Technology is outpacing our ability to morally look at things, and we may make laws that three or four years down the road may be obsolete" (Goff, Washington Times, 3/4).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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