Fertility in the age of the Octomom
As specialists in the field of fertility, we cringe every time a higher order multiple pregnancy (three or more gestations) receives special attention. Almost every Mother’s Day contest for “Mother of the Year” selects a woman who has carried and delivered four, five, or six babies at once. “Jon & Kate Plus 8,” which chronicles a couple raising twins and sextuplets, has become one of the most popular reality TV shows. To fertility specialists, such pregnancies are associated with preterm labor, tiny babies that need weeks or months of special care in the nursery, and likely one or more children with long-term health or behavioral difficulties. So the public outcry against the recent birth of octuplets by Nadya Suleman can have a positive effect.
It’s hard to believe that any conscientious professional would ever consider
transferring six embryos into a young woman’s uterus. The current guidelines by the American Society for Reproductive
Medicine state that women less than 35 should have one or two embryos
transferred into their uterus. Yes, a patient has a right to make her own
decisions about health care, but her physician has an obligation to ensure that
those decisions are well-informed. Dr. Kamrava’s decision to transfer six embryos into the uterus of 32-year-old Nadya Suleman
deviated so much from professional guidelines that every agency that has the
power to sanction him should.
When medical care falls below the standard of care, there are many avenues available to reprimand the physician. Hospitals can withdraw privileges, medical societies can expel a member, state licensing boards can suspend the physician’s license, and patients can file a liability claim. Whatever official sanctions are imposed, the negative publicity has significantly harmed, if not ruined, Dr. Kamrava’s career. The public backlash should strongly deter other physicians.
So why the cry for new laws to “protect” the public from another set of octuplets? Professional guidelines by the
American Society for Reproductive Medicine are strong and have been shown to be
effective in reducing the number of embryos transferred and risk of multiple
pregnancies. Those who label fertility care as the “wild west of medicine” aren’t aware that the clinical delivery of fertility care in the United States is one
of the most regulated areas in medicine.
In response to the birth of the octuplets, we should punish the rogue physician
who completely ignored established standards of care in the field of
reproductive medicine. But until the government mandates insurance coverage for
IVF, don’t let lawmakers who know nothing about reproductive medicine — and often have other reproductive agendas — pass regulations that protect neither patients, the public, nor future
Dr. Lorna Marshall is a practicing specialist in reproductive endocrinology and infertility in Seattle, Wash.