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Wednesday, April 1, 2009 07:06 am

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 children.

Dr. Lorna Marshall is a practicing specialist in reproductive endocrinology and infertility in Seattle, Wash.

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