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Octo-mom May Affect Future Medical Practices of Fertility Doctors

By Joan Firstenberg     Mar 7, 2009 in Health
It isn't just the media and the public who are so critical of Octo-Mom, Nadya Suleman's behavior. Now, fertility specialists are voicing their concern for their industry, and posing some hard questions.
The Washington Times reports that many reproductive endocrinologists are voicing their concern about the doctor who performed the in-vitro fertilization for Suleman. They question how he could have misused a profession that has a highly refined art and science of helping women who have struggled unsuccessfully for years to get pregnant. Dr. Suheil Muasher, the medical director of the Muasher Center for Fertility and IVF in Fairfax, Virginia has been performing IVF and other fertility procedures for more than 20 years. He says
"Most in my specialty are outraged. It really reflects badly on us. While we don't really know the exact facts of the case, whatever was done here was outside the guidelines."
The American Society for Reproductive Medicine (ASRM), the professional organization for fertility specialists, issues recommendations instead of a strict code because as the industry sees it, each medical case is a complicated mix of factors, including age, fertility problems and previous pregnancies.
The current ASRM guidelines call for women younger than 35 with a favorable prognosis (such as Miss Suleman, who already had delivered six healthy children before she conceived the octuplets) to have no more than one embryo transferred to the uterus during an IVF procedure. Women younger than 35 with a more complicated case and women ages 35 to 37 should have no more than two embryos transferred; women ages 38 to 40, no more than three.
Miss Suleman confirmed in her interview with NBC that six embryos were transferred during the procedure that produced the octuplets.
R. Dale McClure, president of the ASRM, says he's happy that the California Medical Board will be investigating the case.
"Physicians have known for many years about the dangers of multiple pregnancies. 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 [ART] cycles."
Dr. McClure the number of high multiple-births has been decreasing since 1997, the year after the ASRM issued its first guidelines. In 1996, 7 percent of ART pregnancies were triplets or more. By 2005, that number had fallen to 2 percent. Meanwhile, success rates for fertility doctors continued to improve, from 28 percent in 1996 to 34 percent in 2005.
But Many fertility doctors are worried now that a highly publicized event such as the births of the octuplets will negate their hard work to build a practice high on ethics and success rates and low on higher-order multiple births.
Stephen R. Lincoln, a reproductive endocrinologist with the Genetics and IVF Institute in Fairfax, Virginia says;
"When I started doing this 20 years ago, it was not uncommon to transfer four, five, even six embryos, we were not even good at this. Now, despite the case in California, we have seen a significant reduction in higher-order births of triplets or more. We can do better, and we are trying. There are a lot of factors that pressure people to transfer more."
Dr. Muasher says he is very concerned now that the publicity over Miss Suleman's case will cause some would-be parents to reconsider treatment out of the fear they would conceive six, seven or even eight babies. He says the vast majority of reproductive endocrinologists follow the ASRM guidelines.
Some doctors are concerned that the publicity over the octuplets will lead to an investigation, which will lead to laws regulating specialists. Some European countries have laws regulating the number of embryos transferred. Dr. Lincoln says,
"If there were such laws in the United States, they would affect the success rates of many doctors and patients. We have to remember [the octuplets case] is very much the exception to treatment. We have to be careful that we don't make laws that hurt success rates and deter patients from getting the best treatment possible. 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 today that three or four years down the road may be obsolete."
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