IVF spe­cial­ists ‘out­raged’ by Octo-Mom

The Washington Times Weekly - - Culture, Etc. - BY KAREN GOLD­BERG GOFF

In the month since the birth of Nadya Sule­man’s oc­tu­plets, re­ac­tion has gone from cu­rios­ity to sym­pa­thy to anger. The pub­lic has ques­tions about ev­ery­thing from who the fa­ther is to how she will pay for di­a­pers and med­i­cal care.

Fer­til­ity spe­cial­ists also are ask­ing ques­tions.

Many re­pro­duc­tive en­docri­nol­o­gists have con­cerns about the doc­tor who per­formed in vitro fer­til­iza­tion for Miss Sule­man. They won­der how a pro­fes­sion that has highly re­fined the art and sci­ence of help­ing women who have strug­gled to get preg­nant could be so mis­used.

“Most in my spe­cialty are out­raged,” says Suheil Muasher, med­i­cal di­rec­tor of the Muasher Cen­ter for Fer­til­ity and IVF in Fair­fax, Va. Dr. Muasher has been per­form­ing IVF and other fer­til­ity pro­ce­dures for more than 20 years.

“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,” he says.

Those guide­lines were set by the Amer­i­can So­ci­ety for Re­pro­duc­tive Medicine (ASRM), the pro­fes­sional or­ga­ni­za­tion for fer­til­ity spe­cial­ists. The or­ga­ni­za­tion is­sues rec­om­men­da­tions rather than a strict code be­cause each med­i­cal case is a com­pli­cated mix of fac­tors, in­clud­ing age, fer­til­ity prob­lems and pre­vi­ous preg­nan­cies, he says. Doc­tors come up with the pro­to­col that will be most ef­fec­tive for each case.

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. The guide­lines say women older than 40, who have a slim­mer chance of get­ting preg­nant, should re­ceive no more than five em­bryos.

Miss Sule­man said in an in­ter­view with NBC that six em­bryos were trans­ferred dur­ing the pro­ce­dure that pro­duced the oc­tu­plets.

R. Dale McClure, pres­i­dent of the ASRM, says he is pleased that the Cal­i­for­nia Med­i­cal Board will be in­ves­ti­gat­ing the case.

“Physi­cians have known for many years about the dan­gers of mul­ti­ple preg­nan­cies,” Dr. McClure says. “ASRM and its af­fili- ate, 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 points out that the num­ber of births of higher-or­der mul­ti­ples has been de­creas­ing since 1997, the year af­ter the ASRM is­sued its first guide­lines.

“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.”

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.

Many fer­til­ity spe­cial­ists are con­cerned 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.

“When I started do­ing this 20 years ago, it was not un­com­mon to trans­fer four, five, even six em­bryos,” says Stephen R. Lin­coln, a re­pro­duc­tive en­docri­nol­o­gist with the Ge­net­ics and IVF In­sti­tute in Fair­fax. “We were not ev­ery 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 con­cerned that the pub­lic­ity over Miss Sule­man’s case will cause some would-be par­ents to re­con­sider treat­ment in fear they would con­ceive six, seven or even eight ba­bies. He says the vast ma­jor­ity of re­pro­duc­tive en­docri­nol­o­gists fol­low the ASRM guide­lines.

“The par­tic­u­lar case makes a lot of peo­ple fear­ful,” Dr. Muasher says. “They don’t want to have oc­tu­plets.”

That is not to say as­sisted re­pro­duc­tive tech­nol­ogy is without risks. There are risks to the moth­ers, such as ovar­ian hy­per­stim­u­la­tion, and of course, the risk of con­ceiv­ing more than one baby. Risks of mul­ti­ple preg­nan­cies in­clude high blood pres­sure, ges­ta­tional di­a­betes and pre­ma­ture de­liver y. Most fer tility clin­ics dis­cuss the risks of mul­ti­ples with pa­tients be­fore they sign con­sent forms to be­gin treat­ment.

Doc­tors also dis­cuss se­lec­tive re­duc­tion, or re­duc­ing the num­ber of fe­tuses in a mul­ti­ple preg­nancy. Ob­vi­ously, ter­mi­na­tion is a tough topic to bring up with a woman who has been ea­ger to be­come preg­nant.

“You have got to have a long dis­cus­sion with your pa­tient be­fore they get into the IVF cy­cle,” Dr. Lin­coln says. “You have to present what can hap­pen and say: ‘This is our plan.’ What we do is cer­tainly in­form them, and they sign con­sent forms. We talk about se­lec­tive re­duc­tion if mul­ti­ples are con­ceived. We are not ad­vis­ing pa­tients to do any­thing; we are pre­sent­ing the facts. Ob­vi­ously, it is their choice.”

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. If there were such laws in the United States, they would af­fect the suc­cess rates of many doc­tors and pa­tients, Dr. Lin­coln says.

“We have to re­mem­ber [the oc­tu­plets case] is very much the ex­cep­tion to treat­ment,” he says. “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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