The Suleman octuplets have captured Americans’ hearts, but the actions of the mother and doctor have raised people’s ire. Blogging here last week, Dr. Bruce Patsner pointed out that self-regulation of the infertility industry is insufficient to protect women and children from harm.
Infertility specialist Richard Paulson told Time that we shouldn’t use “this incredibly rare event” to legislate. But the practice of transferring too many embryos is far from rare and suggests that the billion dollar infertility industry needs stricter oversight.
The American Society for Reproductive Medicine guidelines state that for women under 35, only a single embryo should be implanted, and that “no more than two embryos should be transferred in the absence of extraordinary circumstances.” Medically, the chances of pregnancy do not increase if more than two embryos are implanted. Yet, data contained in a Center for Disease Control (CDC) report for 2006, the last year for which data is available, reveals that 80.5% of the 426 IVF clinics reporting data violated the guidelines and transferred more embryos than recommended. Researchers at ISLAT analyzed the dozen clinics that reported the highest average number of embryos transferred in women under age 35 (including the octuplets’ clinic where 6 embryos were implanted in Nadya Suleman). Of these clinics, GYFT Clinic in the state of Washington averaged the most with 4.8 embryos per treatment cycle—more than double the recommended number of embryos. But a higher number of embryos didn’t mean a higher success rate. In fact, 8 of the 12 clinics that implanted the most embryos had a lower success rate of creating babies than the national average.
Some doctors have claimed that fertility clinics appropriately self-regulate and there is no need for oversight. When news of the octuplet’s birth first broke, no doctor could possibly have been involved in that travesty. Kevin Pho, a primary care physician with the Nashua Medical Group and writer of the blog www.KevinMD.com, suggested that it might have been a sneaky insider at the clinic that implanted the embryos in Suleman while the overseeing physician wasn’t looking. Terrence Lee, the Medical Director of Fertility Care of Orange County, thought that Suleman probably injected herself with fertility medication purchased in Tijuana and he said it would be a “huge shock” to find out that the octuplets were the result of in vitro fertilization. But unlike what Drs. Pho and Lee suggest, you don’t need to find an insider or drive to Tijuana to increase your chance of having multiples and the associated health risks. Instead, you can go to Dr. Lee’s own clinic, which implanted an average of 3.2 embryos per treatment cycle in women under age 35, or any of the other 343 clinics that ignored the guidelines in 2006.
If doctors aren’t regulating themselves, should there be a law in the U.S. limiting the number of embryos doctors can implant? Under British law, no more than two embryos can be transferred to a woman under 40. Italian doctors are not even allowed to create more than three embryos at a time. In Germany, doctors can be thrown into jail for up to three years if they put more than three embryos in a woman. Perhaps its time to enforce what the medical community already knows is best.