With the news that Nadya Suleman's fertility doctor has another patient expecting quadruplets, many are calling for new regulations on fertility treatments. But will these regulations unfairly penalize women?
Dr. Michael Kamrava, the doctor who helped Nadya Suleman become pregnant with octuplets, transferred at least seven embryos into another patient a few months after treating Suleman, reports The L.A. Times. The 49-year-old woman already has three children and is now five months pregnant with quadruplets. The woman is hospitalized at Los Angeles County-USC Medical Center, where she was transferred from another hospital because she doesn't have insurance. She spoke to The L.A. Times in a phone interview:
"Please respect my privacy," she said, adding that her circumstances are much different from Suleman's.
The woman has three grown children from a previous marriage but wanted another child with her second husband, who is in his early 30s and doesn't have any children, sources said. She works as an apartment manager; her husband is a contractor.
She started fertility treatments seeking one baby, but after becoming pregnant with quadruplets, declined medical advice to reduce the number of fetuses, the sources said.
The woman's situation is different from Suleman's. For a start, she's employed. But, having multiples is still very risky, and unlike Suleman, this mother's age is a factor.
"I do think it is concerning, and dangerous, especially to the mother. She is close to 50. When women get to be that age, our fear is the cardiovascular complications, such as stroke or heart attack. That's how serious this is," said Dr. John Jain, a fertility specialist with knowledge of the case.
Dr. Jain also appeared on The Today Show this morning, and explained that usually the age of the egg donor determines how many embryos will be implanted. In this case, the donor was 29, so only one or two embryos would usually be implanted. "It's just common sense, this is not what you do," says Jain in the clip below. "This is irresponsible, careless."
Nearly a third of in vitro births involve twins or more, but the government and professional associations want fertility doctors to reduce that number, reports the New York Times.
The American Society for Reproductive Medicine, the association of fertility doctors, even adopted guidelines in 2008 encouraging the transfer of only one embryo for women under 35, and no more than two, except in extraordinary circumstances. The guidelines allow more for older women, up to a maximum of five.
But unlike some other countries, the United States has no laws to enforce those guidelines. The Centers for Disease Control and Prevention has a surveillance system that collects data on fertility clinics, but reporting is voluntary and there are no government sanctions for not reporting.
Part of the problem may be the way that the cost of fertility treatments are covered in the U.S. In Europe, where many countries have banned the transfer of more than one embryo, the countries also cap costs for in vitro fertilization or require health insurance to cover the procedure. One cycle of in vitro costs about $12,000 in the U.S., and since the cost is often not covered by insurance, doctors say they are urged by their patients to implant more embryos. "There was greater pressure for U.S. clinics to deliver, no pun intended, on the first try," Dr. David Hill, who runs a Beverly Hills IVF clinic, told The New York Times, "so they would put back more embryos, and hopefully one of them would take."
A recent Slate article argues that the way to reduce the number of multiple births in this country is actually to increase the number of IVF procedures being performed.
In 2002, Harvard Medical School researchers found, unsurprisingly, that compared with women who pay out of pocket, those whose insurance fully covered IVF were significantly less likely to have multiples since they chose to have fewer implanted embryos. And while international comparisons are fraught with confounders, it's worth noting that Sweden and Australia have almost twice as many IVF births per capita as we do, yet their infant mortality rates remain comfortably lower.
One contributing factor may be that in those countries national health insurances subsidize IVF. Sweden even creates an incentive to reduce multiple births by fully covering repeated IVF attempts if a woman implants one embryo, but limiting coverage if a woman chooses to implant multiple embryos.
The Nadya Suleman case has caused such a furor that she is reportedly receiving death threats, and police are investigating the hundreds of angry emails and phone calls she receives. It's obviously an extreme example and there are other deeply troubling circumstances surrounding her case. But perhaps the Suleman-inspired criticism being leveled against women and doctors who choose to implant multiple embryos isn't entirely justified. Part of the problem is that America has a health care policy that is encouraging multiple births. Slate refers to a study that found making IVF coverage mandatory for health insurance providers would only increase yearly premiums by about 0.1 to 0.3 percent, which amounts to about $20 per year. The extra money may even lead to savings overall, since less taxpayer money would go to medical costs for babies born with health problems due to multiple births.
The idea of limiting the number of embryos a woman can have transferred has come up frequently over the past few weeks. But only limiting the number of embryos transferred may solve the problem by penalizing the vast majority of IVF patients who don't want to have risky multiple births, but can't afford to spend $100,000 on repeated treatments. The United States does need to reexamine its policy on fertility treatments, but the country should adopt a policy that actually fixes the problem without vilifying women who just want to have a child.
Octuplets Doctor Has Another Patient Expecting Quadruplets [L.A. Times]
Birth of Octuplets Puts Focus on Fertility Clinics [The New York Times]
Pregnant Pause [Slate]
LA Police To Investigate Threats To Octuplets Mom [Breitbart]
An Estimate Of The Cost Of In Vitro Fertilization Services In The United States In 1995 [Pub Med]
Is 'Octomom' America's Future? [The Wall Street Journal]
Related: When Eight Children Is Seven Too Many [New Scientist}