The birth of the Suleman octuplets in January of 2009 brought widespread public attention to an ongoing debate in the area of fertility treatment. Who gets to decide how many embryos a woman can have implanted in a single pregnancy? Doctor? Mother to be? Or the legal system?
The American Society of Reproductive Medicine (ASRM) has a pretty strong opinion on the subject. They think the doctor should have the ultimate power to make the decision. And they proved it by revoking the membership of Dr. Michael Kamrava, the doctor responsible for the fertility treatments leading to the birth of the Suleman octuplets. Kamrava is still licensed to practice medicine, as that is in the hands of the state medical board, but ASRM feels that he doesn't meet their standards.
Kamrava transferred six embryos which resulted in eight babies. ASRM guidelines recommend no more than two embryos for women under the age of 35 with a good prognosis. The ASRM review board felt that six was excessive because Suleman was only 33, and had been through several successful IVF procedures before. However, according to Suleman herself, each of her previous pregnancies had also had six embryos implanted, and resulted in four singleton births and one set of twins. It's hard for a layperson to conclusively decide anything, but that's a failure rate of 80% and it probably didn't seem likely that repeating the same procedure would end up quite the way it did. Suleman has also said she requested all the embryos be implanted so that none would be destroyed as she didn't plan to go through any more pregnancies. Admittedly, a single, unemployed mom isn't the best candidate to have octuplets, but that's easy enough to say with the benefit of hindsight. However, given Suleman's history and success rate with IVF in the past, a successful birth of that many babies would have seemed astronomically unlikely at the time the octuplets were implanted.
In ASRM's favor, it does seem that there may have been a long term pattern of questionable behavior by Kamrava that the octuplets merely brought attention to. However, ASRM seems to be endorsing a 'Doctor knows best' approach where the doctor makes the health care decisions rather than the patient making the decisions based on the doctor's advice. Similar debates rage between doctors and advocates of home births and vaginal births after caesareans.
On a final note, it's really a bit frustrating for parents of multiples to read about this ongoing debate regarding IVF. Most press on the subject treats multiple births as a disease that must be eliminated. 9See also the previous article on IVF public policy in Ontario, Canada.)
For additional reading: The press release for ASRM's newly updated guidelines on embryo transfers. The highlight is requiring counseling for any patient who receives more transfers than recommended. Also see the Nashville Infertility Examiner's comments.
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