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Octuplet Mom Also Births Ethical Debate

by Ashley Surdin,  Washington Post,  Feb 4, 2009

LOS ANGELES -- Public opinion seems to be cresting against her, her own mother is rattled, and now fertility experts are suggesting the case of Nadya Suleman and her octuplets constitutes a breach of medical guidelines.

Suleman, 33, gave birth to six boys and two girls by Caesarean section Jan. 26 at a Kaiser Permanente Medical Center in Bellflower, Calif. The miraculous event -- reportedly one of only two live octuplet births ever in the United States -- quickly drew criticism after it was revealed that Suleman is single, unemployed, lives with her mother and already has six children -- including twins -- ranging in age from 2 to 7.

Her daughter "is not evil, but she is obsessed with children. She loves children, she is very good with children, but obviously, she overdid herself," her mother, Angela Suleman, told the Los Angeles Times. She decided to have more embryos implanted in hopes of having "just one more girl."

"And look what happened. Octuplets. Dear God."

The birth of eight babies to a woman who becomes responsible for 14 children is attracting a different set of worries from the medical community, particularly fertility doctors, who say it goes against the mission of their work: to minimize high-risk, multiple-birth pregnancy and safely provide a woman with a single healthy baby. It is also raising questions about the lax regulations covering doctors and clinics that provide such services.

"It was a grave error, whatever happened," said Eleanor Nicoll, a spokeswoman for the American Society for Reproductive Medicine, which along with the Society for Assisted Reproductive Technology provides medical guidelines for fertility treatments. "It should not have happened. Eight children should not have been conceived and born."

Suleman has yet to reveal how the babies were conceived, or which clinic or doctor was involved -- her publicist said she has "reserved that part of her story" for now, and Kaiser said it was not involved in the conception.

Typically, doctors use one of two procedures. One is in vitro fertilization, whereby doctors combine eggs and sperm in a laboratory, creating embryos, and transfer a small number into the uterus. The second is intrauterine insemination, in which doctors stimulate the ovaries to produce eggs and follow that with artificial insemination.

In both procedures, doctors said, they work with two to three embryos, or four at the very most. But never eight.

For a woman in her early 30s, like Suleman, ASRM guidelines for in vitro fertilization call for no more than two transferred embryos.

[Should the number of embryos transferred during IVF be limited? TELL US what you think in our IVF message board.]

Doctors work with few embryos to avoid multi-birth pregnancies, which heighten health risks for both mother and babies. Such pregnancies put a mother at a higher risk of premature labor and delivery. They also put babies at increased risk of brain injuries, underdeveloped lungs and intestines, and cerebral palsy, among other things.

The female body is designed to undergo what Lawrence Werlin, medical director of the Coastal Fertility Center in Irvine, called "the most significant physiological stress that can happen to the body. Certainly, you can imagine what kind of stress that would be with a multi-fetal gestation."

"I would certainly say that this is contrary to what everyone else would do in our field," Werlin added.

It's standard, Werlin said, for doctors to take a patient's history -- say, how long she has been trying to get pregnant or how many children she has -- before beginning a fertility treatment.

He said there's no specific number of previous children or hoped-for babies that determines treatment. But in Suleman's case, he said, he doubted that she requested such a sizable brood.

"I can't believe that she came in and said to the doctor that 'I want eight more children.' I can't believe that," Werlin said, chuckling. "And if she did, I would say, 'I'm sorry, I'm not the person for you.' "

David C. Magnus, director of the Stanford Center for Biomedical Ethics, said that if the octuplets were produced through in vitro fertilization, it would spotlight the poorly regulated infertility and reproduction field.

"This is a huge problem," Magnus said. "You've got a virtually unregulated marketplace with tort law serving as regulation in the U.S."

Magnus said that U.S. medical standards are not unlike those of other countries, but that U.S. guidelines are laced with the language of "you should" rather than strict rules and sanctions.

The professional organizations should take a stricter line with doctors and clinics, he said. "They've been very loath to take that action."

But "if you leave it up to the marketplace," he added, "there will be abuses."

Suleman's babies, who are still in the hospital with their mother, were born 30 1/2 weeks into gestation, weighing between one and a little more than three pounds. They are breathing on their own, according to doctors, but are expected to stay in the hospital for weeks.

In the meantime, Suleman has hired publicists to handle the hundreds of media inquiries from around the world. According to her spokesman, Mike Furtney, the "very bright, very engaging" Suleman has a degree in psychology and hopes to continue work toward a master's degree.

As for some of the criticism aimed at her, Furtney said, "she's hopeful that when she tells the story, people will change their opinion of her -- for the good."

Staff researchers Julie Tate and Madonna Lebling contributed to this report.

Should the number of embryos transferred during IVF be limited by law? Is eight too many? Is two to few?

TELL US what you think in our IVF message board.


Comments (1)

This afternoon I watched the Today show clip, with Ann Curry interviewing Ms. Suleman. It is <em>fascinating</em> to try figure this woman and her motives out. She did raise a point that I think is valid and that's that she's being persecuted because chose to become a single mother . . . You can watch the clip here: It's really interesting . . .

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