WebMD Medical News
Louise Chang, MD
Feb. 10, 2009 - As the mother and grandmother of the two-week-old California
octuplets squared off on competing morning talk shows this week, infertility
specialists continue to voice their dismay over the fertility treatment that
led to the birth of the eight babies.
In an interview that aired on NBC's Today show, Nadya Suleman, 33,
said her fertility doctor did nothing wrong by transferring six embryos into
her womb when she had already given birth to six babies through in vitro
Suleman's mother, Angela Suleman, says she disagrees with her daughter's
decision to undergo the treatment that led to the birth of the octuplets. She
called her daughter's actions "really unconscionable" in an interview
that aired on ABC's Good Morning America.
Infertility specialists have their own views. Many have been deeply critical
of the fertility doctor who treated Suleman.
On Feb. 6, the Medical Board of California announced plans to investigate
the fertility doctor who treated Suleman. The board did not identify the
doctor, but the Today show identified the clinic as the West Coast IVF
Clinic in Beverly Hills, Calif.
"I am deeply disappointed that any fertility clinic in the United
States, or anywhere, would do this," says Colorado reproductive
endocrinologist Eric Surrey, MD, who is a past president of the Society for
Assisted Reproductive Technology (SART).
"There may be a medical justification, but I can't think of one, and
I've been doing this for 20 years," he tells WebMD.
Suleman, who is unmarried, unemployed, and living with her parents, told
NBC's Ann Curry that she knew there was a risk of multiple births if she had
all six of her remaining frozen embryos transferred at one time.
But she said she did not believe it would happen because she had so many
fertility problems, including severe endometriosis and scarred fallopian
All six embryos did implant, however, and two apparently split, resulting in
"The most I would have ever anticipated would have been twins," she
told Curry. "It wasn't. It was twins times four."
She said with her medical history, she considered it "very
appropriate" for her doctor to transfer so many embryos.
"He did nothing wrong," she said.
But Atlanta infertility doctor Mark Perloe, MD, of Georgia Reproductive
Specialists, strongly disagrees.
He points out that her chances for a successful pregnancy were actually very
good, considering her young age and the fact that she had -- by her own account
-- four previous successful single-birth pregnancies and one twin pregnancy
resulting from IVF.
Fertility treatment guidelines call for women under 35 who have favorable
chances for a successful pregnancy to have no more than two fresh embryos
transferred. Suleman's embryos had been frozen, but there was still no
justification for transferring more than two or at most three, Perloe says.
"There was a breach of ethical propriety here that was absolutely
staggering," he tells WebMD.
Perloe even questions the ethics of treating Suleman at all. "I would
not agree to treat a single mom on disability with six small children at home
SART and the American Society for Reproductive Medicine (ASRM) developed
embryo transfer guidelines several years ago in an effort to reduce the number
of high-order pregnancies, defined as triplets or more.
The guidelines make it clear that high-order pregnancies are an undesirable
consequence of infertility treatment because of the extreme risk to the mother
and her babies.
As a result of efforts to restrict the number of embryos transferred during
IVF, the rate of high-order multiple births has been declining in the U.S.
"I would hate for the public to get the sense that this story is
representative of fertility care," Surrey says. "It is a gross
aberration. High-order pregnancies are now relatively rare, precisely because
we have addressed this issue."
At Massachusetts General Hospital the standard practice is to transfer just
one embryo at a time in women who are considered to have good chances of
Mass General chief of reproductive medicine John Petrozza, MD, tells WebMD
that thanks to this practice the multiple pregnancy rate at the institution is
now among the lowest in the country.
"We want to minimize high-order pregnancies because of the very real
danger of premature delivery, low birth weight, and all the problems that go
along with them," he says.
Medical problems associated with preterm high-order pregnancies can include
cerebral palsy, life-threatening respiratory problems, intestinal problems,
developmental delays, and learning disabilities.
Surrey says the likelihood of an adverse outcome due to low birth weight and
premature birth is seven times higher for twins that for single-gestation
babies and 14 times higher for triplets.
The eight California babies are all breathing on their own, which is a very
good sign, but they were a full 10 weeks early at the time of their birth and
weighed between 1.8 and 3.4 pounds.
Multiple-birth experts say it may be years before the extent of their
medical issues are known.
Maureen A. Doolan Boyle, who is the mother of triplets and the executive
director of the organization Mothers of Super Twins (MOST), tells WebMD that
the average gestational age for triplets is 33 to 34 weeks and the average
gestational age for quadruplets is 31 weeks.
A normal pregnancy lasts about 40 weeks. Babies born before 37 weeks are
She says even premature babies who appear to be quite healthy often have
long-term problems and developmental and learning challenges.
"Any baby born before 37 weeks should be followed for developmental
milestones up until they start school," she says.
SOURCES:Eric Surrey, MD, Colorado Center for Reproductive Medicine; former
president, Society for Assisted Reproductive Development.Mark Perloe, MD, reproductive endocrinologist, Georgia Reproductive
Specialists, Atlanta.John Petrozza, MD, chief of reproductive medicine and the IVF Unit,
Massachusetts General Hospital, Boston.Maureen A. Doolan Boyle, executive director, Mothers of Super Twins.Today transcript, interview with Nadya Suleman.Good Morning America transcript, interview with Angela Suleman.
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