New York Times Examines Increasing Scrutiny Of Fertility Industry After Octuplet Birth

The New York Times on Thursday examined how regulators and the fertility industry have begun to view large multiple births as "breakdowns in the system," an issue that has increased debate over how many embryos should be implanted during in vitro fertilization and whether more oversight is warranted. The issue has taken on a renewed focus since the birth of octuplets last month to 33-year-old Nadya Suleman, who has six other children conceived through IVF. According to the Times, nearly one-third of IVF births involve twins or more, and the government and professional medical associations have pushed fertility doctors to lower that number to minimize risks related to multiple births, including infant death, low birth weight, disability and high-cost medical care.

In 2008, the American Society for Reproductive Medicine, an association of fertility doctors, issued guidelines calling for the transfer of no more than two embryos in a woman younger than age 35 and no more than five in women age 35 and older. However, unlike some countries, the U.S. does not enforce the guidelines. The Centers for Disease Control and Prevention collects data on fertility clinic results, but reporting is voluntary. Experts say that many fertility doctors still implant higher numbers of embryos to raise the chances of a pregnancy, the Times reports. The number of triplet births declined from 7% in 1996 to 2% in 2006, a decrease that ASRM considers as one of its successes, according to the Times. However, only 11% of IVF procedures in 2006 involved single embryos, according to CDC data.

The Times reports that efforts to reduce multiple births, such as the guidelines for implanting only one embryo, have caused tension within the fertility industry, a more than $1 billion business. Doctors say patients constantly push for the implantation of multiple embryos. One IVF cycle can cost about $12,000, and "[w]omen who are not successful the first time often try again and again, which can push the cost of having a baby to more than $100,000," the Times reports. The fertility industry in the U.S. has doubled in size since 1996 -- when CDC began tracking data -- and the latest figures show that there are more than 483 clinics and that more than 134,000 procedures have been performed.

Jeffrey Steinberg -- head of Fertility Institutes, a Southern California-based group of fertility clinics -- said, "Every single decision we make about embryo transfers is a tough one, because we don't have a crystal ball." Daniel Potter, medical director of Huntington Reproductive Center in Southern California, said the responsibility of the procedure remains with the doctor, regardless of a patient's requests. He added that if someone came in and wanted to transfer six embryos in a situation" such as Suleman's, then "we have an obligation to protect the patient and not let the patient do things that are unreasonable." Suleman, in an interview on NBC's "Today Show", said that her IVF procedure involved six embryos, and she identified the fertility doctor who performed the procedure as Michael Kamrava of the West Coast IVF Clinic in Beverly Hills, Calif. The Medical Board of California is investigating Kamrava to determine whether there was a violation of standard medical practice. According to the Times, he has "raised eyebrows in the industry" in the past by advocating for a controversial procedure called SEED -- subendometrial embryo delivery, which involves inserting an embryo directly into the uterine lining. Potter said that the procedure's value is not scientifically supported. CDC data from 2006 place Kamrava's clinic among those with the lowest success rates in the country and reveal that the clinic had one of the highest rates of embryos transferred in younger women -- 3.5 embryos versus the average of 2.3 (Saul, New York Times, 2/12).















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