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A Fertility Specialist Discusses the Number of Embryos to Transfer with IVF, Multiple Births & Octomom

by on Aug.09, 2009, under Number of IVF Embryos to Transfer

Octomom and IVF – before June of 2008

  • In June of 2008, Nadya Suleman was a single, unemployed mother of 6 children
  • According to reports, she was receiving some “public assistance”
  • All six of her children were reportedly conceived through in vitro fertilization
  • All 6 kids were under 7 years old, including 2 year old twins

Then, she does IVF again

  • In June of 2008, her IVF doctor transferred 6 frozen-thawed embryos to her uterus.
  • Apparently, all six embryos survived – and 2 split into identical twins – so she ended up with eight fetuses growing in her uterus.
  • Nadya declined having a fetal reduction procedure. Reduction can be done to selectively reduce the number of fetuses.
  • The vast majority octuplet pregnancies would be expected to result in death of all fetuses after a severely premature birth.
  • In her case the pregnancy progressed to viability. All 8 babies were born (prematurely) in January of 2009.
  • This is apparently only the second living set of octuplets ever born in the United States.

Public debate rages

  • Is she a fit mother?
  • Should the fertility specialist have been willing to treat her at all?
  • How many embryos should the doctor have transferred to her uterus?
  • Should a physician that transfers that many embryos to a 33-year-old be sanctioned – or even lose his medical license?
  • Why doesn’t the government pass laws to control fertility doctors?

Violation of guidelines of the American Society for Reproductive Medicine, ASRM

Her fertility physician has been identified as Dr. Michael Kamrava who practices in Beverly Hills California. The American Society for Reproductive Medicine is reportedly investigating Dr. Kamrava related to violating its guidelines on the maximum number of embryos to transfer. Although there are guidelines, there are not any laws in the US regulating the maximum number of embryos transferred.

The ASRM guidelines in place when Nadya Suleman had her IVF procedure said that the maximum number of embryos to be transferred to a woman under 35 years of age should be 1 or 2 depending on the specific medical issues. There was some wiggle room in the guidelines. Since they were frozen embryos, a max of 3 for transfer might also have been considered appropriate.

Comments from a fertility specialist

  • Physicians, including fertility specialists cannot play god and judge who will be a “fit enough parent” to have fertility treatments.
  • Patients undergoing fertility treatment desperately want children and can face huge financial burdens.

The costs of IVF treatment are substantial and although sometimes medical insurance in the US will cover fertility treatment and IVF, more often it does not. Therefore, patients often pressure fertility specialists to transfer more embryos with the hope that they will be more likely to be pregnant.

The ASRM guidelines on the maximum to transfer are appropriate. However, patients are sometimes unhappy about limitations on the number of embryos for transfer – particularly couples with financial difficulties due to IVF costs. For example, some couples will put a second mortgage on their house, max out credit cards, and borrow from parents.

As IVF success rates have increased over the years, the average number of embryos transferred to the uterus has declined. Some cases are now even having single embryo transfers (SET) by choice. This has become a more viable option with utilization of blastocyst embryo transfer which can result in better embryo quality and more control of multiple pregnancy risk.

However, although I have substantially increased the time spent discussing risks of multiple births (including twins), our rate of single embryo transfer is still low. Patients rarely accept single embryo transfer – even after hearing about increased risks with twins. Infertile couples fear failing to become pregnant at all more than they fear the risks to the babies from multiple pregnancies.

When will there be laws regulating the number of IVF embryos that can be transferred?

I think it unlikely that our government will pass laws regulating how many embryos can be transferred unless they also mandate insurance coverage for IVF treatments in order to relieve the financial burden for couples with fertility problems.

Conclusions

  • The ASRM guidelines on the maximum number for transfer should be closely followed (whenever possible)
  • In a case such as this, a maximum of 2 embryos should be transferred
  • 6 embryos should never be transferred to a 33 year old woman – no matter what she says about accepting risks.
Richard Sherbahn

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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