The fertility conundrum

2/23/2009

WHEN a California woman gave birth to eight babies late last month, doctors initially crowed about the medical miracle because it was only the second time in recorded American history that a set of octuplets had been born.

But the jubilation in the delivery room a room packed with 46 staff members, including two anesthesiologists, three obstetricians, seven neonatologists, and an assortment of respiratory technicians and nurses quickly gave way to rancorous debate on medical ethics.

Just because modern medicine can push the boundaries of what is humanly possible, should such procedures be permitted? Should ordering babies from a fertility clinic be as simple as buying hamburgers at a fast-food restaurant? We know that eating 14 burgers in one sitting is a bad idea, but there s no way to prohibit gluttony. Surely more controls are necessary when we re talking about the lives of children.

Nadya Suleman, 33, is an unmarried college student who lives with her parents and already had six children, ages 2 through 7, each the result of in vitro fertilization. She will face physical, economic, and emotional challenges that are unimaginable.

The medical costs alone for her eight premature babies they are more likely than full-term, single-birth babies to face long-term disabilities will be astronomical. The logistics will be beyond difficult. Already, her six older children sleep in cribs, bunk beds, and on mattresses on the floor of her mother s three-bedroom home.

Yet, in interviews, Ms. Suleman, an only child, seems unwilling to acknowledge the demands that are to come. She casually describes her motivation as a mere desire to have the large family that she herself was denied. Her own mother describes her as being obsessed with babies.

Did her fertility specialist the same doctor who apparently implanted the embryos in all of Ms. Suleman s pregnancies conduct any psychological evaluation? And why did he implant so many embryos?

The American Society for Reproductive Medicine, which has been alarmed by an increase in multiple births resulting from fertility treatments, has recommended limiting the number of embryos transferred to women under 35 to one or two, and no more than five in older women.

Ms. Suleman identified her doctor as Michael Kamrava of the West Coast IVF Clinic in Beverly Hills. The state medical board is investigating to determine whether he violated standard medical practice.

Ms. Suleman s outcome demands it, but further scrutiny of the burgeoning fertility industry is warranted, too. Nationwide, the number of in vitro procedures has doubled in just 12 years and accounts for more than $1 billion in business.

Ms. Suleman s experience suggests that voluntary medical guidelines don t provide sufficient safeguards in this most personal medical specialty. Just because something can be done doesn t mean it should be.