Octuplets: An Infertility Doctor’s Perspective

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One must consider the media frenzy that has surrounded the octuplets case, and the subsequent media coverage of Ms. Suleman has raised several issues.

We now know that Ms. Suleman underwent IVF not only for this pregnancy, but also for her previous ones. We also know that she is not currently in a relationship per her history. We thus don’t know if she even has any fertility issues or trouble conceiving since per what I understand, she used a directed sperm donor. These cases are usually solved with IUIs, but she had IVF and there’s speculation that her tubes are non-functioning. One must then realize that this would give Ms. Suleman the best prognosis for conceiving with treatments which should prompt a conservative approach, following guidelines from our governing body ASRM.

Ms. Suleman claims that for each IVF attempt, she had about six embryos transferred, which may represent a deviation of the standard of care whether this occurred in the first attempt or last. This case is currently being evaluated by the California Medical Board. Please note that nothing Illegal was done here.

It is not unusual for REs to transfer six or even more embryos to a select group of patients, in particular those who are older, have diminished ovarian reserve, and/or have multiple IVF failures. These patients MUST also be willing to have selective reduction performed in the event of the low likelihood of high-order multiples. Each case warrants its own evaluation and we hope that REs will continue to have the freedom to make this decision with their patients for their best interest. Regulating the quantity of embryos transferred would decrease the amount of high-order multiple births, but would also cheat many patients of the opportunity of being parents until a better proven technology is developed.

It is unfortunate that in some cases and not this one in particular, REs can be motivated to transfer more embryos than normal to state that they have “the highest pregnancy rates in town”, using this as a tool to recruit patients. Epidemiological studies have been performed to prove/disprove this theory and we hope that these are a minority of REs and that if anything, this case makes REs think twice about being aggressive with embryo transfers when not indicated to “make themselves look good.”

Ms. Suleman has made it clear that she basically demanded that all embryos be transferred into her stating she clearly understood the risks involved. This places the RE in a very difficult situation since we operate under the notion of Patient Autonomy; a patient gets to decide her course of treatment when fully understanding the risks and benefits. Paternalistic medicine is not usually practiced in the USA unless the patient is unable to make a decision.

Thus in Ms. Suleman’s case, psychological along with home and social evaluation by professionals needed to be considered prior to performing such an aggressive transfer. This type of evaluation is not routinely done, but Ms. Suleman’s case is also far from routine. The RE would have then had more of a case to not respect the patient’s autonomy and be conservative with the transfer of embryos. But what if the patient was “Angelina Jolie” who may pass these tests? Should the RE then respect the patient’s wishes knowing that the likelihood of octuplets is extremely low? And if then, should the RE be liable for any risks/damages the babies and pregnancy may have after this type of evaluation respecting the patient’s decision? These are questions that our field is currently trying to tackle and we can only hope that only good arises from this case.

This is solely my opinion regarding the octuplets case in California.


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