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REPRODUCTIVE HEALTH SERVICES | Birth of Octuplets Raises Ethical Debate Among Fertility Experts

REPRODUCTIVE HEALTH SERVICES | Birth of Octuplets Raises Ethical Debate Among Fertility Experts
[Feb. 4, 2009]

The birth of octuplets to 33-year-old Los Angeles resident Nadya Suleman has heightened the ethical debate surrounding the use of fertility treatments, with some experts questioning whether the case breached medical guidelines, the Washington Post reports (Surdin, Washington Post, 2/4). According to the New York Times, the type of fertility treatment Suleman used -- as well as the clinic and physician that provided the treatment -- has not been confirmed. However, Suleman's mother told the Associated Press that the octuplet pregnancy and her previous pregnancies resulting in six other children were the result of in vitro fertilization (Archibold, New York Times, 2/4).

The case is drawing criticism from some fertility physicians, who say it goes against their mission to minimize high-risk, multiple pregnancies and provide women with a single healthy infant, the Post reports. The case also is raising questions about the regulation of physicians and clinics that provide fertility treatments. Eleanor Nicoll -- a spokesperson for the American Society of Reproductive Medicine, which creates medical guidelines for fertility treatments along with the Society for Assisted Reproductive Technology -- said, "It was a grave error, whatever happened." She added, "It should not have happened. Eight children should not have been conceived and born." The ASRM guidelines for women ages 30 and older who undergo IVF call for the implantation of no more than two embryos.

According to the Post, physicians typically work with two or three embryos, or four at the most, in both IVF and intrauterine insemination treatments to avoid creating pregnancies with high-order multiples. Such pregnancies have higher risks for premature labor, underdeveloped lungs in the infant and other health complications (Washington Post, 2/4).

The Times reports that there are no laws in place restricting the number of embryos that can be implanted in a woman. However, physicians generally abide by medical guidelines recommending that they take into account a woman's physical and mental condition, as well as her home life. Arthur Caplan, a bioethicist at the University of Pennsylvania, said the octuplets case posed the question of whether Suleman should have been accepted as a fertility patient considering that she already has six children and would be faced with the costs of caring for 14 children (New York Times, 2/4). David Magnus, director of the Stanford Center for Biomedical Ethics, said that if IVF was used to conceive the octuplets, then the case could be seen as exemplifying the lax regulations of assisted reproduction. Magnus said, "You've got a virtually unregulated marketplace with tort law serving as regulation in the U.S." He added that professional organizations have been "very loath" to take action against physicians and clinics and that stricter guidelines and sanctions are needed (Washington Post, 2/4).