Posts Tagged ‘guidelines’

Octuplet Doctor Crosses Line, Second Patient Expecting Quadruplets

February 15, 2009

Ever since Dr. Michael Kamrava’s name was announced on NBC’s Dateline special about his patient, Nadya Suleman who gave birth to octuplets after he implanted her with six embryos, he has been under scrutiny. Due to his lack of following guidelines set forth regarding embryo implantation by the American Society for Reproductive Medicine, his career has been in the hot seat. But now, he might loose his medical license after a second patient of his has announced she’s expecting quadruplets — four babies when she really only wanted one. It is reported that Dr. Kamrava transferred at least seven embryos to this woman age 49. Now she’s five months pregnant with quadruplets and hospitalized at Los Angeles County-USC Medical Center.

In fertility medicine, any pregnancy greater than twins is considered a poor outcome because of the danger it poses to the mother and the babies. Quadruplet births are rare, with an average of 14 sets born in California each year, according to state records. “Historically, we have been very hesitant to regulate anything close to procreation from parents making judgments about how many children they will have and when,” said Kirk O. Hanson, ethics professor and executive director of the Markkula Center for Applied Ethics at Santa Clara University.

The woman in the latest case arrived recently at Good Samaritan Hospital in Los Angeles for unspecified treatment but was transferred last week to County-USC Medical Center because she lacks insurance. Doctors placed her on bed rest until the birth of the babies, which could be two or three months from now.

The California Medical Board has said it is looking into the octuplets’ case to determine whether a doctor may have violated any standards of care. The American Society for Reproductive Medicine, which has guidelines limiting the number of embryos that can be transferred depending on the woman’s age and other circumstances, said it is also examining the doctor’s practice. No laws govern this issue. The guidelines allow for the transfer of more embryos in older women. But in this case, the woman was using embryos made from eggs donated by a woman in her late 20s — which fertility specialists said increased the possibility of a multiple birth.

“I do think it is concerning, and dangerous, especially to the mother. She is close to 50. When women get to be that age, our fear is the cardiovascular complications, such as stroke or heart attack. That’s how serious this is,” said Dr. John Jain, a fertility specialist with knowledge of the case.

Reached by telephone, the woman did not confirm that Kamrava is her doctor. However, The Times has verified the information through several independent sources. She said her doctors urged her not to talk to the media because she is already dealing with a high-risk pregnancy and doesn’t need more stress. “Please respect my privacy,” she said, adding that her circumstances are much different from Suleman’s.

The woman has three grown children from a previous marriage but wanted another child with her second husband, who is in his early 30s and doesn’t have any children, sources said. She works as an apartment manager; her husband is a contractor. She started fertility treatments seeking one baby, but after becoming pregnant with quadruplets, declined medical advice to reduce the number of fetuses, the sources said.

Kamrava could not be reached for comment and has declined previous interview requests. A woman who answered the phone at his West Coast IVF Clinic said: “If [a] mother wants to bring four kids, so what?” Doctors at County-USC and Good Samaritan Hospital also declined to comment, citing patient confidentiality.

Suleman said in an interview with NBC that her doctor transferred six embryos. She gave birth Jan. 26, and although the births were initially celebrated as a medical miracle, public opinion quickly turned when it was discovered that Suleman had six other children, was a single mother and was relying on some public assistance, including food stamps and Social Security benefits.

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Octuplet Mom Sparks Ethics Debate Over IVF and Embryo Implantation

February 12, 2009


Baby Lifestyles has moved.

We wish Nadya Suleman and her fourteen children well. Regardless of her motives, the octuplet mother has opened Pandora’s Box when it comes to ethics over how IVF regulations and emryo implantation ethics.

Dr. Jeffrey Keenan, the medical director for the National Embryo Donation Center, believes Suleman and her doctor are flat out lying about the number of embryos that were transferred. “The odds of this happening are just remarkably, remarkably low, and frankly I don’t believe it,” he admits. “Frankly I think more embryos were transferred than they say because otherwise you’re saying an event happened that, you know, is maybe one in 100,000 [to] one in a half-million — something like that.”

In June of 2008, the American Society for Reproductive Medicine (ASRM) issued updated guidelines on the number of embryos that should be transferred to a woman’s body in the hopes they’ll implant in the uterus and lead to a live birth. According to the guidelines, women under 35 should transfer no more than two embryos, down from the maximum of three recommended in 1998, and women over 40 should attempt no more than five.

Now that Suleman has sparked a debate due to her current unemployment status, financial background issues, and her six other children at home, you have to wonder how far away these guidelines are from becoming laws. Reproductive medicine is currently regulated by U.S. clinics reporting to the Centers for Disease Control and Prevention (CDCP) the number of embryos transferred in each IVF cycle, the resulting number of live births, and a clinic’s number of triplets and higher multiples, who are more likely to have serious health problems. As IVF success rates have increased, the average number of embryos transferred has gone down, from 3.9 in 1996 to 2.4 in 2005. Single-embryo transfers are now recommended in many cases; generally, the younger the patient, the likelier it is that an embryo will implant.

So where do regulations go from here? Will doctors begin to limit the number of embryos implanted based on how many children a family currently has or based on the family’s financial background? When you’re spending no less than $10,000 on one round of IVF and a doctor will only implant one, if it doesn’t take is it merely seen as a way for a doctor to make more money by having a second, third or fourth round done? The United States is not China with a maximum child amount policy. But how long will it be before regulations go as far as limiting the size of your family if you cannot conceive naturally? Time will tell.

Mothers Work, Inc.