Birth Control

Just about the time that eight babies began growing inside a California woman's womb, some nationwide policies about fertility treatment were being codified. In June, the American Society for Reproductive Medicine (ASRM) issued updated "Guidelines on Number of Embryos Transferred." Women under age 35 - the octuplets' mom is reportedly 33 - should attempt to transfer no more than two, and preferably only one, fertilized embryo at a time. Women over age 40 should attempt no more than five.

"I think the word cowboys comes to mind," says Robert Stillman, medical director at Shady Grove Fertility Center in Rockville, Md., the country's largest fertility clinic.

But fertility doctors counter that reproductive medicine is among the most regulated specialties in the U.S. Clinics must report to the Centers for Disease Control and Prevention the number of embryos transferred in each IVF cycle - in which sperm and egg are fertilized outside a woman's body, then transferred to her uterus - as well as the number of babies born as a result of that treatment cycle.

This requirement was originally set up to empower patients, who can now assess their chances of getting pregnant on the basis of a particular clinic's success rate. But the reporting system has evolved into being a way to monitor a clinic's number of multiple births, which are more dangerous - and more costly - for mother and baby.

In the past decade, the number of multiple births resulting from IVF cycles has declined even as the number of IVF cycles has increased. As the science of IVF has improved, the Society of Assisted Reproductive Technology, an affiliate of the ASRM, has progressively lowered its recommendations regarding how many embryos should be transferred in each cycle. According to the group, IVF-facilitated births of three or more babies dropped 69% from 1996 to 2005. That's no coincidence: in the same period, the average number of embryos transferred went from 3.9 to 2.4, a 38% drop.

Single-embryo transfers are now the name of the game in many cases. A recent article in the journal Fertility and Sterility generated controversy when it suggested recasting how fertility clinics view outcomes. A singleton birth should be considered a success, triplets a failure.

But in the U.S., where fertility treatment is often scoffed at by insurance companies, women paying for the costly procedures out of pocket want to wind up with a baby as quickly - and cheaply - as possible. One IVF cycle can cost upwards of $10,000. Often, women decide their best shot is by increasing the number of embryos transferred.

Physicians may advise a patient to transfer only one or two embryos, but the patient may insist on double the number - or more. "Doctors' attorneys are advising them, 'You have to do it,' " says Sean Tipton, spokesman for the ASRM. "The courts have made clear that decisions about what to do with embryos are in the hands of patients, not in the hands of physicians."

A doctor, after all, is not the same as a judge.

If women who already have a bunch of kids were to approach Stillman for help conceiving more, he says he'd be obligated to help. "As a parent of two kids, I may think they're crazy, but I'd tell them what I always tell patients: our goal here is as many children as you want, but preferably one at a time."

Richard Paulson, director of the fertility program at the University of Southern California, helped write the original professional recommendations regarding embryo transfer. Although he decries the birth of triplets, he's irritated at calls to legislate assisted reproduction. Doctors aren't the problem, he contends; laws are. Some European countries limit the number of embryos transferred, but that doesn't allow for physicians to take into account individual medical histories; generally, the older the patient, the less likely embryos will implant.

The California octuplets are only the second set to be born in U.S. history. "We're picking out this incredibly rare event, and all of a sudden, we want to pass laws," says Paulson. "Would we write laws limiting the size of someone's family to six? Would we write laws mandating selective reduction?" he asks, referring to the option of aborting some embryos if a high number successfully implant in the uterus. "Restricting reproductive rights would be a minefield."

In the meantime, the subject of how the California woman came to deliver eight babies - 10 years after a Houston woman gave birth to the first-known living octuplets - is preoccupying fertility doctors across the country. The ASRM is caught up in the craziness too. "If this resulted from an IVF treatment, we can say that transferring eight embryos in an IVF cycle is well beyond our guidelines," the group's president, R. Dale McClure, said in a statement issued four days after Kaiser Permanente Medical Center in Bellflower, a Los Angeles suburb, announced the babies' birth. "We have a process for looking into these kind of matters and taking appropriate action."

But at most, all the group can do is revoke society membership from a clinic gone astray. "We have no legal authority to stop someone from practicing," says Tipton, the group's spokesman.

Over the weekend at Duke Fertility Center in Durham, N.C., the extraordinary birth was on everyone's mind. Fertility clinics are round-the-clock operations, and women came and went for fertility monitoring. Susannah Copland, who oversees the IVF program at Duke University, was on call and noticed that "everyone was buzzing about the octuplets." Some were shocked, others unnerved. "I don't want eight babies," they told her.

"And we don't want you to have eight babies," she responded.

"I will continue to counsel patients that one embryo is the way to go," says Copland. "What does Mother Nature usually give us? One baby at a time."

Yet she worries that some patients may be inspired by news of the octuplets. "It's a pebble dropped in the pond," she says, "and who knows where the ripples will go?"

Source by http://news.yahoo.com/s/time/20090204/hl_time/08599187623200

Labels: birth control, doctors, fertility