Birth of Octuplets Stirs Ethical Concerns

By Ashley Surdin
Washington Post Staff Writer
Wednesday, February 4, 2009

LOS ANGELES, Feb. 3 -- Public opinion seems to be cresting against her, her own mother is rattled, and now fertility experts are suggesting the case of Nadya Suleman and her octuplets constitutes a breach of medical guidelines.

Suleman, 33, gave birth to six boys and two girls by Caesarean section Jan. 26 at a Kaiser Permanente Medical Center in Bellflower, Calif. The miraculous event -- reportedly one of only two live octuplet births ever in the United States -- quickly drew criticism after it was revealed that Suleman is single, unemployed, lives with her mother and already has six children -- including twins -- ranging in age from 2 to 7.

Her daughter "is not evil, but she is obsessed with children. She loves children, she is very good with children, but obviously, she overdid herself," her mother, Angela Suleman, told the Los Angeles Times. She decided to have more embryos implanted in hopes of having "just one more girl."

"And look what happened. Octuplets. Dear God."

The birth of eight babies to a woman who becomes responsible for 14 children is attracting a different set of worries from the medical community, particularly fertility doctors, who say it goes against the mission of their work: to minimize high-risk, multiple-birth pregnancy and safely provide a woman with a single healthy baby. It is also raising questions about the lax regulations covering doctors and clinics that provide such services.

"It was a grave error, whatever happened," said Eleanor Nicoll, a spokeswoman for the American Society for Reproductive Medicine, which along with the Society for Assisted Reproductive Technology provides medical guidelines for fertility treatments. "It should not have happened. Eight children should not have been conceived and born."

Suleman has yet to reveal how the babies were conceived, or which clinic or doctor was involved -- her publicist said she has "reserved that part of her story" for now, and Kaiser said it was not involved in the conception.

Typically, doctors use one of two procedures. One is in vitro fertilization, whereby doctors combine eggs and sperm in a laboratory, creating embryos, and transfer a small number into the uterus. The second is intrauterine insemination, in which doctors stimulate the ovaries to produce eggs and follow that with artificial insemination.

In both procedures, doctors said, they work with two to three embryos, or four at the very most. But never eight.

For a woman in her early 30s, like Suleman, ASRM guidelines for in vitro fertilization call for no more than two transferred embryos.

Doctors work with few embryos to avoid multi-birth pregnancies, which heighten health risks for both mother and babies. Such pregnancies put a mother at a higher risk of premature labor and delivery. They also put babies at increased risk of brain injuries, underdeveloped lungs and intestines, and cerebral palsy, among other things.

The female body is designed to undergo what Lawrence Werlin, medical director of the Coastal Fertility Center in Irvine, called "the most significant physiological stress that can happen to the body. Certainly, you can imagine what kind of stress that would be with a multi-fetal gestation.

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