IVF Octuplets Controversy
The recent birth of eight babies to one Californian mother following IVF treatment has sparked a wave of controversy in the last few months. The IVF octuplets were born in January 2009, to 33-year-old Nadya Suleman, who had undergone IVF treatment at the Beverly Hills fertility clinic. The babies were born nine weeks prematurely, by C-section, and all weighed between 0.68 and 1.47 kilograms. The octuplets have brought the debate on the ethics of IVF treatment and the risk of multiple pregnancy to the forefront of people's minds, in the U.S. and the UK, and indeed all over the world.
IVF And Multiple Pregnancy
During IVF treatment, eggs are taken directly from a woman's ovaries and are fertilized in a laboratory using a sperm sample taken either from the woman's partner or from an anonymous donor. Once the eggs have been fertilised, some of the resulting embryos are transferred back into the woman's uterus. Hopefully at least one of the embryos will implant in the lining of the uterus and grow into a healthy baby. Only 20 % of embryos transferred to the uterus successfully implant and develop. Therefore, fertility doctors often transfer more than one embryo, in the hope that at least one will take hold and grow. Sometimes, however, more than one embryo implants and that's why we see a higher number of twins and triplets born from IVF than from naturally conceived pregnancies. In the UK, 25 % of IVF births involve twins, and 1.7 % involve triplets or more.
The Ethical Question
Multiple pregnancy poses increased risks to the health of the mother and her babies. There is higher chance of miscarriage, hemorrage, high blood pressure during pregnancy, preeclampsia, diabetes during pregnancy and complications during birth. The babies themselves have an increased risk of being stillborn or disabled. Most multiple births are performed by C-section. For all these reasons, fertility doctors are required to adhere to certain standards of practice. In the U.S. and the UK, doctors are not supposed to transfer more than two embryos into the uterus of a woman under the age of 35, unless there are exceptional circumstances, such the woman having poor quality eggs.
The Suleman Case
The fertility doctor who helped Nadya Suleman conceive her octuplets, Dr Michael Kamrava, transferred six embryos into her uterus. The octuplets are not Ms Suleman's first children, she has six others, including twins, all of whom were conceived via IVF. She claims that the same doctor helped her conceive all of these pregnancies and that she had six embryos transferred into her uterus each time. The doctor would therefore have known that she already had six children. Ms Suleman was expecting twins at the very most to result from the pregnancy, however, all six embryos must have implanted and one of the six clearly divided in two inside the uterus. Her doctor, Dr Kamrava, is now under investigation by the Medical Board of California. Some fertility doctors believe that Dr Kamrava has broken the ethical codes of his profession and by so doing, endangered the health of his patient and her babies. Other fertility specialists argue that a doctor has no right to dictate to a mother how many children she can have.
Dr Kamrava is considered by some fertility specialists to be a somewhat controversial figure. He has worked to develop a new method of transferring fertilised embryos or eggs and sperm directly into the lining of the uterus, supposedly giving the embryo a better chance of successful implantation. As yet, it isn't known whether or not this method was used in Ms Suleman's case. A report has been published on the activities of Dr Kamrava's clinic in 2006. He performed 20 IVF procedures, of which two resulted in births, one of which produced twins. On average, he transferred 3.5 embryos per procedure. On first glance this would seem to exceed the recommended number, however, this is only an average figure and other fertility specialists have advised against judging Dr Kamrava before all the facts are known - there may have been exceptional circumstances.
The Octuplets' Future
All eight of Nayda Suleman's babies have survived and, at the time of writing this article, some of them have even been sent home from hospital to live with her and her other children. Whether or not their future development will be affected by their multiple birth remains to be seen. Ms Suleman is believed to have the support of her parents and is receiving help from the public authorities in the rearing of her very large family. There is no doubt that the octuplets will have to get used to life in the public eye. Their story provides much food for thought for couples considering or undergoing IVF treatment. If this is you and you have concerns about multiple pregnancy, speak to your fertility specialist.