Feb. 10, 2009 - As the mother and grandmother of the two-week-old California octuplets squared off on competing morning talk shows this week, infertility specialists continue to voice their dismay over the fertility treatment that led to the birth of the eight babies.
In an interview that aired on NBC's Today show, Nadya Suleman, 33, said her fertility doctor did nothing wrong by transferring six embryos into her womb when she had already given birth to six babies through in vitro fertilization (IVF).
Suleman's mother, Angela Suleman, says she disagrees with her daughter's decision to undergo the treatment that led to the birth of the octuplets. She called her daughter's actions "really unconscionable" in an interview that aired on ABC's Good Morning America.
Infertility specialists have their own views. Many have been deeply critical of the fertility doctor who treated Suleman.
On Feb. 6, the Medical Board of California announced plans to investigate the fertility doctor who treated Suleman. The board did not identify the doctor, but the Today show identified the clinic as the West Coast IVF Clinic in Beverly Hills, Calif.
"I am deeply disappointed that any fertility clinic in the United States, or anywhere, would do this," says Colorado reproductive endocrinologist Eric Surrey, MD, who is a past president of the Society for Assisted Reproductive Technology (SART).
"There may be a medical justification, but I can't think of one, and I've been doing this for 20 years," he tells WebMD.
Nadya Suleman's View
Suleman, who is unmarried, unemployed, and living with her parents, told NBC's Ann Curry that she knew there was a risk of multiple births if she had all six of her remaining frozen embryos transferred at one time.
But she said she did not believe it would happen because she had so many fertility problems, including severe endometriosis and scarred fallopian tubes.
All six embryos did implant, however, and two apparently split, resulting in eight babies.
"The most I would have ever anticipated would have been twins," she told Curry. "It wasn't. It was twins times four."
She said with her medical history, she considered it "very appropriate" for her doctor to transfer so many embryos.
"He did nothing wrong," she said.
But Atlanta infertility doctor Mark Perloe, MD, of Georgia Reproductive Specialists, strongly disagrees.
He points out that her chances for a successful pregnancy were actually very good, considering her young age and the fact that she had -- by her own account -- four previous successful single-birth pregnancies and one twin pregnancy resulting from IVF.
Guidelines for Embryo Transfers
Fertility treatment guidelines call for women under 35 who have favorable chances for a successful pregnancy to have no more than two fresh embryos transferred. Suleman's embryos had been frozen, but there was still no justification for transferring more than two or at most three, Perloe says.
"There was a breach of ethical propriety here that was absolutely staggering," he tells WebMD.
Perloe even questions the ethics of treating Suleman at all. "I would not agree to treat a single mom on disability with six small children at home already."
SART and the American Society for Reproductive Medicine (ASRM) developed embryo transfer guidelines several years ago in an effort to reduce the number of high-order pregnancies, defined as triplets or more.
The guidelines make it clear that high-order pregnancies are an undesirable consequence of infertility treatment because of the extreme risk to the mother and her babies.
As a result of efforts to restrict the number of embryos transferred during IVF, the rate of high-order multiple births has been declining in the U.S.
"I would hate for the public to get the sense that this story is representative of fertility care," Surrey says. "It is a gross aberration. High-order pregnancies are now relatively rare, precisely because we have addressed this issue."
At Massachusetts General Hospital the standard practice is to transfer just one embryo at a time in women who are considered to have good chances of successful pregnancies.
Mass General chief of reproductive medicine John Petrozza, MD, tells WebMD that thanks to this practice the multiple pregnancy rate at the institution is now among the lowest in the country.
"We want to minimize high-order pregnancies because of the very real danger of premature delivery, low birth weight, and all the problems that go along with them," he says.
Medical Concerns for Multiple Births
Medical problems associated with preterm high-order pregnancies can include cerebral palsy, life-threatening respiratory problems, intestinal problems, developmental delays, and learning disabilities.
Surrey says the likelihood of an adverse outcome due to low birth weight and premature birth is seven times higher for twins that for single-gestation babies and 14 times higher for triplets.
The eight California babies are all breathing on their own, which is a very good sign, but they were a full 10 weeks early at the time of their birth and weighed between 1.8 and 3.4 pounds.
Multiple-birth experts say it may be years before the extent of their medical issues are known.
Maureen A. Doolan Boyle, who is the mother of triplets and the executive director of the organization Mothers of Super Twins (MOST), tells WebMD that the average gestational age for triplets is 33 to 34 weeks and the average gestational age for quadruplets is 31 weeks.
A normal pregnancy lasts about 40 weeks. Babies born before 37 weeks are considered preterm.
She says even premature babies who appear to be quite healthy often have long-term problems and developmental and learning challenges.
"Any baby born before 37 weeks should be followed for developmental milestones up until they start school," she says.