Birth of Octuplets Raises Questions

The Washington Times (Washington, DC), March 8, 2009 | Go to article overview

Birth of Octuplets Raises Questions


Byline: Dr. R. Dale McClure, SPECIAL TO THE WASHINGTON TIMES

Like most observers all over the country and indeed the world, I was disturbed by the news of the octuplet birth in Southern California. The problem was compounded by the unsettled situation of the mother and the number of children she already had. Regardless, a pregnancy with eight human babies is a medical failure, even when it ends with all eight infants surviving. It is difficult to discuss some aspects of this case because we don't know the facts. We can't even say the regulatory system failed because the incident is still under investigation and we don't know what the final sanctions will be. But I can offer some perspective on the medical issues raised by this case.

The most important medical fact to consider is that the occurrence of any multiple pregnancy after an IVF cycle is undesirable. High-order multiple pregnancies are particularly problematic because they bring with them high risk of prematurity, birth defects and long-term disabilities. Thanks to surveillance data first collected by the Society for Assisted Reproductive Technology (SART) in 1988 and by the Centers for Disease Control and Prevention (CDC) since 1995, we can track the number of births resulting from assisted reproductive technology (ART) treatments.

Until 1996, we were seeing an increase in the number of high-order multiple births. Recognizing that increase and understanding the consequences, SART and its parent group, the American Society for Reproductive Medicine, moved to address the problem.

Starting in 1998, we issued guidelines on the number of embryos to transfer in ART procedures. In the subsequent 10 years, we have revised those guidelines downward four times to the point where current guidelines for women under 35 with a good prognosis encourage single embryo transfer and only allow the transfer of more than two embryos in less than favorable circumstances.

It is very clear that these guidelines have worked. Articles have been published in prestigious medical journals that attest to their effectiveness. In addition, everyone can go to the SART Web site (www.sart.org) and see that the triplet rate has dropped from more than 6 percent of all IVF cycles in 2003 to only 1.8 percent in 2007. We are pleased the data allowed us to issue and revise these guidelines, gratified our members complied with them and proud of the resulting drop in triplet and higher births.

Looking at these outcomes, it is evident that the vast majority of U.S. physicians performing IVF have acted with the best interests of their patients and babies in mind seeking to maximize the chance of success while reducing risks associated with multiple pregnancy. The determination of the precise number of embryos to be transferred is a highly personalized decision made between patients and their physicians. When making a recommendation, the physician takes into account the diagnosis of the patient, her age, her prior experiences with medical treatment and the quality and quantity of embryos available.

As you can imagine, this is a very complex decision that must be individualized for each patient each time she seeks treatment. It simply does not lend itself to blanket regulations for all patients in all circumstances. A government mandate dictating the same treatment for all women in all circumstances would be bad medicine and an unprecedented intrusion into the patient-physician relationship. …

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