- The Washington Times - Saturday, February 21, 2009

NEW YORK (AP) | The California fertility doctor who implanted the octuplet mom with a large number of embryos was no lone wolf: Fewer than 20 percent of U.S. clinics follow professional guidelines on how many embryos should be used for younger women.

“Clearly, most programs are not adhering to the guidelines,” said Dr. Bradley Van Voorhis, director of the fertility clinic at the University of Iowa.

The furor over Nadya Suleman and her octuplets has brought scrutiny to U.S. fertility clinics and to how well they observe the guidelines, which are purely voluntary. The controversy had led to talk of passing laws to regulate clinics, something that has already been done in Western Europe.

“There are enough clinics that quite openly flout professional guidelines that we really do need to start thinking about public policy in this area,” said Marcy Darnovsky of the Oakland, Calif.-based Center for Genetics and Society. “I think it’s way overdue.”

The 20 percent figure is contained in reports filed by clinics with the Centers for Disease Control and Prevention.

Fertility doctors say there are many reasons clinics skirt the guidelines: pressure from patients who want to use more embryos to improve their chances of getting pregnant; financial concerns from those who are paying for their treatment out of their own pockets; and the competition among clinics to post good success rates.

The only penalty for violating the guidelines is expulsion from some of the industry’s professional organizations, though that can affect whether insurance companies will cover a clinic’s treatments.

“You have patients who are desperate and you have doctors who are driven by success rates. It’s not a good combination,” said Pamela Madsen, founder and former head of the American Fertility Association.

When the guidelines were issued in 1996 by the American Society of Reproductive Medicine, the intent was to reduce the number of multiple births, particularly triplets and higher, that can result when many embryos are implanted and more than one takes. Big multiple births can lead to disastrous, life-threatening complications, lifelong disabilities such as cerebral palsy, and crushing medical costs.

The guidelines suggest how many embryos doctors should use, with the number varying by age and other factors. They also allow for some flexibility for more if previous attempts have failed or the embryo quality is poor.

“These decisions are complex and need to be individualized, which is why we strongly believe that guidelines are better than hard rules,” said Dr. David Adamson, a former president of the reproductive medicine society.

The group credits the guidelines with reducing triplets and higher multiple pregnancies from 7 percent of attempts to 2 percent in 2006. Nearly two-thirds of the procedures involved four or more embryos in 1996; that has fallen to 16 percent.

But for women under 35, government records show that just 83 of 426 clinics followed the guidance calling for one and no more than two embryos. The average for fresh embryos (as opposed to frozen) implanted in women in that age group ranged from a 1.4 to 4.8. The vast majority of the clinics averaged between two and three embryos.

Dr. Mousa Shamonki, director of the IVF program at the University of California, Los Angeles, said his patients frequently ask for more embryos to boost their chances of getting pregnant, which he discourages.

“The only thing that happens when you add additional embryos is you’re increasing the multiple pregnancy rate,” he said. “You’re rarely increasing the overall pregnancy rate significantly.”

Fertility specialists have attacked Dr. Michael Kamrava for putting so many embryos into Ms. Suleman, 33, who has said she had six embryos implanted; two presumably split. Dr. Kamrava has declined requests for interviews.

The reproductive medicine society and the Medical Board of California are looking into the case.

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