Octuplets Mother Speaks Out

Nadya Suleman, mother of the recent octuplets born in California, has done her first interview with a major news outlet. (Although Suleman was seeking USD 2 million for the interview, NBC maintains that they did not pay her. However, that doesn't rule out "compensation" in other forms.)

Unfortunately, Suleman's interview has continued to raise, rather than answer, questions. Foremost among them, for me, is her claim that she had six embryos implants per IVF procedure. This... simply does not ring true. Or at least plausible, if she was using a US fertility expert.

Consider this: in order to have done so, this means Suleman would have needed to find, at age 26, a fertility doctor who would implant six embryos. ASRM guidelines are no more than 3 embryos for a woman under the age of 35, and that's if she has a history of problems with conception. With a 'clean' history, only 2 embryos are recommended. Now, it sounds like Suleman might have qualified as having difficulty conceiving, with several ectopic pregnancies and miscarriages prior to IVF. But even accounting for that, it's double the recommended standard. For each pregnancy.

But stop to do the math. While one vial of donor sperm would be more than enough for all of this, it means that they collected at least 36 eggs from Suleman, and that all of those eggs were viable enough to implant once fertilized. Realistically, not every egg retrieved is going to be mature, and not every egg is going to fertilize (unless you're using something like ICSI). Realistically, you're looking, at the very least, at 1/3rd more eggs than that being pulled out (and even that is a very, very low number - remember, they're saying that there were six viable eggs to implant per cycle. A quick web search shows that 1/3 of the eggs removed at any time are not mature, and of the ones that are mature, only half reach the point of being "good enough" to implant).

Now let's go over to CDC stats. While the last data is from 2005, which was going on 5 years ago, Suleman started her IVF course in 2001, so some of this data is specifically applicable (and some of it only extrapolation). According to the CDC, only 35% of ART cycles resulted in a pregnancy, and of those, 82% resulted in a live birth. So again, Suleman seems to have defied the odds. A lot. And as the CDC says about frozen eggs, "[b]ecause some embryos do not survive the thawing process, the percentage of thawed embryos that resulted in live births is usually lower than the percentage of transfers resulting in live births." While only 15% of embryos transferred were frozen, of those 15%, only slightly more than 1/4 ended up in live births.

Again, the odds make this seem incredibly unlikely.

Finally, fertility clinics are required by law to report their ART data, under the Fertility Clinic Success Rate and Certification Act. This gives us a decent way of tracking ART results - and also who is doing ART. In 2005, eleven clinics in California did not report their ART data (which would include embryo transfers/live birth data/etc). Of those eleven places, it looks like seven were within an hour of her home (keeping in mind her back injury likely limited the distance she could travel). Of the clinics that did report their data, 35 are within an hour of Whittier, California. However, given these clinics are compliant with reporting their data, it seems safe to eliminate them from immediate suspicion. (As for the potential Mexcio connection, Tijuana is approximately two hours away. Certainly not out of the question; an hour was a random number drawn from thin air. Suleman has certainly shown herself to be willing to go to significant length, and pain, to achieve her goals.)

All in all, what does this mean? Not much. Over 300 pages of records on Suleman have been released to the press, under a public records request to California's Division of Workers' Compensation. While it doesn't appear that the fertility clinic (or doctor) that treated her is in those records, there is ample evidence to support that she did have problems conceiving, and that she had known psychiatric issues, including what was diagnosed as either postpartum depression or PTSD. Issues that should have limited, if not prevented, future implantations.

Ultimately, until Suleman names her doctor, or said doctor speaks out, little will be conclusively known. But the facts remain simple: the facts do not add up.
-Kelly Hills

We’ll take only one baby please…

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?