Fertility clinics are round-the-clock operations, with women coming and going seven days a week for estrogen-monitoring and egg retrieval. The weekend after a California woman gave birth to octuplets, traffic was steady at the Duke Fertility Center in Durham, N.C. Susannah Copland, who oversees Duke's in vitro fertilization (IVF) program, was on call and noticed that "everyone was buzzing about the octuplets." Some patients were shocked, others unnerved. "I don't want eight babies," they told her. "And we don't want you to have eight babies," she responded.
How Nadya Suleman, 33, became pregnant with octuplets is the subject of rampant speculation. Her mother has indicated that the preemies are the result of IVF treatment, a confounding thought from both a parent's perspective--Suleman already has six children under the age of 8--and a physician's. In June, just about the time those eight babies began growing inside her womb, the American Society for Reproductive Medicine (ASRM) issued updated guidelines on the number of embryos that should be transferred to a woman's body in the hope they'll implant in the uterus and lead to a live birth. Women under 35 should transfer no more than two embryos, down from the maximum of three recommended in 1998, and women over 40 should attempt no more than five. (See the top 10 medical breakthroughs of 2008.)
These are guidelines, however, not laws. And until Suleman discloses how the octuplets came to be (via fertility drugs? IVF? embryos splitting into multiples in utero?), the mere possibility of a doctor's transferring a large number of embryos to a relatively young patient--an unmarried mom raising four singletons and a set of twins--has put fertility specialists on the defensive as they try to counter the perception that theirs is an undisciplined, irresponsible profession. "The word cowboys comes to mind," says Robert Stillman, medical director at Shady Grove Fertility Center in Rockville, Md., the country's largest fertility clinic.
But he and other fertility doctors contend that reproductive medicine is among the most regulated specialties in the U.S. Clinics have to report to the Centers for Disease Control and Prevention the number of embryos transferred in each IVF cycle--in which sperm and egg are fertilized outside a woman's body then transferred to her uterus--as well as the resulting number of live births. This reporting system was set up to help potential patients assess their chances of having a baby but has evolved into a way to monitor a clinic's number of triplets and higher multiples, who are more likely to have serious health problems.
As IVF success rates have increased, the average number of embryos transferred has gone down, from 3.9 in 1996 to 2.4 in 2005. Single-embryo transfers are now recommended in many cases; generally, the younger the patient, the likelier it is that an embryo will implant. A recent article in the journal Fertility and Sterility even suggested recasting how fertility clinics view outcomes: a singleton birth should be considered a success, triplets a failure.