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In the U.S., where one IVF cycle can cost upwards of $12,000, women who have to pay out of pocket may not be able to afford to try and try again. And if physicians are pushed to transfer more embryos? "Doctors' attorneys are advising them, 'You have to do it,'" says ASRM spokesman Sean Tipton. "The courts have made clear that decisions about what to do with embryos are in the hands of patients, not in the hands of physicians."
If moms of multiples were to approach Stillman for more reproductive assistance, he says, he'd be obligated to help. "As a parent of two kids, I may think they're crazy, but I'd tell them what I always tell patients: Our goal here is as many children as you want, but preferably one at a time." (Read "The Year in Medicine 2008: From A to Z.")
Arthur Caplan, a medical-ethics expert at the University of Pennsylvania, takes issue with that stance. It's O.K. for doctors to say no, he says; they do it all the time. Some surgeons, for example, won't insert breast implants in women under 18. "Medicine is not a restaurant, and doctors are not waiters," Caplan says. "They don't take orders from patients."
Some fertility specialists worry that Suleman's octuplets--only the second set in U.S. history--will lead to calls for a system like the one in England, where reproductive medicine is overseen by a government agency that can revoke a doctor's license or close a clinic and sets age limits for fertility treatments. "Would we write laws limiting the size of someone's family to six?" asks Richard Paulson, director of the fertility program at the University of Southern California. "Would we write laws mandating selective reduction?" he asks, referring to the option of aborting some embryos if a high number of them successfully implant in the uterus.
The answer may partly depend on Suleman. She has yet to divulge who helped her get pregnant with the octuplets. But she has hired a p.r. firm and is rumored to be weighing seven-figure offers for her first televised interview. Her publicist, Joann Killeen, told reporters, "As soon as she's able, she will tell her story, and it's an amazing story." Doctors, moms and ethicists are all ears.