The California Octuplet Story will fade soon enough. For now, I think it provides an excellent opportunity for the zoom lens on an industry that carries a great weight silently on its shoulders.
From the outside, reproductive medicine might appear like a bonus-filled health care vocation: the possibility for financial reward, mostly scheduled routines with little gore, the facilitation of creating lives that are powerfully desired...
Now and then, though, a story like The Octuplets comes along and reminds us that repro med exists in a swirl of unanswered society-altering questions. If perpetually standing firm on basic hard ground is what you long for, reproductive medicine ain't the place to be.
Here's a paragraph from the blog of Dr. Samuel Wood in San Diego, in which he candidly spells out what many fertility patients know and often keep hidden from their 'fertile' friends, John & Jane Q. Public:
Virtually every physician has been asked to prescribe medications or perform procedures that are clearly not in a patient’s best interests or are outside acceptable medical practice. Frankly, it's routine in our practice. A significant percentage of those undergoing treatment through IVF request that we transfer an inappropriately large number of embryos, because they want to "make sure" they get pregnant, and because they have previously failed so many time on their own. Their concern is not multiple pregnancy, but becoming pregnant at all. It is the physician’s responsibility to provide a patient with only those treatment options that fall within the standard of care for the condition they are treating. Under such circumstances, even obtaining “informed consent” from the patient does not eliminate or even diminish the physician's responsibility.
If I had a dime for every patient overheard uttering they'd "love" to have twins... But besides that group, there are far more people who simply will risk much for anything they can get.
(My opinion is these are often people who have never had the chance to conceive or who have never carried a pregnancy to term. They are also not the folks who have adopted or are fostering children and are still wanting to conceive a biological child. My personal experience (and for the record, I did not use IVF) was that once I had my own desire -- the birth of a healthy genetically-related child -- fulfilled, thoughts about avoiding risks to his health and well-being or the same of any other child's became paramount. Like nearly any parent, after having my own child I could easily say that I would sacrifice my own happiness for his well-being. But I digress...)
Perhaps obviously (and only more facts on the case will tell the real tale), we're not talking about Nadya Suleman here. Hers is a psyche with which I am not familiar. I think.
It's not entirely the fault of baby-crazed fertility patients.
Just this week, I had the opportunity to talk to Dr. Robert Stillman of Shady Grove Fertility (yes - full disclosure - I write for them) about the huge retrospective study they conducted and that is available online in the journal Fertility & Sterility. The study didn't just say that elective single embryo transfer (eSET) is good and viable treatment that doesn't have to impact a clinic's bottom-line stats. The results also led to a clear interpretation that the more a patient has to pay for their IVF treatment (:::nudge nudge in the ribs to insurance companies:::), the more likely that patient is to lean with less caution toward upping their odds of success with each cycle.
That is to say if I, Patient Wanna-Baby-Bad, have typically limited cash and/or typically limited insurance coverage, I'm going to follow this typical path:
(a) Because my insurance policy says I must, I'll first try superovulation with mega fertility drugs plus intrauterine insemination (IUI, y'all) as many as three times before going for the safer and better bet of IVF.
(b) And if I don't have any insurance coverage at all, I'll aim for the big guns of IVF and try to talk my doctor into transferring the max (or more) number of embryos recommended because, after all, it's the last batch of $12k I've got on hand.
So, Nadya Suleman's story -- even before we've heard it all -- is revealing things about this fascinating field of creating life that a lot of people don't know. Many of them are sharing their ignorant, harsher viewpoints in caustic and sometimes downright hate-filled responses to blogged news items. I won't even bother to post a link to them here. More muck and mire is not what's needed here.
I'm not sure legislated regulations are necessary either. What is needed -- the faint thread that has always wound through reproductive science and its clinical practice -- is individual clarity by professionals about the tasks at hand, expanded transparency of reporting on clinic practices, and continuing education of the public -- that is, health care consumers -- about the notion (oft-cited in professional ethics realms) that 'just because we can, doesn't mean we should.'
