State licensing boards must rein in free market fertility
Celebrity news website TMZ released this picture of a very pregnant Nadya Suleman, who gave birth to octuplets last month in California.
Last month, 33-year-old Nadya Suleman gave birth to octuplets in a California hospital. The eight babies — and their six older siblings, the oldest of whom is 7 — were the result of infertility treatments.
Ms. Suleman’s pregnancies raise troubling questions whose implications are at once both deeply personal and broadly societal.
Babies already have been conceived to donate bone marrow to a seriously ill sibling. Now, clinics are advertising their skills at sex selection, allowing prospective parents to choose a boy or a girl.
A Los Angeles clinic announces “the pending availability” of testing to achieve “a preselected choice of . . . eye color, hair color and complexion.”
Such practices raise profound questions as remarkable technological advances have, at times, leapt far beyond ethical guideposts.
In the case of the octuplets, Ms. Suleman has said that Dr. Michael M. Kamrava, a Beverly Hills, Calif., infertility specialist, implanted six embryos, two of which later split into twins.
Guidelines by the American Society of Reproductive Medicine say doctors should implant no more than two embryos in women under the age of 35.
Infertility medicine is a fiercely competitive business. Federal officials publish clinic success rates that many prospective parents use to shop for doctors.
Dr. Kamrava had a relatively low success rate. He achieved just five pregnancies from 61 procedures during 2006, the most recent year for which numbers are available. Only two resulted in births — one of them was a pair of twins born to Ms. Suleman before she got pregnant with the octuplets.
Dr. Michael Kamrava performs an ultrasound on Nadya Suleman in an image from a 2006 interview with KTLA TV.
The more embryos that are implanted, the greater the odds of success, which is good for business. But more embryos also increase the odds of multiple births, which put mother and babies at risk.
Pregnancies with three or more babies are much more likely to end prematurely. Premature babies are more likely to need expensive medical care.
Ms. Suleman, who is unemployed, apparently paid for her infertility treatments with money from disability payments. The treatments cost $12,000 or more.
The Kaiser Permanente hospital, where her octuplets were born, reportedly has billed MediCal, California’s Medicaid program, for the costs of their births.
One study found that fewer than 20 percent of infertility clinics perform psychological testing on prospective patients. Almost none make home visits, as an adoption agency would before placing a child. Ms. Suleman and her six children were living with her parents, who had filed for bankruptcy, before the octuplets were born.
Much as we love to hate them, insurance companies play an important role in health care. By spelling out what they cover and when, insurance companies encourage quality care and enforce ethical boundaries.
Hospitals probably would be happy to play a similar role, since that’s where risky multiple births take place.
But many fertility clinics aren’t associated with hospitals. And infertility treatment isn’t covered by insurance. The market, with a few broad federal or state guidelines, sets the rules.
Patients and doctors alike have been reluctant to change that, and with good reason. There’s something profoundly troubling about the idea of government deciding who should, or should not, become parents.
But there’s also something troubling about Ms. Suleman’s story. And about advertising that encourages parents to shop for a child’s “eye color, hair color and complexion” as if they were a buying a dress or a car.
If the market can’t regulate itself, someone else has to step in. That’s a role state medical licensing boards should fill. California authorities reportedly now are investigating Dr. Kamrava.
It won’t be an easy case, but it’s a crucially important one.
Doctors who put patients’ lives at risk by implanting too many embryos deserve censure — or more — just as much as those who endanger patients by incompetence or addiction. It’s
This only just adds to my positive view of this woman.