The Octuplet Debacle: Where do we go from here?

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by Geoffrey Sher, MD

The entire debacle surrounding the IVF “Octuplets” raises serious ethical issues. .At the same time, it sounds an alarm that it is time for all well intended people involved in Reproductive Health Care, to take action.

The situation itself is nothing short of outrageous. Not only does it represent an example of “medical science gone wild”, but it evokes the concern about the unregulated field of Reproductive Medicine and asks the question, “Is this field on the verge of being out of control.” There can be no pussy-footing around the fact that the Hippocratic Oath which binds physicians to “do no harm” was ignored in this unfortunate case.

Most women going through IVF are desperate to have a baby and many are even willing to cast safety to the wind, abandon all cautions, and virtually do anything it takes to achieve success. Such women are highly vulnerable to the (fortunately) few reckless medical practitioners who might exploit such desperation.  
The problem with high order multiple births (triplets or greater) is that in about 50% of such cases the severe premature births that commonly occur in such cases, result in death or severe developmental complications such as cerebral palsy, psychomotor retardation, blindness and mental retardation; conditions which severely compromise the quality of life after birth and lead to devastating financial, social and societal hardship.

There is undoubtedly an urgent need to protect uninformed IVF consumers from the few reckless IVF physicians who are willing to transfer of large numbers of embryos simply to improve pregnancy rates at any cost. It is such deplorable practice has led to a virtual explosion in the incidence of IVF-induced high order multiple births. What is urgently needed is stringent enforceable regulations that limit the transfer of numerous embryos, especially to younger women (under 35 years) where the incidence of high order multiple pregnancies is the highest.

Many countries outside the United States already limit the number of embryos that are allowed to be transferred and it is time that we step up to the plate as well.

The recent introduction of genetic tests such as comparative genomic hybridization (CGH) allows for the identification of those embryos that are most likely to propagate a viable pregnancy. With these new methods that can more than double the IVF baby rate per embryo transferred, we can approach IVF with the goal of one embryo – one baby.  Yes, the time is fast approaching that the transfer of but one (1) embryo will result in one healthy baby more than 60% of the time. Indeed such genetic embryo markers that can improve the efficiency of the IVF process reduce miscarriages and minimize the risk of chromosomal birth defects such as Downs Syndrome could provide a “better way” to help patients safely build their families successfully.

No physician seeks to limit the freedom by which he or she practices medicine. On the other hand, when outrages such as this occur, it is time to go back to the drawing board to re-examine and revamp existing policies so as to avoid similar catastrophes from occurring in the future.
GEOFFREY SHER MD
SHER INSTITUTE FOR REPRODUCTIVE MEDICINE (SIRM)

Please feel free to send us your comments. We may publish them in our next newsletter.

Dr. Sher is an active member of the board of directors of INCIID. He is an avid advocate for ethical treatment of patients. Dr. Sher helped INCIID launch the From INCIID the Heart Scholarship Program in 2004 and remains an  active participant. He is an outspoken advocate for women and their families in their quest to become parents.

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