Sherman Silber, MD, Director of the Infertility Center of St. Louis at St. Luke’s Hospital

How to Prevent Another Octomom

By Aisha Sultan
St. Louis Post-Dispatch, February 28, 2009

Up until now, I've been pretty glad our government doesn't dictate who can have a baby or how many babies we're allowed to have.

Then along came Octomom. That's the media's moniker for Nadya Suleman, the California single mother who recently bore octuplets, after having six small children already at home. She has touched a nerve so sensitive that even her publicity firm has dropped her as a client. Death threats have sent her into "an undisclosed location."

Octomom is the infertility world's perfect storm: How could this have happened?

There is not a lack of regulation of infertility clinics. A federal law requires that they report in vitro fertilization pregnancy rates, their success and failure stats, to the Centers for Disease Control and Prevention every year. There are voluntary guidelines suggested by professional medical associations, such as the American Society for Reproductive Medicine. And there are five agencies including the FDA, SART, CAP, CDC, and CLIA, that regulate IVF centers. But the reporting requirement is ironically the major cause of the problem.

Industry guidelines state that no more than two embryos should be implanted in a healthy woman her age. Despite Suleman's six other young children. Despite her questionable mental status and reliance on food stamps to provide for those children. We've never said poor people cannot have children. That isn't the issue here.

But infertility specialist Dr. Sherman Silber, of the Infertility Center of St. Louis, says: "Transferring so many embryos in a young woman like that is absolutely criminal." Dr. Silber also says he is sure the quadruplet pregnancy in a 50 year old woman is from transferring too many young, fertile, donor eggs.

A quad pregnancy for a 50-year-old woman could be a death sentence for her — and a serious risk for her offspring — given the extreme health risks, Silber said.

"I stay out of the ethical, psychological, cultural debate. It can really be very, very confusing," Silber said. "But, it's pretty clear on the issue of medical safety: Women should be having one at a time — at most, two."

Silber says the mandated reporting system for fertility clinics is fundamentally flawed: Some clinics with poor results will try to up their odds of "success" — pregnancy — by transferring unsafe numbers of embryos. Furthermore, the failure of insurance companies to cover IVF prompts women to push their doctors into transferring more embryos than are safe because they cannot afford another IVF cycle and feel an urgency to increase their pregnancy rate.

Silber says he supports a law restricting the number of embryos transferred in a single cycle — but insurance companies should provide coverage for treatment. Then the patient would not feel the need to pressure her doctor into transferring too many embryos, and the insurance company could put a restriction on how many embryos are transferred.

A limit on embryo transfers is common sense. It is accepted, sound medical practice at reputable clinics. Silber says, "The whole dilemma for infertile women could be solved if insurance would cover IVF but limit the numbers of embryos transferred. This would actually save the stupid insurance companies money, and prevent these dangerous multiple births."

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