The Suleman octuplets: What can an aberration teach us?

Stillman, Robert J.

doi:10.1016/j.fertnstert.2009.12.012

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…As noted, the BOctomom^incident placed US fertility practices under the microscope [14,[27][28][29]70]. Yet, updated 2009 ASRM-SART guidelines made no alteration to the number of embryos recommended for transfer [71].…”

Section: Usa: 20 Years Of Embryo Transfer Guidelinesmentioning

confidence: 99%

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

White

2017

J Assist Reprod Genet

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In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple-birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father, went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multiple-embryo transfers in the context of US surrogacy arrangements.Offering an original analysis of data obtained from the US national-assisted reproduction registry, it examines singleand multiple-embryo transfer trends over a 12-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in fewer than 42% of the cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemented.

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Section: Usa: 20 Years Of Embryo Transfer Guidelinesmentioning

confidence: 99%

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

White

2017

J Assist Reprod Genet

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“…When we abrogate our responsibility to educate, an uninformed patient's autonomy can lead them to seek multiple gestation (Stillman et al, 2009;ASRM/SART, 2012). Let us remember the role physician acquiescence played in actualizing the octuplet birth following Nadya Suleman's exercise of her autonomy (Stillman, 2010).…”

Section: Informed Consentmentioning

confidence: 99%

“…In 1997, Faber challenged our field stating, 'In the practice of advanced reproductive medicine we have progressed from the miracle baby to the day of the litter' (Faber, 1997). His words were prescient of mediafrenzied aberrations like Octomom (Stillman, 2010). Transfer of multiple embryos became open to critique as implantation rates continued to improve and more higher order multiple pregnancies (triplet or higher plurality) resulted (Templeton, 2000;Jones and Schnorr, 2001;Alper, 2004), subjecting a significant and growing number of women and their children to the much higher morbidity and mortality associated with such pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Refuting a misguided campaign against the goal of single-embryo transfer and singleton birth in assisted reproduction

2013

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Much recent progress has been made by assisted reproductive technology (ART) professionals toward minimizing the incidence of multiple pregnancy following ART treatment. While a healthy singleton birth is widely considered to be the ideal outcome of such treatment, a vocal minority continues a campaign to advocate the benefits of multiple embryo transfer as treatment and twin pregnancy as outcome for most ART patients. Proponents of twinning argue four points: that patients prefer twins, that multiple embryo transfer maximizes success rates, that the costs per infant are lower with twins and that one twin pregnancy and birth is associated with no higher risk than two consecutive singleton pregnancies and births. We find fault with the reasoning and data behind each of these tenets. First, we respect the principle of patient autonomy to choose the number of embryos for transfer but counter that it has been shown that better patient education reduces their desire for twins. In addition, reasonable and evidentially supported limits may be placed on autonomy in exchange for public or private insurance coverage for ART treatment, and counterbalancing ethical principles to autonomy exist, especially beneficence (doing good) and non-maleficence (doing no harm). Second, comparisons between success rates following single-embryo transfer (SET) and double-embryo transfers favor double-embryo transfers only when embryo utilization is not comparable; cumulative pregnancy and birth rates that take into account utilization of cryopreserved embryos (and the additional cryopreserved embryo available with single fresh embryo transfer) consistently demonstrate no advantage to double-embryo transfer. Third, while comparisons of costs are system dependent and not easy to assess, several independent studies all suggest that short-term costs per child (through the neonatal period alone) are lower with transfers of one rather than two embryos. And, finally, abundant evidence conclusively demonstrates that the risks to both mother and especially to children are substantially greater with one twin birth compared with two singleton births. Thus, the arguments used by some to promote multiple embryo transfer and twinning are not supported by the facts. They should not detract from efforts to further promote SET and thus reduce ART-associated multiple pregnancy and its inherent risks.

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The Suleman Octuplet Case and Egregious Ethical Breaches

Rosenthal¹

2011

Women's Health Issues

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The Suleman octuplets: What can an aberration teach us?

Cited by 6 publications

References 17 publications

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

Refuting a misguided campaign against the goal of single-embryo transfer and singleton birth in assisted reproduction

The Suleman Octuplet Case and Egregious Ethical Breaches

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