With the births of octuplets to Nadya Suleman -- the California woman in whom six embryos were implanted, one of which split, and who is already the mother of six young children -- concerns about fertility treatments have suddenly become a hot-button issue.
Such has been the case for some time, but in Suleman's situation, there is the issue of asking to be implanted at all; the moral question of her acting responsibly; the morality of her doctor's actions in implanting so many embryos; the health of the babies, several of whom face developmental challenges; and the problem of who will take care of the babies' needs -- and who will pay for that care?
Suleman, who's been labeled "Octo Mom" -- a rather unkind and cutting nickname -- has said publicly that as an only child, she always felt lonely, and as such, wanted a large family of her own.
Is this a good reason to have so many kids, especially as a single parent?
"Medical psychiatry is the way we think about having the capacity to make decisions -- and if somebody doesn't seem to make a decision that makes sense," said Deborah Kim, a specialist in women's mental health and an attending physician in the University of Pennsylvania psychiatry department.
"Generally, when someone requests something unorthodox or not normally requested, that person should be evaluated. The issue in this case is having the rationality to manipulate the information -- a process that could have been affected by depression, obsession or psychosis.
"It's really impossible to tell in this particular case, but, in any such case, it's really on the doctor" to notice key problems.
With regard to the ideal attached to the idea of fertility treatments, Martin Freedman -- a board-certified reproductive endocrinologist aligned with Northern Fertility and Reproductive Associates that has offices in Willow Grove, Blue Bell and Center City -- said: "Most doctors go for one pregnancy; a perfect scenario would be to have a single-term pregnancy on every occasion. However, people will accept twins, [though] the births can be premature."
He said that he didn't know of any fertility clinic in the Philadelphia area that would have gone along with the treatments given to Suleman.
Fertility doctors, he explained, "have a moral responsibility to show an ethical standard of care, [and] should take that responsibility very, very seriously, and never violate patient trust," as well as "do the appropriate number [of implants], based on the woman's age."
In U.S. clinics, the invitro-fertilization success rate for women younger than 35 is 50 percent to 60 percent -- about 50 percent when women are between 35 and 38, and 25 percent to 30 percent for women 39 to 49 years old, according to Freedman, an attending physician in the department of obstetrics and gynecology at Thomas Jefferson University Hospital, and a fellow at the American College of Obstetricians and Gynecologists.
"It's an age-based success rate, since as a woman ages so do her eggs," he remarked.
Freedman said that after a consultation with any couple, the most that he and his associates will do is three.
"From day one, we lay out all of the ground rules, including a consideration of the woman's age. If a couple decides on three implants, for example, they must understand all of the options and risks. When all three implants take, that's a serious outcome."
There is no law anywhere in the United States that governs fertility treatments, he stated, only recommendations from the American Society of Reproductive Medicine.
"It's estimated that up to 15 percent of married couples, one in six or seven couples, have a problem conceiving, so it's a pervasive problem, but our science and technology have taken us to a place we could never have dreamed of. It can be a bad thing [to] lose sight of the ideal goal."
Said Arthur Kaplan, the prominent bioethicist at Penn: "People have been quick to criticize the mom [Suleman] in this, but that's not a good thing. All of the signs are there that she has some issues, such as that she's even competent. How did she even become a patient? It was completely and utterly wrong for the doctor in question to do this to her. Doctors have to think of the babies' interests, too."