How was Nadya Suleman impregnated with octuplets? Is IVF, the mother, or her doctors to blame?

Many have been asking me to comment on the recent octuplet case in the news.

I have to admit, this is out of my field, so I’ll point to a few other physicians who have been talking about the case.

When it was first reported, it was speculated that Ms. Suleman used fertility medications indiscriminately, and then had intercourse. Gynecologist Amy Tuteur suspected illicit use of Pergonal, a medication that stimulates the ovaries to produce more eggs. To achieve octuplets, the ovaries would need to be coaxed into producing eight or more follicles, a circumstance where every physician would have advised against sex.

Indeed, that was reproductive endocrinologist Terrence Lee’s first thought as well: “It is feasible to think that somebody injected herself with medication, unmonitored and unaware of exactly how many follicles she was developing. Therefore it would be more understandable that she subjected herself to the risk of octuplets when in fact, she thought she had much fewer eggs.”

However, it now appears that Ms. Suleman was indeed the recipient of in-vitro fertilization. Ethics aside (you can read elsewhere for an extensive discussion of the ethical controversies surrounding the case, as well as the patient’s questionable background), Dr. Lee explains the long odds for successful implantation of that many embryos.

Under perfect circumstances, including an unlikely 75 percent per embryo success rate, going 8 for 8 puts the likelihood at around 10 percent. At a more realistic, but still generous 60 percent implantation rate, the chances of octuplets drops to 1.68 percent.

“It would be more likely to imagine transferring, say 14 embryos and having eight take,” Dr. Lee speculates, but “it is hard to imagine any physician eager to transfer eight (let alone fourteen) embryos under these circumstances.”

Was Ms. Suleman paid to under IVF? Did an “insider” at a fertiliy program pull this off without a physician’s knowledge? Could the fertility doctor be bribed to implant that many embryos? Will this incidence lead to increased regulation of the reproductive endocrine community?

All excellent questions, and I suggest heading over to Dr. Lee’s blog, Fertility File, to read his take on the story.