Public outrage over the IVF-conceived octuplets born in January to Nadya Suleman in California has led US legislators in Missouri and Georgia to propose laws that would limit the number of embryos a woman may have implanted when receiving a single fertility treatment. Georgia Senator Ralph Hudgens criticised Suleman's case, saying it is 'unforgiveable that she is unemployed and having 14 children on the backs of the taxpayers...' Supporters hope these measures will prevent rogue fertility clinics from unethically transferring a high number of embryos into women to increase their pregnancy success rates.
Critics argue that assisted reproduction is not an exact science and a blanket limit removes clinicians' flexibility to provide the best medical care. Dr Andrew Toledo, medical director of an Atlanta-based fertility clinic, warns that the measures are a 'cookie-cutter, one size-fits-all approach' and disregard important individual circumstances that determine the optimum number of embryos transferred for increased chances of pregnancy. Legal experts have voiced constitutionality concerns against the legislation impinging fundamental reproductive freedom and use of own genetic materials. A spokesman for the American Society of Reproductive Medicine (ASRM) specifically decried the Georgia bill as using the octuplets as 'an excuse to pass an extreme anti-abortion measure'. The Center for Genetics and Society called for a federal solution to prevent the state 'mishmash of policies' allowing patients to shop state-to-state for their desired treatment law.
The ASRM national guidelines recommend that a certain number of embryos be transferred depending on a woman's age and medical prognosis for successfully responding to IVF treatment. These recommend that women under 35 should have no more than two embryos transferred and women between 35 and 40 should have no more than three embryos transferred. Women over forty may have up to five embryos transferred during a single treatment due to their increased difficulty to conceive.
Missouri Republican Dr Robert Schaaf has tabled a measure that would convert these guidelines into state law. He acknowledges that it is a self-regulating industry wherein most specialists already comply with these standards, and the incidence of multiple-birth pregnancies has significantly decreased in the last decade. Still, he wishes that doctors be legally prevented from complying with patient requests to participate in harmful procedures as with Suleman, 33, who requested that five embryos be transferred despite the risks. California's medical board is currently investigating Suleman's fertility doctor and has proposed legislation empowering its Medical Board to supervise California-based fertility clinics.
The Georgia bill limits women under forty to having at most two embryos transferred and women over forty to three embryos maximum. The bill, titled The Ethical Treatment of Human Embryos Act, also outlaws the disposal of frozen embryos - similar to Louisiana law - and defines an embryo as a 'biological human being'. It was drafted by lawyers from the Bioethics Defense Fund, an anti-abortion and anti-embryonic stem cell research group and is supported by the Georgia Right to Life. Republican Senator Hudgens, who sponsored the bill for committee review last Thursday, denied it impacts on abortion and claims it only aims to prevent 'what happened in California from happening in Georgia'.
Suleman's story also attracted international fascination and highlighted the relevance of an ongoing UK debate that ultimately has led to the Human Fertilisation and Embryology Authority (HFEA), the government's fertility watchdog, rolling out a new multiple birth policy that strongly encourages single embryo transfer (SET) where medically appropriate. The HFEA wrote a letter at the end of February to the NHS Directors of Public Health outlining the importance that individual clinics devise consistent policies of their own implementing the HFEA policy initiative for each clinic to reduce its annual percentage of multiple birth rates over three years to a target 10 per cent from a 24 per cent limit in 2009.