The birth last year in Los Angeles of eight babies to Nadya Suleman after IVF treatment -- as well as cases in which embryos have been stolen or transferred into the wrong patients -- has spurred discussion about whether the field of assisted reproductive technologies should be subjected to government oversight.
The major professional group of infertility specialists hinted in statements last year that perhaps the field -- which is largely self-governed and relies on voluntary participation of doctors -- could use a greater degree of regulation. As we reported last September in Booster Shots, Robert W. Rebar, executive director of the American Society for Reproductive Medicine said:
"The time has come for policy makers to sit down with the leading experts in the field to explore ways we can codify our standards to give them additional regulatory teeth. . .We will lead an effort involving our members, representatives of patient groups, policy makers and other stakeholders to work together to come up with solutions."
The ASRM then held a workshop in December in Washington, D.C., to seek input on oversight from government agencies, patients, physicians, academic experts and others.
The group issued its decision on further oversight in a paper released Wednesday that -- stunningly -- finds that no further oversight is needed to prevent "Octomom" cases and other ethically and medically questionable incidents. The report concludes that better insurance coverage of assisted reproductive technologies would greatly reduce inappropriate uses of the technology.
If everyone had infertility treatment insurance coverage, ASRM leaders argue in the report, patients would be less tempted to transfer a high number of embryos or use dangerous fertility drugs. Insurance providers, moreover, could then enact rules that limit the number of embryos transferred and select which reputable doctors and centers would be allowed to perform specific treatments. "Unlike most medical procedures to treat most diseases, insurance coverage for ART treatments remains rare in the United States," the report states.
ART practitioners must abide by federal, state and Food and Drug Administration rules, as well as professional self-regulation and physician board certification, thus making the field already "one of the most highly regulated of all medical practices in the United States." Thus, ASRM leaders conclude, no further government oversight is necessary at this time. "A simple legal restriction on the number of embryos transferred would not be desirable," they wrote.
The report notes that the doctor involved in the "Octomom" cases is being appropriately punished under existing state medical regulations and that this one notorious case has led to unnecessary calls for additional legal enforcement and punishments of doctors who breach voluntary guidelines. But, the report says, "Standards set by members of the profession for the practice of reproductive medicine are widely followed and successful."
Given the comments that L.A. Times readers submitted to our website after Octomom gave birth, however, it seems that many people do believe further regulation of the industry is needed -- even if it's to control the occasional rogue doctor. The ASRM's "We're just fine, thanks" position is sure to be challenged. According to a position paper by ethics think tank the Hastings Center, the ASRM clearly lacks the ability to enforce its voluntary guidelines.
"Without governmental oversight, clinicians may practice medicine in accordance with their own beliefs. Variability in the beliefs of different practitioners permits most patients turned down by one clinic to find another where practitioners will feel comfortable treating them," the Hastings Center's position paper states. "The lack of regulation and practitioner variability means that individual decisions about eligibility for ARTs may be arbitrary, biased and inconsistent, shielding practitioner prejudices, subjecting prospective parents to great uncertainty and avoiding public discussion of difficult policy issues in reproductive policy."
-- Shari Roan
Photo: One of the Suleman babies. Credit: AP Photo / NBC NEWS