ACRM's Jim Toner, MD, PhD, Clinical Director of SART, comments on Octuplets...

Jim Toner, MD, PhD, Clinical Director of SART

The recent birth of octuplets following IVF treatment tarnishes the integrity of the many fertility specialists around the country, and should not have occurred. Limits on the number of embryos to be transferred have been in place for more than a decade, and have been very effective in reducing the problem of multiple pregnancies. It seems clear that the physician involved in this case well exceeded these limits; he is currently under investigation in California, and his affiliation with the Reproductive professional society (the American Society for Reproductive Medicine (ASRM), and its affiliate, the Society for Assisted Reproductive Medicine (SART)) will likely also be reviewed.

Fertility specialists have been actively overseeing their own industry for many years, even before federal reporting requirements were established in 1992. As laboratory improvements were made, the profession has adjusted the limits on the number of embryos to transfer. These limits, initially established in 1998, have been revised three times since: in 1999, 2004, and most recently in 2006. These guidelines now state that in women under age 35, at most 2 embryos are to be transferred. If the patient has prior success with IVF, or has good quality embryos with excess embryos available for freezing, only 1 is to be transferred. Only in “exceptional circumstances” would transfer of 3 or more be justifiable. It is not obvious that any such exceptional circumstances existed in this case, and yet it seems that 6 or more embryos were transferred in this case. This appears to be a clear violation of ASRM / SART guidelines.

The success of the profession’s guidelines in reducing multiple pregnancy while at the same time increasing the overall pregnancy rate is clear: In 1998, 28% of transfers led to a live born child; in 2005, the rate rose to 34%. At the same time points, the 7% chance of triplets fell to 2%. This reduction is largely due to transfer of fewer embryos: in 1996, 4 or more embryos were transferred in women under age 35 in 64% of cycles; whereas in 2005, only 4% of such cycles involved transfer of that many embryos.

Jim Toner, MD, PhD

Dr. Toner currently serves as a Clinical Director for the Society of Assisted Reproductive Technologies, and is a partner at Atlanta Center for Reproductive Medicine (www.acrm.com). He was trained in IVF at the Jones Institute in Norfolk, Virginia, where the first successful IVF birth in the US occurred. Dr. Toner is Board Certified in Reproductive Endocrinology and Infertility by the American College of Obstetricians and Gynecologists.

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