The decision to implant six embryos into Nadya Suleman leading to the birth of octuplets has attracted international opprobrium. The 33-year-old unemployed single mother already had six children conceived after IVF with the same fertility doctor; all aged below eight, including two-year-old twins and an autistic son. On 6 February, the Medical Board of California announced an investigation into the doctor for 'a violation of the standard of care'. Television journalist Ann Curry described Suleman as 'the most vilified mother in America' in a recent exclusive interview on NBC. The show revealed the doctor to be Dr Michael Kamrava, who runs the West Coast IVF Clinic in Beverly Hills. He has not commented on the investigation. 

The interview fuelled an international debate on reproductive ethics. Some medical experts disapprove of the provision of treatment to Suleman, particularly without mental health counseling. Others argue that it is not clinicians' responsibility to police reproductive choices, including the number of children wanted, saying ultimately that this is the prospective mother's decision once informed of the risks involved.

Suleman revealed to Curry how she always dreamed of having a large family to make up for the 'isolation' she felt as an only child in a 'dysfunctional family'. When at 16 she learned her reproductive system was prematurely aging she decided to quickly pursue her dream. For her, pregnancy was a response to her 'deep need to connect' and give herself a 'feeling of self and identity'. She had extra stored embryos and considered those her 'children' so insisted they were all transferred. She explained it's always a 'risk' but she took it with each IVF cycle she underwent. However, she said she only wanted a seventh child and at most thought she risked twins. She told Curry it was 'very appropriate' for her doctor to transfer multiple embryos at her request despite knowing the risks and defended that Dr Kamrava did 'nothing wrong'. 

Most countries' guidelines warn against multiple-embryo transfer as too risky for the mother and children. 'I am deeply disappointed that any fertility clinic... anywhere, would do this,' commented Colorado reproductive endocrinologist Eric Surrey, former president of the Society for Assisted Reproductive Technology (SART). He described it as a 'gross aberration' in fertility treatment, explaining that that the risk of adverse health complications for mothers and babies are seven times higher for twins than singlets, 14 times higher for triplets and increase exponentially for higher-order pregnancies. 

Most experts and bioethicists concur that there was no medical justification for transferring six embryos in this case, given Suleman's age and previous IVF success. The octuplets were nearly 10 weeks premature with low birth-weights ranging between 1.8 and 3.4 pounds. Specialists say it may be years before the extent of their medical issues are known.

Suleman, who lives with her parents in a three bedroom house, tried for seven years to conceive and then began to work double shifts as a psychiatric technician in order to save for IVF, claiming she has spent nearly £69,400 of 'hoarded money' on IVF. She is divorced - the same friend has donated sperm for all 14 children. She suffered an injury at work that qualified her for compensation and disability benefits. She raised her six children on her disability allowance and student loans. Her publicist confirmed that she receives food stamps and welfare payments to help care for three children who are disabled.

Suleman told Curry she is being persecuted by society for choosing 'an unconventional lifestyle' as a single mother. If a couple were doing the same it would be 'more acceptable to society', she said. She defended her choice as responsible as she is determined to provide a better future for her children and is not 'just sitting down and watching TV' which would be 'selfish'. She has a child development degree and is currently studying for a masters' degree in counselling. She told Curry that she believes she will be able to support all her children once she has completed her studies.

Reproduced from BioNews with permission, a web- and email-based source of news, information and comment on assisted reproduction and human genetics, published by Progress Educational Trust.