Dr. Marc Bernhisel coaches women who want so desperately to get pregnant they are willing to risk using too many embryos during in-vitro fertilization.
At $13,000 per attempt, most patients want to improve the odds anyway they can. But Bernhisel, director of IVF at the Reproductive Medicine Group, must get them to pull back.
The outrage about Nadya Suleman and her in-vitro octuplets has led to a bill in the Georgia Legislature and a general feeling of unease at infertility clinics, as doctors and patients wonder if government regulation could one day limit their options.
So far no similar bill limiting the number of embryos a doctor can transfer has been introduced in Florida. Around the Tampa Bay area, statistics show that doctors like Bernhisel have been carefully regulating themselves for some time. The number of multiple births is on the decline, and so is the number of embryos used in the process.
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Bernhisel and other Florida fertility doctors say they try to use no more than two embryos in women under 37. In-vitro fertilization works so well now that there is a movement to reduce the number of embryos used to just one. These days, some doctors consider triplets and even twins a fertility treatment failure, because they increase health risks to mother and babies.
"It's nice to think about having twins for the Christmas pictures," Bernhisel said, "but really the safety of the pregnancy is better if you do it with one embryo."
In in-vitro fertilization, doctors harvest multiple eggs and fertilize them in a petri dish, hoping to create one or more high-quality embryos. Not all of the eggs fertilize, and not all of the embryos are viable, which makes the process impossible to control precisely. Women sometimes end up with no embryos, while others have more than they need to become pregnant. The extras are discarded, used in research or frozen for future attempts.
Doctors decide how many embryos to transfer to the uterus based on a number of factors, including the woman's age and reproductive history.
Angela Stuecher was 33 when she went to the Reproductive Medicine Group for help getting pregnant. Her doctor told her she should receive two embryos.
"There was no discussion," said Stuecher, now 38 and a surgical nurse at the practice. "It was, 'This is what we will put back in at most.' "
Stuecher got pregnant with a boy, now 4, on her first IVF attempt. Later, her doctor transferred two frozen embryos and she got pregnant again with her second son, now 2.
Now doctors at the Reproductive Medicine Group say transferring just one embryo often produces the same results as using two.
Success rates have improved so much, women under 35 who went through IVF using one embryo got pregnant 80 percent of the time in 2007 and 2008. Those women were good candidates for single-embryo use because they had high-quality embryos or used donor eggs. Ten years ago, women used more embryos and got pregnant only 30 percent of the time.
The Society for Assisted Reproductive Technology has guidelines on the number of embryos doctors should transfer. Ten years ago, they recommended three in women under 35. Today, they suggest two. Soon it could be one, said Sean Tipton, spokesperson for the organization.
"This is not a cookbook; it's the practice of medicine," Tipton said. "But the reason we started having guidelines was to reduce the number of high multiple births."
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The octomom backlash has begun. Legislators in Missouri are seeking to make doctors follow the guidelines of the Society for Assisted Reproductive Technology. The Georgia bill, drafted in part by Georgia Right to Life, contained language that limited the number of embryos placed in a woman, banned compensation for donor sperm or eggs, and eliminated stem cell research using leftover embryos. A watered-down version passed the Georgia Senate last week.
Here in Florida, nothing so far. Fertility doctors and lawyers hope it stays that way.
"The eight babies? This is one episode with one particular doctor," said Robert Terenzio, an Orlando lawyer who handles reproductive cases. "I think every reproductive doctor in the country is cringing because this doctor chose to operate well outside the guidelines."
Fertility clinics report pregnancy rates and the number of embryos they transfer to the Centers for Disease Control and Prevention. Florida's 28 reporting clinics averaged between two and three fresh embryos in women under 35 in 2007. In older women or women who experienced repeat failures, just three clinics transferred an average of four. Most used two or three — all within the industry's norms.
"Our goal is to have a single healthy baby," said Dr. Catherine Cowart, a Tampa fertility doctor. "We understand, however, that when people are paying over $10,000 out of pocket, very often they want to stack the odds in their favor. The physician has to not succumb to that kind of pressure."
Nationally and locally, multiple births have steadily declined over a five-year period. Florida mothers who got pregnant with IVF had 2,418 children and gave birth to multiple children 48 percent of the time in 2005 — down from 54 percent in 2001.
The Reproductive Medicine Group, the largest fertility practice in the Tampa Bay area with offices in Tampa, Brandon and Clearwater, has seen a 2 percentage point decline in twins and triplets in one year. There were no quadruplets or higher multiples, which are extremely rare in IVF.
Much of that decline has come from doctors and patients discussing the risks, said Dr. Timothy Yeko.
"They're listening now more carefully."
Times researcher Shirl Kennedy contributed to this report. Leonora LaPeter Anton can be reached at firstname.lastname@example.org or 727-893-8640.