A few months after Dr. Michael Kamrava helped Nadya Suleman become pregnant with octuplets, he transferred at least seven embryos to another patient.
She was in her late 40s and wanted just one baby.
Now she's five months pregnant with quadruplets and hospitalized at Los Angeles County-USC Medical Center, according to several sources familiar with the situation.
The new case could add to concerns about Kamrava's practice and about whether the fertility industry needs more regulation.
In fertility medicine, any pregnancy greater than twins is considered a poor outcome because of the danger it poses to the mother and the babies. Quadruplet births are rare, with an average of 14 sets born in California each year, according to state records.
"Historically, we have been very hesitant to regulate anything close to procreation from parents making judgments about how many children they will have and when," said Kirk O. Hanson, ethics professor and executive director of the Markkula Center for Applied Ethics at Santa Clara University.
"However, that worked under a natural process of fertilization and incubation. There are serious questions about whether it works in an era of scientifically enhanced procreation."
The woman in the latest case arrived recently at Good Samaritan Hospital in Los Angeles for unspecified treatment but was transferred last week to County-USC Medical Center because she lacks insurance. Doctors placed her on bed rest until the birth of the babies, which could be two or three months from now.
The California Medical Board has said it is looking into the octuplets' case to determine whether a doctor may have violated any standards of care.
The American Society for Reproductive Medicine, which has guidelines limiting the number of embryos that can be transferred depending on the woman's age and other circumstances, said it is also examining the doctor's practice. No laws govern this issue.
The guidelines allow for the transfer of more embryos in older women. But in this case, the woman was using embryos made from eggs donated by a woman in her late 20s -- which fertility specialists said increased the possibility of a multiple birth.
"I do think it is concerning, and dangerous, especially to the mother. She is close to 50. When women get to be that age, our fear is the cardiovascular complications, such as stroke or heart attack. That's how serious this is," said Dr. John Jain, a fertility specialist with knowledge of the case.
Reached by telephone, the woman did not confirm that Kamrava is her doctor. However, The Times has verified the information through several independent sources.
She said her doctors urged her not to talk to the media because she is already dealing with a high-risk pregnancy and doesn't need more stress.
"Please respect my privacy," she said, adding that her circumstances are much different from Suleman's.
The woman has three grown children from a previous marriage but wanted another child with her second husband, who is in his early 30s and doesn't have any children, sources said. She works as an apartment manager; her husband is a contractor.
She started fertility treatments seeking one baby, but after becoming pregnant with quadruplets, declined medical advice to reduce the number of fetuses, the sources said.
Kamrava could not be reached for comment and has declined previous interview requests. A woman who answered the phone at his West Coast IVF Clinic said: "If [a] mother wants to bring four kids, so what?"
Doctors at County-USC and Good Samaritan Hospital also declined to comment, citing patient confidentiality.
Suleman said in an interview with NBC that her doctor transferred six embryos. She gave birth Jan. 26, and although the births were initially celebrated as a medical miracle, public opinion quickly turned when it was discovered that Suleman had six other children, was a single mother and was relying on some public assistance, including food stamps and Social Security benefits.
Los Angeles police said Thursday that they are investigating death threats made against Suleman and her publicist.
Times staff writers Seema Mehta and Ruben Vives contributed to this report.