When the identity of Nadya Suleman's fertility doctor was made public this week, the Internet lit up with angry commentary.
Many called for Dr. Michael Kamrava to be stripped of his medical license -- or worse -- for providing the fertility treatments that led to Suleman's 14 children, including last month's octuplets.
Rosalind Saxton had a different reaction.
"If anything, this incident has increased my confidence in the doctor," said the 41-year-old, who has been preparing to do in vitro fertilization with Kamrava since three other doctors turned her down, telling her to lose weight first.
Suleman "was successful," she said. "That would give anybody confidence."
Saxton's view contrasts sharply with that of fertility experts, who consider any pregnancy resulting in more than twins to be a poor outcome because of the danger it poses to the mother and babies.
Her view points to a key problem in fertility medicine: Treatment is a private bargain between doctor and patient, insulated from the outside world.
It escapes the scrutiny of insurance companies because most patients pay out of pocket. And it escapes government regulation largely because policymakers have been uncomfortable treading into the minefield of reproductive rights.
That makes the field ripe for periodic scandal and controversy: The 66-year-old woman who delivers twins, the doctor who steals eggs, the unwanted embryos in deep-freeze limbo.
The interests of fertility doctors and patients can converge with disturbing and even disastrous consequences that extend far beyond the people directly involved.
Patients, especially those with limited resources, may push for extreme treatments. And doctors, striving to succeed in a highly competitive field, may push the boundaries of good medical practice.
Children of "high-order" multiple births -- triplets and beyond -- usually arrive prematurely and are more likely to have developmental problems and disabilities.
Society can wind up bearing the cost, as in the case of Suleman's octuplets, whose care may be covered by Medi-Cal -- the state health plan for the poor -- and could cost taxpayers millions.
Kirk O. Hanson, an ethicist at Santa Clara University, said Suleman's case raises the issue of who should be allowed to have children and how many.
"We are loath to let the government have a say in this," he said, "but an incident like this inevitably forces us to ask whether in vitro fertilization should be regulated."
