The U.S. fertility industry has long resisted calls for more regulation, arguing instead for a system of self-monitoring that focuses on helping struggling clinics improve their outcomes.
"Laws tend to interfere with the flexibility needed to treat patients on an individual basis," said Dr. Michael Feinman, a Tarzana fertility specialist. He worried that "one doctor's irresponsible behavior may bring restrictive legislation down on the rest of us."
The laissez-faire approach has persisted despite ethical debates and scandal. A notable example occurred at UC Irvine, where in the mid-1990s a team of fertility doctors was found to be stealing eggs and embryos from patients and using them to impregnate other women. Two of the doctors are now fugitives in Latin America.
As reproductive technology has advanced, new controversies have arisen. Sexagenarians can now become pregnant, but not without serious risks to them and their babies.
At the same time, the procedures are becoming more accessible to everyone. With ads for discount IVF treatment abounding on the Internet and some clinics offering payment plans, fertility treatment is no longer just the realm of the rich. Poor childless patients bring shoe boxes stuffed with cash.
"We see patients who save up the money," said Dr. Bruce Kovacs, a USC maternal fetal medicine specialist. Medi-Cal doesn't cover IVF, which typically costs $15,000, but "once you are pregnant, the state pays the rest," Kovacs said.
Despite the ethical quandaries, fertility industry leaders say their self-regulation generally works. The rates of triplets and other higher-order multiples fell from 7% of all IVF births in 1996 to 2% in 2006. The average number of embryos used in each procedure has also been decreasing.
Still, some experts say the numbers are too high.
Statistics show that some doctors vastly exceed the guidelines of the American Society of Reproductive Medicine, which recommends that most women under 35 receive one embryo, or two at most.
In 629 cases during 2005 -- a tiny fraction of the more than 35,000 treatments for women under 35 -- the patients received at least five embryos, according to a recent analysis by the CDC. Nearly 8% of the deliveries for those patients involved triplets or more.
Doctors who acknowledge exceeding the guidelines often say their patients are more difficult to treat -- a factor not included in the statistics.
