To some patients, all that matters are success rates. They use the CDC data like Consumer Reports. And that can put pressure on doctors to use more embryos per procedure.
"What has evolved is a culture to achieve high pregnancy rates," said Dr. Mark Hornstein, a reproductive endocrinologist at Harvard.
Patients are often willing to try anything, despite the risks.
"You're just kind of like, 'Let's try the most aggressive treatment and do what we can and deal with it," said Yasmin Thadani, 41, a former patient of Kamrava who did not become pregnant through IVF but later conceived naturally.
Some doctors operate under the principle that the customer is usually right.
"The sole custodian for the embryos are the father and mother," said Dr. Hisham Greiss of the Midwest Fertility Center in Downers Grove, Ill. "If she is on the table and says put them all in, I have no choice."
Greiss said he especially sympathizes with patients who have mortgaged their homes to pay for the procedure and want to transfer more embryos to increase their odds of success on the first attempt.
"This is the dilemma," he said. "We always have this problem."
When he can't dissuade patients, Greiss has them sign a waiver accepting the risks.
For his patients under 35 in 2006, four of his clinic's 29 births were triplets -- a rate nearly seven times the national average. Greiss said all four mothers were patients with low odds of conceiving. Each had insisted on three embryos, and they all took.
"I consider a triplet birth a failure," he said.
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alan.zarembo@latimes.com
Times staff writers Jessica Garrison and Kimi Yoshino contributed to this report.
