The Octuplets Saga

Malleability and fragility of human ethics is exemplified in the recently unraveled octuplet saga. The community in general and reproductive endocrinologists in particular are striving to comprehend the circumstances that fostered the practitioner’s poor judgment, deviance from guiding principles of practice and above all, an utter disregard to the wellbeing of a clearly “vulnerable” patient and her family!

Disregard of the woman’s psychological wellbeing and social circumstances are unpardonable, and yet pale against the reckless act of transferring multiple (six!!) embryos in a young woman of proven fertility for whom selective embryo reduction was not an option. Not only were the subspecialty specific guidelines (The American Society for Reproductive Medicine Society for Assisted Reproductive Technology offer clear guidelines regarding the number of embryos to transfer in an ART cycle to ensure against undue risk of high order multiple pregnancies) ignored, but also dismissed was the essence of the Hippocratic oath! While detailed explanations may never be available for the case under study, a need for introspection is quite apparent. In a consumer driven society where service is expected, nay demanded for a fee, these events may very well reflect thoughtless compliance to a pressing customer’s demands.

In times when economic successes more than intellectual prowess or integrity may define progress, it is simplistic to expect the medical community to stay immune to social pressures and be self shepherded within practice “guidelines”. Indeed, in a society where irrational demands of a few may be met by an occasional, the case of octuplets following assisted reproductive technology identifies a need for moving beyond the realm of “guidelines” to incorporate “reasonable requisites” to ensure wellbeing of an emotionally vulnerable population, i.e. those coping with a spectrum of psychological, social and economic stresses that remain intrinsic to a diagnosis of infertility.