Tag Archives: IVF

ESHRE Endorses Egg Freezing : ASRM Lifts Experimental Label From Egg Freezing

The American Society of Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) have endorsed oocyte freezing as a standard and safe procedure in  2012. ASRM  issued a new report on 22 October, 2012 stating that in young patients egg freezing techniques have been shown to produce pregnancy rates, leading to the birth of healthy babies, comparable to IVF cycles using fresh eggs. After much work and deliberation by fertility experts, who reviewed the world literature on the effectiveness and safety of egg freezing and, most importantly, on the desired outcome: healthy babies, egg freezing is can now be used in routine practice. More studies are being published regarding this age range, and all is reassuring.



Egg freezing could provide a viable alternative source for couples needing donor eggs to build their families. In addition, among the medical indications for its use are fertility preservation for patients who may be left infertile following medical treatments for other diseases  (viz., cancer),  some genetic conditions, or IVF treatment interrupted by the unexpected inability to obtain sperm.Cryotec



The Committee points out that the age of the woman at the time of egg freezing is a very important factor. “Success rates with oocyte cryopreservation appear to decline with maternal age consistent with the clinical experience with fresh oocytes.”  ASRM did not encourage egg freezing for “social reasons,” such as a delay in childbearing as, although the technical procedure of egg freezing is safe, we do not have enough long-term data about babies born to women using eggs frozen when they are older than 35. Cryotec VitrificationCiting a lack of data on safety, efficacy, cost-effectiveness, and potential emotional risks, the report states, “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing. Patients who wish to pursue this technology should be carefully counseled.”



Rotunda is now offering oocyte cryopreservation as part of its ART services  using the latest cutting edge Cryotec vitrification technique. We also have initiated donor egg bank. We have achieved comparable success rates with frozen donor oocytes  to fresh donor oocytes.

Rotunda Egg Freezing ProgramThe excellent survival rates, embryo development and pregnancy rates have given a tremendous new hope to young cancer women. These young cancer patients can now dream of becoming a mother one day in future when they are cured of their disease.


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59 year old becomes oldest person ever to be given IVF treatment by a British clinic!

A 59-year-old woman has become the oldest person ever to be offered fertility treatment by a British clinic.

Doctors at the private London Women’s Clinic on Harley Street, one of the most successful IVF units in the country, have unanimously agreed to help Susan Tollefsen conceive.

Mrs Tollefsen, a retired teacher who turns 60 in October, said: ‘I’m still so full of life and healthy at 60 I don’t see any reason why I shouldn’t be treated.’

Until last week’s decision, older women have had to travel abroad for treatment – so-called ‘fertility tourism’ – because Government guidelines say the NHS should not recommend IVF to women over the age of 40 and private clinics generally will not treat women older than 50.

But in a move that has provoked an ethical storm over whether post-menopausal women have the right to fertility treatment, the clinic has decided to revise its policy.

Mrs Tollefsen already has a two-year-old child, conceived at a Russian clinic after she was refused treatment in the UK because of her age.

There are now calls for an upper age limit for fertility treatment to be enshrined in law, rather than simply a guideline.

Clinicians usually refuse to offer to treat women older than 50 because of health concerns, the reduced chances of success, and fears for the upbringing of children with such an old parent. Critics claim that women who put off motherhood until later in life are selfishly putting their own needs before a child’s.

Clinics also risk having their licences suspended if they do not take the welfare of any resulting children into account when providing IVF treatment. However, they do not have to inform the regulators if they are treating an older woman.

Normally, private clinics treat women over 50 only in exceptional circumstances, for example if she still has a menstrual cycle.

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Accelerated fertility treatment leads to shortened time to pregnancy and cost savings

A major new trial recently published in the journal Fertility and Sterility shows that for couples beginning infertility treatments, an accelerated path to in-vitro fertilization (IVF) can offer a shorter time to pregnancy, cost savings of nearly $10,000, and a lowered risk of multiple births.

For the first time, these results demonstrate that the long held treatment combining fertility injections with insemination (IUI) does not have a place in infertility treatments today. This study also demonstrates that today’s infertility treatments are very successful. When fertility care is covered by insurance (or alternatively when couples can afford all needed treatment), the vast majority will have a baby, and the quickest way to get pregnant is to follow this new shortened protocol.

Elizabeth Ginsburg, President of the Society for Assisted Reproductive Technology, commented, “This is a very important study that will likely influence physicians to reduce the number of stimulated inseminations for patients with unexplained infertility. Adoption of such an accelerated course of treatment could result in many patients conceiving in less time with less expense.”

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Céline Dion Pregnant with Embryo Frozen for Eight Years

As wake-up calls go, this one was hard to beat. Thérèse Dion was asleep in her room at the five-star Hotel Le Bristol in Paris, where she had gone to film episodes of the cooking show she hosts on Canadian TV, when the phone rang at 7 a.m. on Jan. 25. On the line, more than 4,500 miles away at Palms West Hospital in Loxahatchee, Fla., the youngest of her 14 children, pop diva Celine Dion, was 18 hours into labor and literally seconds from giving birth. “I heard the baby’s first cry live on the telephone,” says an elated Thérèse, 73, who spoke to her daughter only briefly. “Celine told me, ‘The baby is in good health, but the mother, she is tired.'”

As well she might have been. After years of publicly wishing for a child—and enduring an intensive round of in vitro fertilization treatments to conceive—Dion, 32, and her husband-manager, René Angélil, 59, finally welcomed 6-lb. 8-oz. René-Charles three weeks before his Valentine’s Day due date.

“Everybody was just crying tears of joy,” says Dion’s obstetrician Dr. Ronald Ackerman, 48, who assisted in the cesarean section delivery performed by his partner Dr. Steven Pliskow, 37. “Nurses, doctors, experienced people—there was not a dry eye in the room.” Least of all those of the proud parents (who declined to release pictures of the newborn). “This was their dream,” says record producer David Foster, a longtime friend. “It’s bigger than any hit record, bigger than anything for them.”

Dion had been relaxing at the couple’s 10-bedroom mansion in nearby Jupiter when contractions began on Wednesday afternoon. After consulting Ackerman, the singer and her husband packed their black Mercedes 500 and drove to the hospital 40 minutes away. But the baby for whom they had waited so long wasn’t ready to take the stage just yet. At one point Ackerman and Pliskow tried to induce the birth chemically, to no avail. “They gave it every chance to be a vaginal delivery,” says maternity nurse Helene Schilian, who cared for Dion during her three-day hospital stay. “But at some point the baby just seemed to say, ‘I’m tired, let me out.'” By 1 a.m. Thursday (up to 24 hours of labor is not unusual for a first-time birth), the doctors became concerned that the umbilical cord was in a position to damage the child and performed a cesarean section.

Throughout the birth Dion was “focused and calm,” says Ackerman. “This is a lady with extreme focus and fortitude,” adds Pliskow. After Angélil helped cut the cord, René-Charles was placed in his tearful mother’s arms before being washed and wrapped in a hospital-issue blue-and-pink-striped blanket, topped with a knitted cap. Then Angélil and Dion’s sister Linda, 41, who had also attended the birth, began the task of spreading the news. “The baby of the family had a baby!” sister Liette, 50, who lives in Montreal, exclaimed when she heard of the birth. “We were that much more excited because she so wanted to have a baby and the way she became pregnant was a miracle in itself.”

The next morning Dion made some phone calls of her own (“I had a boy!” she announced to Manhattan fertility specialist Dr. Zev Rosenwaks, who had administered her IVF treatment back in May) and made a careful inventory of her new baby’s features. “He has René’s little feet, René’s toes and the little ears of René,” she told her mother over the phone. “He has my chin, though, and my hair color.” Over the next couple of days the songstress never left her birthing suite, a green-and-peach-hued room with a bathroom, dining table and two foldout beds that Angélil and Linda occupied at night. Dion cooed softly to the baby in French (“Mon amour”) and approached her mothering with the singular determination that earned her five Grammys and more than 100 million worldwide album sales in her singing career. “She took to nursing the baby like she’d had 12 others,” says Schilian. “She handled that baby like a pro.”

For his part, “René was very attentive,” Schilian adds. “He was up for every feeding during the night, making sure the baby got fed every three hours. He changed diapers.” Whenever he did step out, the new father couldn’t conceal his joy. After munching on a chili hot dog at the nearby Chicago Style Grille on Thursday, Angélil returned the next day with a signed photograph of his wife for the deli’s owner Scott Verdung. At breakfast on Saturday at a local diner he tipped waitress Erla Simon, 18, $20 on a $20 check—”The biggest tip I ever got!” she says. And staff at the nearby Babies R Us were struck with Angéli’s happiness when he stopped by that same day for a bottle sterilizer, a nursing pillow and a baby car seat, which store clerk Mike Maldonado helped him install in his Mercedes. “You could tell he was a little nervous,” says Maldonado, “a little anxious about making sure it was done right.”

Maybe so. But when it comes to raising children, both Dion and Angélil have had plenty of practice. Dion dotes on her 32 nephews and nieces—for whom she bankrolls annual Christmas toy shopping free-for-alls—as well as the children of friends. “Even when a baby is crying or upset, as soon as she takes them in her arms they become quiet and happy,” says her pal and Canadian press agent Francine Chaloult. “She knows how to hold a baby, cradle a baby, feed a baby, handle a baby.” So does Angélil, who had his share of diaper duty while raising his three other children—Patrick, 33, Jean-Pierre, 26, and Anne-Marie, 23—from two prior marriages. “If you want to know what kind of a parent René is, look at those children,” says David Foster. “They’re polite, nice, successful.”

Their father had been divorced for three years when he and Dion, whose career he had nurtured since she was just 12, revealed their love to each other in 1988. Four years would pass before they admitted their relationship to the world. But there was nothing secretive about their 1994 wedding, a lavish affair with 500 guests at Montreal’s Notre Dame Basilica. (Five years later the pair renewed their vows in an equally opulent Arab-themed ceremony, complete with live camels and belly dancers, in Las Vegas.) From the start, having children was a priority. “I never thought that my life would fall apart if I didn’t have a child,” Dion wrote in her book My Story, My Dream, published last October. “But even so, I was waiting for it, looking for it and making it part of my plans.”

What the couple hadn’t planned on was the need for artificial conception. In the spring of 1999 Angélil was diagnosed with squamous cell carcinoma on a lymph gland in his neck. Concerned about the potential side effects of the chemotherapy and radiation he would require, the couple froze some of his sperm for future use. Tests before freezing found that Angélil’s sperm count was already too low for standard IVF treatments to be successful. So Dr. Ackerman suggested a procedure known as intracytoplasmic sperm injection—using a single, isolated sperm cell to fertilize an egg, which is then placed in the uterus. For a time the couple focused their energy on Angélil’s cancer treatment; they had already announced that beginning in 2000 Dion would take at least a year off from performing to “chill out and a discover new things,” as she put it—including starting a family.

Then, last February, the couple met with fertility specialist Rosenwaks. Four months later, after undergoing a battery of drug treatments and invasive, sometimes painful procedures, Dion received the happy news. “Congratulations, lovers,” Rosenwaks told them over the phone from Manhattan while Ackerman was by their side at their home. “You’re pregnant, Celine.”

Earlier that day the couple had learned that after some 38 rounds of chemotherapy and radiation, Angélil’s cancer had been cured. Overjoyed and eager to preempt tabloid reports, they shared the news of Dion’s pregnancy with her fans the very next morning: “There’s no hiding happiness,” they said in a statement. “We can’t keep something so big, so wonderful a secret just for us.”

Despite René-Charles’s extraordinary history, Dion enjoyed “a very normal pregnancy,” says obstetrician Pliskow. She followed a balanced diet, took prenatal vitamins, did water exercises, attended Spanish classes and read up on pregnancy and motherhood. “I’m basically now just a slob on the sofa,” she told David Foster over the phone one day. “That’s my life.” Still, she was as much the perfectionist in pregnancy as she was in her performing career. “She went above what she needed to do,” says her hairstylist Sheila Stott. “If the doctor said, you need rest, she’d go to bed for three days.”

Which, if you’re Celine Dion, is a long time away from the mall. On doctors orders, she-of-the-thousand-shoes stopped playing golf (she has an 11 handicap) and singing, but no one said anything about her other passion: shopping. At the upmarket stores near her Florida home, Dion stocked up on baby linens in white with gold trim at the Purple Turtle and visited Ralph Lauren, Saks Fifth Avenue, Charles David and Valentino, where sales assistants were impressed by the slim 5’7″ star’s maternity chic: clingy dresses (she gained just 25 lbs. during her pregnancy) with high heels and oversize sunglasses. At the Palm Beach outlet of the French baby-boutique chain Bonpoint-where infant sweaters sell for about $50—Dion “bought the entire autumn-winter 2000 collection and a few pieces from the spring-summer 2001,” reports store spokesman Vincent Debear. “In all, about 200 pieces.”

Celine and René, who divide their time between Florida and Canada, have already decorated the Florida nursery in white and blue, with a French provincial bassinet, a Burberry baby carriage (worth $4,250) and a wardrobe stocked with everything from blue-and-white onesies to baby golf shoes. But there was even more baby booty to be had at a surprise shower thrown by René’s daughter Anne-Marie and close friend Mia Dumont at Donald Trump’s Palm Beach club Mar-a-Lago on Jan. 3. The 90 guests—including many members of Dion’s family, whom Angélil had flown in for the event—all hid in a darkened room and when Celine entered yelled, “Surprise!” “Celine doesn’t really like surprises, but she was very happy,” says her friend Coco Lacroix. Later the couple opened gifts—including a handmade teddy bear from Thérèse, stuffed with heat beads, which had her daughter in tears. “This baby,” says Lacroix, “is the most lucky child in the world.”

Indeed, the media in Dion’s home province of Quebec has already dubbed René-Charles “Le Petit Prince.” And there’s little doubt he’ll be treated as such when Dion takes him home to be doted upon by grandmama Thérèse and grandpapa Adhémar, 77, a former butcher, and the infant’s 13 aunts and uncles. The trip, which she hopes to make in June, may turn out to be more restful than she imagines. “She won’t be seeing much of her little boy,” notes sister Liette. “Everyone will want to hold him!” Before then Thérèse plans to spend time in Florida helping her daughter; sister Linda has already been chosen to be the baby’s godmother. As for the future, only one thing is certain: Dion is in no hurry to resume her career. “I suspect that by 2002 she’ll be back to work in some form,” says Foster. “But that first year with her child is extremely important to her.”

Friends also suspect that René-Charles won’t stay an only child for long. Doctors say there is no reason the star couldn’t become pregnant again. And conveniently, a second embryo, frozen during her IVF procedure, lies stored at Rosenwaks’s Manhattan fertility clinic. “I will go get it,” Dion said an interview in December with Canada’s French-language TVA television station. “That’s for sure.” Maybe in the near future: As she left Palms West Hospital on Jan. 27, 2001 Dion bade a fond farewell to the staff of the maternity wing, then added breezily, “See you next year!”

Céline Dion, now expecting her second child, is “very excited,” says her doctor, Dr. Zev Rosenwaks, who performed the in vitro fertilization procedure that made the 41-year-old singer’s pregnancy possible. When he called her earlier this week to say the pregnancy test was positive, “You could hear her chuckling,” he says. “She was very happy. So was René. They are both very thankful.”

Rosenwaks, director of the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at New York-Presbyerian Hospital/Weill Cornell Center Medical Center, implanted a embryo that had been kept frozen in liquid nitrogen for the past eight years. “She is very, very early in her pregnancy,” says her doc.

Dion had her embryos frozen when she went through IVF while trying to conceive her first child, René-Charles, who was born in 2001. When she completed her performance run in Las Vegas in 2007, she consulted Rosenwaks about trying again. “She came back to have the embryos transferred back because she wanted to have another baby,” he says.

According to the fertility specialist, freezing an embryo for eight years is not necessarily a problem. “There have been embryos that have been [frozen] for more than 10 years, and even more than 15 years, that have successfully thawed and resulted in a pregnancy,” says Rosenwaks.

Meanwhile, the doctor says, “She is feeling well. So far, so good. I look forward to hearing the fetal heartbeat. René and Céline are both looking forward to a pregnancy that is a healthy one.” He adds, “There is no question she is ecstatic.” Picture 1


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Debate Over Genetic Screening of Embryos as New Tests Emerge

As more families opt for pre-implantation genetic diagnosis to screen embryos for inherited diseases, determining the regulatory and ethical guidelines to govern such screenings is “proving difficult,” the Chicago Tribune reports. Although the field of embryonic testing initially focused on identifying genetic defects that are certain to cause suffering or death early in life, it has broadened to include tests for genes linked to breast and ovarian cancer, which are not always fatal, occur later in life and affect 50% to 85% of those who carry the gene, according to the Tribune. The leading U.S. genetic diagnosis clinic, which is the largest in the world, conducted more than 1,800 screenings in 2008 “aimed at weeding out embryos that carried worrisome family conditions, from sickle cell anemia to cystic fibrosis,” the Tribune reports. Different countries vary in their regulation of PGD. In the U.S., doctors are allowed to select embryos for a particular sex, a practice that is not allowed in Great Britain, where each instance of PGD must be registered with the British Human Fertilization and Embryology Authority. BFEA has approved the use of PGD for about 70 genetic defects “after intensive public consultation about what is a serious enough problem to justify trying to eliminate it,” the Tribune reports. It is “significantly easier” to conduct PGD in the U.S. because the government only licenses clinics, not individual procedures, the Tribune reports. Mark Hughes, director of the Detroit-based Genesis Genetics Institute, said his company has tested for 171 genetic defects. In the U.S., “there is no approval mechanism,” Hughes said, adding, “No one is saying you can do this to save a sibling but you can’t do this for BRCA1,” a gene linked to breast cancer. According to a John Hopkins University study, nearly 40% of individuals surveyed believed that embryo screening should be regulated more closely for ethical reasons. An additional 19% said the screening should be banned altogether, for reasons ranging from the belief that discarding an embryo is immoral to concerns that selecting against certain diseases will devalue the lives of people already living with those conditions. Clare Williams, a bioethics specialist at Kings College London, said that during public hearings in Britain, “quite a lot of people felt there could well be treatment (for some conditions) by the time these children grow up, and then (their condition) won’t be an issue.” Some experts say it would be beneficial to place limits on the type of genetic defects doctors are allowed to screen for in the U.S., the Tribune reports. The Hopkins study found that, as of 2006, 65% of about 200 U.S. clinics offering embryo screenings allowed clients to choose the gender of the implanted embryo, regardless of the gender of existing children or whether the child was their first. The Tribune reports that such data and a California-based genetics lab’s recent announcement that it would be able to select eye and hair color have raised public concerns about genetic selection of embryos. The lab’s claims have been “disproved,” and many experts believe that expanded embryo screening “probably is not a slippery slope toward designer babies” because PGD is “costly and difficult,” there are a limited number of embryos to choose from and “finding one that includes a number of desired traits would be very difficult,” the Tribune reports. Hughes said the “things you might want to select for in a child — intelligence, athletic prowess, body stature — involve not single genes but many, many genes.” According to the Tribune, PGD, used in conjunction with in vitro fertilization, costs about $3,500 in the U.S. and twice that in Britain (Goering, Chicago Tribune, 3/25).

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Reproducing Makes You Famous

People like Nadya Suleman, the IVF junkie mother of 14, and Alfie Patten,picture-11the 13-year-old father from England, are getting famous just for reproducing. It’s a pretty gross trend. Probably the most troubling thing of all is how greedily we’ve slopped all this stuff up. But after making celebrity baby covers the biggest sellers for the likes of Us, People and OK!, we get the freakshow news we deserve. Still hungry for more and more babies, we’ve turned to the circus disaster that is regular lives made alien and shocking when bad choices mixed with a few bits of bad luck and stories were born. Maybe it comes from exhaustion with all the other media. First it was scripted television shows, and then their high-concept reality descendants. And now we’ve sifted through every last layer of story until we’ve gone and found a low, universal denominator. People come out of other people’s vaginas sometimes. The more that come out of the same one or the younger the owners of the necessary body parts are, the more we’re interested. 220 channels and nothing else was on, so we’ve settled on the baby zoo currently on display on TLC or sitting in a dimly-lit room across from Ann Curry. While Suleman’s desire to go and get herself knocked up with octuplets when she was already a cash-strapped mother of six probably had far more to do with some murky and deep-seated emotional cataclysms than it did with a desire for fame, the end result has been a raft of high profile TV appearances, implied hopes for a reality series, and a website asking fans or followers or whomever to donate money to this Elephantitis-suffering family. Ms. Suleman has become a rickety celebrity simply by making the wreckless decision to bring many children into this world for whom she had no way of caring. Good for us! Little Mister Patten may not have been courting fame when he got his young girlfriend pregnant, but now he’s likely being paid exclusivity fees by the Sun. And, in the wake of the media frenzy surrounding the unsettling story, two more boyspicture-2 have come forward, claiming paternity of 15-year-old Chantelle Steadman’s daughter. There are posed photos of the two boys, aged 14 and 16, on Splash, the photo agency where I find many of the silly celebrity pictures I use for Open Caption. It had become fairly routine for celebrities to profit off the act of procreation, what with the big glossy magazine industry and whatnot. But now common folks are saying “me too!” and the troubling thing is, if you don’t already have a certain degree of popularity, you have to make your babymaking pretty sensational to get any attention. And what’s sensational is often ugly. Again these folks probably didn’t enter into reproduction with designs on tabloid notoriety, but once the first publicist calls or newspaper camera flashes… Well, the Siren call is tough to resist. Though humanity has its limits, and the public outcry against Nadya Suleman—and the sad revulsion expressed over the Patten thing—suggests that maybe there is a limit to this mayhem. But we don’t suspect it will die down quickly. Prepare yourselves for other strange stories, for other curious and unpleasant parlor tricks of the body. After all, while everything’s being torn down around it, Coney Island still has its sideshow.

-Richard @ gawker.com

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Ethical Issues Related to Birth of IVF Octuplets : Not a Cause for Celebration, Doctors Warn


Two newspapers recently published two opinion pieces examining the ethical issues surrounding the recent birth of octuplets to a California woman, Nadya Suleman, who reportedly underwent fertility treatments. Summaries appear below.


~ Arthur Caplan, Philadelphia Inquirer: “Something has gone terribly wrong when a 33-year-old single woman — who has no home of her own, no job and a mother who worries her daughter is ‘obsessed’ with having children — winds up with 14 of them,” Caplan, director of the University of Pennsylvania Center for Bioethics, writes in an opinion piece. “Examining what exactly went wrong may shed some light on what ought to be done,” Caplan says, adding, “If doctors cannot prevent such shambles from recurring, then society must.” Caplan reports that Suleman became pregnant with all of her 14 children through in vitro fertilization. He writes that the “most obvious questions raised by this sad saga include: How did Nadya Suleman become a fertility patient? And how did she get eight embryos implanted when she already had six young children to care for in a tiny house, with no partner and no income?” Although “[s]ome fertility doctors would answer that it’s not their job to decide how many children a person can have,” Caplan writes that the “idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers.” He continues, “Society needs to discourage mega-multiple births. And it is clear what needs to be done to accomplish that.” Government “needs to get involved,” Caplan says, concluding, “Other nations, such as Britain, keep a regulatory eye on reproductive technologies and those who wish to use them, knowing their use can put kids at risk in ways that nature never envisioned. We owe the same to children born here” (Caplan, Philadelphia Inquirer, 2/6).

~ Ellen Goodman, Miami Herald:  The medical team that delivered the octuplets “expected kudos and high fives,” but “instead of smiles, they saw jaws drop,” syndicated columnist Goodman writes. She continues, “Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.” Questions about whether anyone has “a right to tell anyone else how many kids to have” and whether only women with husbands or certain income levels should have children are “questions that make us feel queasy when we are talking about old-fashioned families,” Goodman writes. She adds, “But they take on a new flavor in the unregulated wild west of fertility technology.” According to Goodman, the “heart of this case” is that “it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.” She adds that it is “against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, those who endanger patients ought to lose their licenses.” Goodman also writes that the infants will need “at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies.” A “reproductive business that generates so much controversy has produced a remarkable consensus,” she says, concluding, “Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is ‘nuts'” (Goodman, Miami Herald, 2/6).

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