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MeritCare explains its position on embryos after octuplets cause stir

Dr. Michael Kamrava, the fertility specialist who treated the Southern California mother of octuplets, is a well-known and controversial figure in his field who may have broken national guidelines for fertilization.

Kamrava's name emerged last week as a result of an interview aired on NBC with Nadya Suleman, who gave birth to eight babies Jan. 26. The American Society for Reproductive Medicine announced the next day that it is investigating the case because it may have violated the group's guidelines for in-vitro fertilization.

Suleman, who already had six children, told NBC last week that she had six embryos implanted for each of her pregnancies. The octuplets were a surprise result of her last set of six embryos, she said, explaining she had expected twins at most. Two of the embryos evidently divided in the womb.

Medical ethicists have criticized the implanting of so many embryos. American Society for Reproductive Medicine guidelines put the norm at two to three embryos for a woman of Suleman's age, except in extraordinary circumstances.

At MeritCare's reproductive clinic, the only of its kind in North Dakota, three embryos is the maximum and that would only be in unusual circumstances, said Dr. Steffen Christensen. If a patient were to ask to have more embryos than that implanted, which happens on occasion, "We would have said we don't feel like that's the right thing to do," Christensen said.

Kamrava, 56, did not return calls seeking comment from The Associated Press, and a receptionist at his clinic near Rodeo Drive said he was not giving interviews.

Some specialists said Kamrava, who pioneered a method for helping women conceive, is a notorious fertility doctor.

"He's tried some novel techniques and some of those methods have been controversial," said Dr. John Jain, founder of Santa Monica Fertility Specialists.

Jain criticized the decision to implant so many embryos, saying: "I do think that this doctor really stepped outside the guidelines in a very extreme matter, and as such, put both the mother and children at extra high risk of disability and even death."

Christensen said the goal with in vitro fertilization is to produce a single baby because that provides the best chances for survival.

"We're not even particularly happy with twins," he said.

Dr. Jeffrey Steinberg, a professional acquaintance of Kamrava's, said Kamrava worked to develop an embryo transfer device that allows doctors to implant an embryo - or sometimes sperm with an unfertilized egg - directly into the uterine lining.

"Usually we inject the embryos into the uterus and they float around and attach themselves," Steinberg said. However, Steinberg said there was no evidence the method improved success rates for pregnancy. It is not known if the technique was used on Suleman.

Kamrava's clinic performed 20 in vitro procedures on women under 35 in 2006, according to the most recent national report compiled by the Centers for Disease Control and Prevention. Of those 20 procedures, four resulted in pregnancies and two in births. One woman delivered twins.

The average number of embryos he transferred per procedure for women under 35 was 3.5, the report said. The national average, Christensen said, is 2.3.

Fertility doctors often implant more than one embryo to increase the chances that one will take hold, though Christensen said one-embryo implantations are becoming more frequent.

"That's actually felt to be the wave of the future," he said.

An in-vitro procedure typically costs between $8,000 and $15,000. Asked on NBC how she was able to afford the treatments, Suleman said she had saved money and used some of the more than $165,000 in disability payments she received after being injured in a 1999 riot at a state mental hospital where she worked.

Dr. Richard Paulson, who heads the fertility program at the University of Southern California, cautioned against rushing to judgment in this case because questions remain about the quality of Suleman's eggs and whether there were any extraordinary circumstances that would lead Kamrava to transfer so many embryos.

As for the technique Kamrava pioneered, "those of us who are the scientists in the field do not feel this is a significant improvement," Paulson said. He said some doctors advertise that technique as "a way of making patients feel that they are trying something new."

Suleman, who is 33, single and unemployed, told NBC's "Today" show she was "fixated" on having children. Suleman said her doctor "did nothing wrong" and had warned her of possible complications to the pregnancy and risks to the development of the babies.