Since 1971, the rate of higher-order multiple births has more than tripled. The latest family to join that trend was Susan and Robert Hasson of Westminster, Calif., who had quadruplets over Mother's Day weekend. Those figures represent live births, not pregnancies reduced by miscarriage or selective reduction. The American Society of Reproductive Medicine, much to the dismay of some infertility specialists, is considering the first guidelines to limit the number of embryos transferred during in vitro fertilization to four for women age 34 and younger, with more liberal guidelines for older women who are not as likely to become pregnant. Such guidelines are the law in some countries, including England.
Some ethicists say limits on the number of embryos transferred violates a couple's freedom.
And many infertility doctors argue that the guidelines would drastically lower the chances that a woman would get pregnant with even one baby and would increase, on average, the number of costly in vitro fertilization cycles required to produce a pregnancy. All of the society's recommendations would be voluntary. But health insurance companies are also applying some pressure on reproductive specialists to back off. Dr. Salem, for example, helped produce healthy quadruplets only a few weeks after the Shier quintuplets were born in January, but is hardly bursting with pride. Insurers may not give me a contract.