I guess Dr. Michael Kamrava is not alone:

Fewer than 20 percent of U.S. clinics follow professional guidelines on how many embryos should be used for younger women. “Clearly, most programs are not adhering to the guidelines,” said Dr. Bradley Van Voorhis, director of the fertility clinic at the University of Iowa.

The furor over Nadya Suleman and her octuplets has brought scrutiny to U.S. fertility clinics and how well they observe the guidelines, which are purely voluntary. The controversy had led to talk of passing laws to regulate clinics, something that has already been done in Western Europe….

The 20 percent figure is contained in reports filed by clinics with the Centers for Disease Control and Prevention.

Fertility doctors say there are many reasons clinics skirt the guidelines: pressure from patients who want to use more embryos to improve their chances of getting pregnant; financial concerns from those who are paying for their treatment out of their own pockets; and the competition among clinics to post good success rates.

And the only penalty for violating the guidelines is expulsion from some of the industry’s professional organizations, though that can affect whether insurance companies will cover a clinic’s treatments.

When the guidelines were issued in 1996 by the American Society of Reproductive Medicine, the intent was to cut down the number of multiple births, particularly triplets and higher, that can result when many embryos are implanted and more than one takes. Big multiple births can lead to disastrous, life-threatening complications, lifelong disabilities such as cerebral palsy, and crushing medical costs.

The guidelines suggest how many embryos doctors should use, with the number varying by age and other factors. They also allow for some flexibility for more if previous attempts have failed or the embryo quality is poor.

The group credits the guidelines with reducing triplets and higher multiple pregnancies from 7 percent of attempts to 2 percent in 2006. Nearly two-thirds of the procedures involved four or more embryos in 1996; that has fallen to 16 percent.

But for women under 35, government records show that just 83 of 426 clinics followed the guidance calling for one and no more than two embryos. The average for fresh embryos (as opposed to frozen) implanted in women in that age group ranged from a 1.4 to 4.8. The vast majority of the clinics averaged between two and three embryos.

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