Well, it has finally happened. The infamous octomom fertility specialist, Dr. Michael Kamrava, has been formally charged with negligence by the California Medical Board.

The case has been handled as a type of sideshow by the media, and indeed, there are many aspects of it—single mom, 14 kids from IVF, all conceived with donor sperm, etc.—that seem stranger than fiction.

However, responsible fertility specialists have taken this case very seriously. An octuplet pregnancy is a significant complication of fertility care. Since we are aware of this possible severe scenario, we take very strong measures to try to avoid situations in which it may arise, and attempt to prevent it by controlling the amount of fertility medications that are used, and by reducing the number of embryos that are transferred.

It should be pointed out that the complaint filed by the California Medical Board is likely based on an expert review of the medical records and not on sworn testimony. Therefore, the revelations presented in the complaint may or may not be substantiated at the time of the hearing. Nevertheless, several interesting observations are made by the complaint.

Firstly, the complaint specifically states that all of the fertility procedures the mother underwent involved fresh embryos. This is in direct contradiction of the story that was presented to the media, in which the mother stated that the embryos used for the treatment that resulted in the octuplet births had involved frozen embryos.

This is relevant because if the complaint is accurate—and the mother was not truthful about this aspect of the fertility treatment—it is also possible that other parts of the story may not be accurate. For example, she said that six embryos were transferred and that two of them had apparently split into identical twins, thus resulting in eight babies. It may very well turn out that a larger number of embryos were transferred.

Secondly, the complaint specifically cites Dr. Kamrava for failure to refer the patient for a mental health evaluation. It seems unlikely to me that this will be upheld during the hearing; the guidelines for when and how to refer patients for mental health evaluation are sketchy at best. But it does point out that we should ask ourselves, when helping someone to conceive, whether or not their support system is adequate to help them deal with the resulting child or children.

As I said previously, the facts in the complaint are based on a review of the medical records, and have not yet been verified or substantiated. Nevertheless, it seems like a good thing that the public sees that there is a mechanism for reviewing and critically evaluating cases that lead to unfavorable outcomes.

An octuplet birth may be seen as a blessing; however, it is only a blessing if the doctors managing the pregnancy are successful in bringing the babies to a healthy live birth. From the perspective of fertility care, it is an extremely serious—and potentially lethal—complication of fertility care. It should be treated as such.