The Irresponsibility of Dr. Michael Kamrava

There was a very disturbing entry in today’s LA Times and it’s high time we all get a whole lot more outraged at the irresponsibility of Dr. Michael Kamrava.

In an excellent article by Alan Zarembo, a current patient of Kamrava’s is quoted:

"If anything, this incident has increased my confidence in the doctor," said the 41-year-old [Rosalind Saxton], who has been preparing to do in vitro fertilization with Kamrava since three other doctors turned her down, telling her to lose weight first.

Dear readers, I am going to tell you why I believe this “doctor” needs to be stopped immediately. There are two very problematic things going on in that quote.

It’s true that women are putting off having children longer, but that does not mean that doctors have found a way to prevent the complications of pregnancy in older women—they have learned how to treat them to the point women don’t die of those complications, but they cannot stop these complications.

The quoted woman goes on to say that three other doctors turned her down for IVF because of her weight. The nurse in me says a couple of things here: one, that this woman could be having conception problems due to her weight, and two, given her age and the fact she is overweight, she very well could already be hypertensive or diabetic.

Here’s a nice little study from 2008 I found on PubMed. I will translate (red font) when necessary.

…Obesity during pregnancy is considered a high-risk state because it is associated with many complications. Compared with normal-weight patients, obese patients have a higher prevalence of infertility. Once they conceive, they have higher rate of early miscarriage and congenital anomalies, including neural tube defects [spina bifida, anencephaly, which means the baby is born without most of its brain]. Besides the coexistence of preexisting diabetes mellitus and chronic hypertension, obese women are more likely to have pregnancy-induced hypertension, gestational diabetes, thromboembolism, macrosomia [baby with excessive birth weight due to maternal diabetes], and spontaneous intrauterine demises in the latter half of pregnancy [baby just dies in utero, no known cause]. Obese women also require instrument [forceps] or Cesarean section delivery more often than average-weight women. Following Cesarean section delivery, obese women have a higher incidence of wound infection and disruption. Irrespective of the delivery mode, children born to obese mothers have a higher incidence of macrosomia and associated shoulder dystocia, which can be highly unpredictable [baby’s shoulder gets hung up in the birth canal, and those deliveries are scary and very messy!]. In addition to being large at birth, children born to obese mothers are also more susceptible to obesity in adolescence and adulthood. Prevention is the best way to prevent this problem. As pregnancy is the worst time to lose weight, women with a high BMI should be encouraged to lose weight prior to conceiving. During preconception counseling, they should be educated about the complications associated with high a BMI. Obese women should also be screened for hypertension and diabetes mellitus. In early pregnancy, besides being watchful about the higher association of miscarriage, obese women should be screened with ultrasound for congenital anomalies around 18 to 22 weeks. The ultrasound should be repeated close to term to check on the estimated fetal weight to rule out macrosomia. Obese pregnant women are screened for gestational diabetes around 24 to 28 weeks. During the second half of pregnancy, one needs to closely watch for signs and symptoms of pregnancy-induced hypertension.… When Cesarean section is performed, many obstetricians prefer an incision above the pannus [hanging flap of tissue, no bikini cut!] to avoid skin infection…. Peripartum, special attention is given to avoid thromboembolism by using compression stockings and early ambulation.

The fact that this doctor is putting another woman at risk is ridiculous. Yes, I feel for him in that there are concerns about saying “no” to patients, especially a nice cash-paying patient like an IVF client. But doctors are first supposed to “do no harm,” and there is no way any sort of medical practitioner could say that placing multiple embryos into an obese, “elderly” mother is a reasonable thing to do.

I just hope that this third woman (that we know about anyway) has her health insurance premiums paid up, or that she is wealthy enough to pay outright for her hospitalizations prior to delivery and that she can pay for time her no doubt multiple babies will need to spend in the NICU.

Maternal obesity and pregnancy

Octuplets draw critical eyes to fertility industry