Saturday, February 14, 2009

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


ritanita said...

Good grief! I just don't get this guy, I think he thought that the Hippocratic Oath was the Hypocritic Oath as in, "how much money can I rake in by ignoring the health of my patients."

This Dr. Kamrava reminds me of Dr. Jan Adams. He operated on Donda West, the mother of rapper Kanye West.

Ms. West died the day after her breast reduction and abdominoplasty (tummy tuck).

She had been turned down by one plastic surgeon because she needed a medical clearance due to her age and health conditions.

Instead of doing that, she "doctor shopped."

I hope these other new mothers do well and deliver healthy babies. I am very fearful for them.

Thanks CaliGirl9 for the update.

Geralyn said...

This whole story is just so infuriating. I had the opportunity to view Dateline's show devoted to this. When I saw her autistic child of hers just circle around and around it was just heartbreaking to watch.

How on earth did Kamrava perform this procedure on a once suicidal and clearly delusional patent!!!! There a story out there about this very "doctor" implanting 7 embryos into a woman who is 51 years old, resulting in quadruplets! Obviously, he should have his license pulled.

Before I forget, Happy Valentine's Day to all my fellow T&T people!

Anonymous said...

Wasn't it Dr. Baden, in the first Spector trial, who said something along the lines of the Hippocratic Oath really being more of a suggestion/guideline? THAT didn't go over very well!

gale shea said...

He should loose his license.

Anonymous said...

I just don't share the outrage about performing IVF for obese women. I happen to be an obese woman (220 pounds) who had six sets of IVF embryo transfers before conceiving my 6 year old and 3 year old sons. I don't have high blood pressure or diabetes, although my high-risk OB/GYN specialist monitored me carefully throughout my pregnancies in case I developed these conditions or any other like pre-eclampsia, toxemia, etc. My 6 year old was born via natural childbirth within an hour of my entering the hospital in labor, and the only reason I needed a c-section for my 3 year old was because he decided to shift around and stick out his foot instead of his head.

Nobody should be denied parenthood just because they are "higher risk." They should certainly be informed of what they can to do monitor and reduce any risks (for example, taking folic acid before conception to reduce the risk of spina bifuda) but people should be allowed to decide for themselves how much risk is acceptable.

CaliGirl9 said...

Katprint, I agree with you perhaps halfway.

I don’t know if the 41-year old prospective IVF mom has other complications due to her weight, but being 41 years of age in itself is a problem, regardless of weight, especially if this is a first pregnancy/baby. I suspect the three doctors who rejected her did so not only because of her weight, but because she already has a co-morbidity associated with her weight that will be exacerbated by her age. To me that’s a huge red flag; there are so many excellent fertility specialists that to have three reject someone is just not coincidental; it’s probably smart medicine.

Just like Ritanita pointed out above, there are real dangers going doctor-shopping to get what you want. Donda West certainly wasn’t that old, but she could still be alive if she’d just heeded that first doctor’s advice and dealt with whatever issues she had. Very sad really if you think about it.

The other thing that bugs me about this Kamrava thing, as far as I can tell, he manages to impregnate a few women via IVF, and then passes off their care to another poor schmuck that had nothing to do with the decision to stick a litter of babies into a uterus.

I agree that a patient needs to be fully informed of the risks, but that prospective mom/family also needs to be prepared to deal with the consequences, including medical care, and with our litigious society the way it is, be willing to not blame a doctor for a bad outcome. I know bad outcomes are not the norm, even in a high-risk pregnancy, and your boys are an example of that. I was on bedrest from 28 weeks to an induced delivery at 37 weeks due to preeclampsia, and ended up delivering at a major medical center after two hospitalizations because my blood pressure didn't respond to treatment. It sure wasn’t fun (or cheap) and is a reason I have one kid and hypertension today.

It’s just the RN left in me that scares me about the latest two Dr. Kamrava patients … I don’t even like to think of what I’d be doing to protect myself (and my license) if I found myself being assigned to the care of any of those women, including Octo-mom.

(Now that I think about it, I wonder if she has any birth injury lawsuits floating around out there over the three kids with already identified problems, especially the full-blown autistic kid … )

Anonymous said...

IVF is EXPENSIVE. Where did Suleman get the money to have this done? On the California taxpayers' dime?
Neither one of the principal parties in this have ANY shred of conscience. Unfortunately, it's the babies... all 14 of them who will suffer from these two egos run rampant.

The reality is that the taxpayers of California will be bearing the brunt of this fiasco in so many many ways.

good luck... glad I just moved out of there.