Octuplets Are Cautionary Tale Not Triumph

As the world marvels over the miracle births of eight seemingly healthy babies in California, medical ethicists and fertility experts argue that the media is sending the wrong message with its focus on the creation of an instant Brady-Bunch like family.

It’s fine to celebrate the healthy delivery, said Sean Tipton, spokesperson for the American Society for Reproductive Medicine. But, a pregnancy resulting in this many babies is “clearly is not a medical triumph. Eight babies is not an outcome anyone should want.”

Unbridled celebration of these multiple births ignores the risks that this type of pregnancy can bring and the huge costs to the medical system and the parents, say experts.

“I think when the press goes googoo and gaga over these multiples, they don’t seem to understand that it’s really risky for the mothers and for their fetuses,” said Arthur Caplan, chair of the department of medical ethics at the University of Pennsylvania and an msnbc.com contributor.

Fertility experts interviewed by msnbc.com all said that the most optimal situation was a pregnancy with one embryo — something that often can be accomplished through careful monitoring of the woman during her fertility treatments.

Hormone injections likely led to octuplets
All said their comments came with the caveat that no one currently knows the circumstances of how the California mom became pregnant, since neither she nor her doctor has spoken publicly.

But, the experts said, it’s highly unlikely that a woman could become pregnant with eight embryos without some kind of fertility treatment. The most likely scenario is that the woman was given hormone injections to spur the growth of follicles and then was either inseminated artificially or told when she should have intercourse with her spouse.

With this type of fertility treatment, doctors need to monitor the woman’s cycle very closely because it’s impossible to predict exactly how many follicles will grow when the ovaries are stimulated, said Dr. Mark Perloe, medical director at Georgia Reproductive Specialists in Atlanta. You can get a good idea of how many follicles are growing if you run regular blood tests and ultrasounds of the woman’s ovaries.

If it looks like the woman is developing too many follicles, then doctors have two choices, Perloe said. You can chose either to skip the cycle and try again with a lower dose of the follicle-stimulating hormones or you can harvest the eggs, freeze them, and then do in vitro fertilization later. With in vitro fertilization, the doctor has control over how many embryos are transferred to a woman’s uterus.

But, Perloe said, sometimes women ignore their doctor’s advice and go ahead with the cycle.

And that puts both the mom and her fetuses at risk.

“From the obstetrician’s point of view, you want to prevent higher order multiples,” said Dr. Zev Rosenwaks, director of the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “As a rule, singleton pregnancies do better than twins. And twins do better than triplets.”

Problems down the road?
As the number of embryos increases, so does the risk, Rosenwaks said. And while the California woman’s babies, which were delivered at 30 weeks, may look fine now, they could end up with problems later on, he added.

“It’s hard to tell right now,” Caplan agreed. “It’s tough to get them all born without pre-maturity and disability. I don’t know of any birth that involved seven or eight fetuses that hasn’t resulted in both.”

Premature babies are at risk for lung problems, stroke and intestinal problems, said Dr. Elisabeth Ginsburg, medical director of the in vitro fertilization program at Brigham and Women’s Hospital and president of the Society for Assisted Reproductive Technology.

Even if the babies survive the delivery, they may die later — as was the case with first U.S. set of live born octuplets. One died a week after they were born in Houston in 1998. And surviving children can end up with serious disabilities. Of the seven babies born in 1997 to Kenny and Bobbi McCaughey in Iowa, two ended up with cerebral palsy.

Even when you carefully monitor a woman’s ovaries you can end up with surprises, said Dr. Howard Zacur, professor and director of the division of endocrinology and infertility at the Johns Hopkins Medical Institutions.

“What I’ve learned is that you have to be really careful,” said Zacur.

Ultimately, in vitro fertilization may be the best way to avoid multiples, experts said.

Answer may be tied to insurance
But because insurance companies often offer little or no coverage for in vitro fertilization, couples often feel they must choose fertility drugs with artificial insemination instead because this method costs less, Zacur said, adding that the Europeans may have found a reasonable solution. In Europe, insurance companies have said they would pay for in vitro fertilization if the physician agrees to transfer only one embryo per cycle.

With the big price tag for in vitro fertilization coupled with the rosy picture painted by the press of families with multiples, it’s probably not surprising that many opt for the less expensive, but more risky treatment, Caplan said.

Prospective parents see profiles of these families, Caplan said, and “they think, ‘I saw the people on TV. It looked hectic, but fun.'"

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney.

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