Tag Archives: Multiple Births

Ethical Issues Related to Birth of IVF Octuplets : Not a Cause for Celebration, Doctors Warn

 

Two newspapers recently published two opinion pieces examining the ethical issues surrounding the recent birth of octuplets to a California woman, Nadya Suleman, who reportedly underwent fertility treatments. Summaries appear below.

 


~ Arthur Caplan, Philadelphia Inquirer: “Something has gone terribly wrong when a 33-year-old single woman — who has no home of her own, no job and a mother who worries her daughter is ‘obsessed’ with having children — winds up with 14 of them,” Caplan, director of the University of Pennsylvania Center for Bioethics, writes in an opinion piece. “Examining what exactly went wrong may shed some light on what ought to be done,” Caplan says, adding, “If doctors cannot prevent such shambles from recurring, then society must.” Caplan reports that Suleman became pregnant with all of her 14 children through in vitro fertilization. He writes that the “most obvious questions raised by this sad saga include: How did Nadya Suleman become a fertility patient? And how did she get eight embryos implanted when she already had six young children to care for in a tiny house, with no partner and no income?” Although “[s]ome fertility doctors would answer that it’s not their job to decide how many children a person can have,” Caplan writes that the “idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers.” He continues, “Society needs to discourage mega-multiple births. And it is clear what needs to be done to accomplish that.” Government “needs to get involved,” Caplan says, concluding, “Other nations, such as Britain, keep a regulatory eye on reproductive technologies and those who wish to use them, knowing their use can put kids at risk in ways that nature never envisioned. We owe the same to children born here” (Caplan, Philadelphia Inquirer, 2/6).



~ Ellen Goodman, Miami Herald:  The medical team that delivered the octuplets “expected kudos and high fives,” but “instead of smiles, they saw jaws drop,” syndicated columnist Goodman writes. She continues, “Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.” Questions about whether anyone has “a right to tell anyone else how many kids to have” and whether only women with husbands or certain income levels should have children are “questions that make us feel queasy when we are talking about old-fashioned families,” Goodman writes. She adds, “But they take on a new flavor in the unregulated wild west of fertility technology.” According to Goodman, the “heart of this case” is that “it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.” She adds that it is “against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, those who endanger patients ought to lose their licenses.” Goodman also writes that the infants will need “at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies.” A “reproductive business that generates so much controversy has produced a remarkable consensus,” she says, concluding, “Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is ‘nuts'” (Goodman, Miami Herald, 2/6).

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Multiple joys: Three gynecologists — and moms — are personal experts on twins and triplets

Talk about multitasking. Of the eight female obstetrician-gynecologists who deliver babies at Sutter Roseville Medical Center in Roseville, California, three are the mothers of multiples.

 

Dr. Amy Riley’s triplets, Julia, Vivian and Alec are now four years old. Dr. Anna Almonte’s twin daughters, Katherine and Elizabeth, are 6. And Dr. Jackie Ho gave birth to the babies of the group – twins Marissa and Ellie Ow – on May 16.

Even more impressive, all three doctors have older children as well. Clearly, they’re well versed in the art of juggling the demands of home and family and a busy career.

 

“People will say, ‘I can’t imagine,’ ” Riley says. “But I can’t imagine anything else.”

For their patients, they set an encouraging example. Riley, Almonte and Ho understand the reassurance implicit in their care of nervous expectant mothers overwhelmed with the idea of carrying, delivering and raising multiples.

“I’m very encouraging about twins,” says Almonte, 37, who immigrated from Ukraine a dozen years ago. “I always say, ‘It’s double trouble, but it’s a double joy.’ “

 

According to Centers for Disease Control and Prevention statistics, the twin birth rate – more than 32 per 1,000 births – has increased 42 percent since 1990 and 70 percent since 1980, in large part the result of delayed childbearing. Beginning in their 30s, women are more likely to conceive twins naturally – and even more so when fertility treatments are involved.

 

In contrast, the birth rate for triplets and other multiples has declined slightly in recent years, the CDC says, following American Society of Reproductive Medicine recommendations limiting the number of embryos transferred during fertility procedures.

 

“When I was pregnant with my twins, I had four other couples at the same time in my practice carrying twins,” says Ho, 39, herself a twin. See? Twins, once a relative rarity, seem like they’re everywhere these days. Scratch the surface of most elementary schools and you’ll find a few sets of multiples.

 

And as Cindy Camarena, president of a California Moms of Multiples club, likes to say, when people see twins, they smile. Something about doubled- and even tripled-up siblings, whether identical or fraternal, still delights us.

 

For the record, Ho and Almonte both conceived their twin daughters the old-fashioned way, without the assistance of reproductive technology. “It was nothing but nature,” says Almonte.

 

On the other hand, when Riley and her husband, Damon, decided it was time to expand their family beyond their first daughter, Brenna, now 10, they struggled for several years. “Then one cycle with in-vitro fertilization, and there were three more kids,” says Amy Riley, who lives in Roseville. “It was like winning the lottery after four years of infertility.”

 

Carrying multiple babies comes with multiple risks, including preterm labor and toxemia. As expectant ob-gyns, the doctors knew more about those risks than most pregnant women.

 

“I think knowledge is always good,” says Ho, whose oldest daughter, Caroline, is 8. “When I found out I was having twins, I was very happy but at the same time worried about potential complications. “I was as excited as I could be, but I thought, ‘Am I going to end up having a C-section? Am I going to be able to take them home with me from the hospital, or will I have to leave them in the (neonatal intensive care unit)?’ “The extra knowledge caused extra concerns. But I also knew what to watch out for.”

 

And what do the twins and triplets watch out for? Often as not, each other.

“When there are three,” says Riley, “they learn to be more patient than other kids are. They all yell, ‘Mom,’ at the same time, but there’s only one mom. So they help each other out. And they’re very good at sharing.” “You teach your kids to be independent,” Almonte says. “They entertain each other.” Riley nods. “We had to constantly entertain our older daughter,” she says. “But these guys entertain each other.”

 

Meanwhile, Ho and her husband, Dr. Randy Ow, an ear, nose and throat specialist, make a point of devoting one night each week to their oldest daughter so she won’t feel overlooked in their newly twin-centered Roseville, Calif., household. “Life is good,” Ho says. “I have a very understanding husband. I’m still trying to be there as much as I can for my patients. When I leave work, I’m 100 percent with my kids. They keep us very busy, nonstop.

“We’re so happy with them.”

 

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Delaying motherhood and defying nature

The average age of women seeking fertility help in Australia has increased from 35.2 years old in 2002 to 35.6 years old in 2006, according to a report by the Australian Institute of Health and Welfare (AIHW). The report showed that record numbers of women over 40 were undergoing fertility treatment – rising from 14.3 per cent in 2002 to 16.2 per cent in 2006 – despite those over 45 having only a two per cent chance of becoming pregnant.

The figures may echo a growing trend in the number of couples delaying parenthood, says Peter Illingworth, a Sydney- based doctor and president of the Fertility Society of Australia .’The vast majority of couples we see who are over 40, for example, have only just met’, he told the Bloomberg Press. ‘It’s not that they have made a conscious decision to do it in their 40s, it’s that the opportunity to have children has only just arisen later on in a woman’s life’, he added.

The report highlighted a 4.6 per cent increase in the number of couples undergoing Assisted Reproduction Techniques (ART), rising from 46,481 in 2002 to 48,706 in 2006. In total 10,522 babies were born in Australia and New Zealand as a result of ART in 2006, with numbers rising at an average rate of 5 per cent per year between 2002 and 2006. Of these, 78 per cent were singleton births, reflecting the recent drive to make single embryo transfer (SET) the policy of all fertility clinics.

Professor Michael Chapman, Head of Women’s and Children’s Health at the University of New South Wales in Sydney told The Age that fewer women than ever were having multiple births, with fewer than one per cent of women having more than two babies.

‘The multiple pregnancy rate, which six or seven years ago was in the 20 per cent range, is now down to 11 per cent’, he said, adding: ‘It’s virtually halved from its peak and that’s good for the parents, it’s good for society, because many of them end up in special care units and with long-term medical problems’.

The aim of SET policy is to avoid the risks associated with multiple births, such as premature birth, low birth weight, an increased risk of death in the first week and an increased risk of cerebral palsy around four times that for singleton births. However, SET is not always considered the best policy. For example, some experts have criticised the recent decision to make SET part of UK fertility guidelines, pointing to the low success rates of IVF, the lack of state provision on the National Health Service and the high private fees.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Septuplet joy for Egyptian couple

An Egyptian woman has given birth to seven babies in the northern city of Alexandria, doctors said. The mother, named as 27-year-old Ghazala Khamis, is said to be well and the septuplets – four boys and three girls – are reported to be stable. The babies are said to weigh between 1.45 and 2.8kg (3-6lb); the couple already have three girls.

They sought fertility treatment hoping to have a boy, and were said to be astonished at the multiple pregnancy. Since the introduction of in-vitro fertilisation (IVF) treatment 30 years ago, the number of multiple births has increased dramatically.

Health experts say septuplets are very rare, and it is even less common for all to survive. The seven were delivered by Caesarean section a month early, and all have been placed in incubators designed for premature babies. The woman’s brother said that the Egyptian health minister had promised free milk and nappies for the babies for two years, to help the family cope.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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