Octuplets - Medical Miracle And Mistake?

Some questions remain unanswered about the birth of octuplets this week, largely celebrated by the media until now.

The as yet unidentified woman is reported to be in her mid-30s and lives with her parents. Her husband has largely been missing from reports, but some say he is a “contract employee” who may be returning to Iraq where he works as a contractor, according to the Los Angeles Times.

Now comes word that the woman has six young children at home, all under the age of seven, and that the family filed for bankruptcy recently and abandoned a home a year ago.  All leaving the question- when does medical ethics play in a role in in-vitro fertilization?

Here is what we know:

• The woman received fertility treatments, according to her mother - but where and what kind of treatment remains an unanswered question
• She went to Kaiser Permanente Bellflower Medical Center, some 17 miles southeast of Los Angeles when she was three months pregnant. Kaiser did not perform the fertility treatment.
• Her mother tells the Los Angeles Times, her daughter never expected the fertility treatments to result in eight pregnancies
• She was told her options- to abort fetuses selectively or to continue with the pregnancy.  The woman said she did not want to abort any embryos
• The eight babies were born nine weeks premature, delivered by Caesarean section
• It took a team of 46 doctors, nurses and assistants to deliver the babies in a span of five minutes
• Six boys and two girls were delivered
• Premature babies are known to have health problems, sometimes throughout their lives, as their organs are not fully developed at birth
• The babies are still in neo-natal intensive care and have not yet been held by their mother
• The babies will remain in the hospital several more weeks but are making good progress
• The babies grandfather is from Iraq and has plans to return to raise money for his growing family while the family lives in a two or three bedroom home outside of Los Angeles
• CBS News reports the family filed for bankruptcy and abandoned a home a little over a year-and-a half ago
• There is no information on how the woman paid for her fertility treatments

What Medical Ethicists Say

When asked whether Kaiser Permanente Bellflower condones providing fertility assistance to a mother who already has many other children, Dr. Harold Henry told reporters, “Kaiser has no policy on that.” 

Instead she was counseled on her options.

The Early Show on CBS talked to Michael Tucker, scientific director of Georgia Reproductive Specialists, which provides reproductive services such as in-vitro fertilization. 

He told reporters the developments leave him “stunned”.  “This is just remarkable to me that any practitioner in our field of reproductive medicine would undertake such a practice,” he said. 

Tucker adds that the woman likely took fertility drugs on her own without a doctor’s guidance.    

The profession, if governed under the American Society of Reproductive Medicine guidelines, encourages a pre-interview of prospective parents to determine if they are psychologically and financially able to raise a child. 

If using in-vitro fertilization, the professional guidelines are to implant one or two embryos at a time in the uterus to end up with a single birth or twins delivered full-term.  

It’s less likely you can control the number of embryos with hormone injections. Hormones spark the growth of follicles which are more receptive to artificial or natural insemination.

Dr. Mark Perloe, a medical director at Georgia Reproductive Specialists, tells MSNBC that with this type of fertility treatment, doctors need to closely monitor the woman's cycle because it is impossible to predict how many pregnancies will result. 

interviewed Dr. Jamie Grifo, a fertility specialist at the NYU Fertility Center.  In his 22 years, he says he’s only seen a quad birth twice.

He attributes that to good communication between patient and doctor. “if you spend time explaining the risks and benefits, most of the time they make a good decision” he says. The risks to the mother include enlarged ovaries, heart failure, and developmental disorders in the children, he says.

Of the seven babies born to an Iowa couple in 1997, two have cerebral palsy. The number of multiple births have been declining in recent years as in-vitro specialists believe the limit a uterus can safely handle is two babies.  

This is just the second time there has been a successful octuplet delivery in the U.S. The last octuplets were born in Houston ten years ago, but one baby died a week later. #