Strollerderby

Queston: Should doctors be focused on scaling back these multiples?

Answer:  Yes

Having been through infertility treatments, I must argue that the primary cause of super multiples is the poorly monitored use of ovulation drugs like Clomid in conjunction with inseminations, and not placement of multiple embryos through IVF.  Not that this is a hard and fast rule, but I can't imagine the doctors who worked with me agreeing to use eight embryos in one cycle.  It seems more likely that the woman hyperovulated and the doctors allowed an insemination to continue instead of terminating the cycle.  Further, while I've heard of embryos splitting and resulting in more babies than there were embryos deposited in the uterus (and I know it can happen because I have a friend who's on bedrest right now with triplets after her doctor implanted only two embryos) the likelihood of this happening is phenomenally low.

That said, I agree that doctors should be required to use the utmost caution in the use of drugs and procedures to ensure that super multiples don't occur.

If anyone is interested in the topic, the author of the book "Everything Conceivable" (can't remember name right now) discusses the ethical questions of such procedures. The whole book is fascinating.

I do think that there should be limits on how many embryos are allowed to be implanted, but the US fertility practice is among the least-regulated in the world. Technically, it interferes with a woman's "choice", right? However, I think that far too few people, doctors and patients both, take the risks of a multiple birth far too lightly. What's more, the couple's financial situation becomes a factor in what they're willing or able to do, which is sad. (e.g. A couple may choose to implant 6 embryos with hopes that at least one will "take" if they can only afford one or two rounds of IVF, which of course poses the real possibility that they'll end up with 6 babies.) This stuff is science fiction.

A few things:

Several doctors have commented that it is highly doubtful that this is the result of IVF. Most likely she was on fertility medicine, hyperovulated, was told the cycle was cancelled and went ahead and sex against her doctor's advice.

Several news outlets are reporting that she is already a mother to 6, including a set of twins. And that she is young (don't know how young though).

Good fertility clinics have nearly equal successful pregnancy results from putting back one or two embryos. In fact, my clinic has only a one percentage difference between the two. There seems to be an industry-wide push to have younger women have eSETs (elective single embryo transfers).

She is also single and lives with her parents!  So she has 14 kids, no husband, no home and no job.  I guess we the taxpayers get to foot the bill for her 14 little miracles.  

This isn't a new issue for reproductive-medicine specialists.  It's been the topic of conversation at their annual meeting at least since 1997, when the McCaughey septuplets were born.  And in fact, the birth of high-order multiples (triplets+) will probably be shown to have peaked around 2006, when we look back in 2020.  Believe me, doctors have been saying "it's time to stop this" for a long, long time.

A couple of issues: if this woman genuinely had six babies already, I wonder what she was doing taking drugs to induce ovulation.  It doesn't seem to be a case of infertility.  (Even Jon & Kate were only attempting their second pregnancy when they pursued additional treatment.)

Many couples would prefer IVF, with its greater control over potential embryos and reduced odds of HOM birth.  However, it's at least twice as expensive as treatment using drugs and ovulation-monitoring instead.  Until we get a handle on insurance coverage for infertility, the risk of HOM births will still be unacceptably high.  (Although some people will still not choose IVF.)

The biggest long-term trend will be in high twin birthrates.  IVF has become successful enough, and twinning rates are high enough (even when only one embryo is transferred) that the twin rates are not likely to drop at all in the years to come.

Another trend this points out: the ever-greater success doctors are having in carrying very HOM births farther.  There have been a number of successful quint and sextuplet births in the past few years (along with some spectacular tragedies), and the large number of positive outcomes would have been inconceivable ten years ago.  To carry eight babies into the thirtieth week of pregnancy?  A remarkable feat.  (And one that does suggest this mother has carried a pregnancy to term before.....)

I just read in the LA Times that she had these embryos implanted. Doesn't that mean that this was IVF?

I took Clomid and was told that there was only a 6% chance of twins or higher.  My first cycle was twins, but I lost his twin at 8 weeks.  Second cycle was a singleton.

My doctor considered anything over twins a failure and was more concerned with his patients having healty babies rather than his percentages.

I agree with Jody on this one, if you only have enough money for 2 tries, you are going to do whatever you have to be successful.  Everyone is crying that they want their birth control covered by their insurance...how about fertility treatments.  

And if you are carrying around a pro-choice badge, how can you say it a woman's choice and then want to regulate her body in this way.  That being said, 8 kids at one time, with another 6 at home with no partner in sight????  That's just plain irresponsible.

gpgirl,

The sourcing on the "implant" comment was the grandmother -- and who knows what she understands about the different types of fertility treatments out there -- so I'm going to hold off until somebody medical actually chimes in before believing it.

What the doctors have said is that she showed up at 12 weeks -- not that she was e.g. transferred over from a fertility practice. That's kind of weird too -- if she was being tracked, even for IUI, wouldn't the HCG numbers have indicated some early ultrasounds would be a good idea? And if it were IVF, then there would almost certainly have been very early ultrasounds.

The IVF boards are wondering if this was a case of mail-ordering drugs without any medical supervision at all. So far that's the most plausible theory I've heard... but nothing says the story has to be plausible, right?

I wish women in the world, and especially in the US, would learn to accept that some of us are just not meant to have biological children.  The American culture of "I want it, and I want it NOW!" leads to things like this.  I'm 29 and am still childless.  I made a decision long ago that if I could not have children in a natural manner, there are so many kids here in the US and abroad that need parents.  I am not so vain as to think that a product of mine and my husband's genes are the only ones worthy of our time and affection.  Every parentless child already on the planet is worthy of this.

I also wish that people would realize that resources are limited.  Not only world resources but also the basic resources of time and attention for a child a parent has.  The more children you have, the thinner those resources are stretched.  

I'm also not sure what to think about people that go about trying to conceive in an unnatural manner and discover that they have a litter growing inside of them and decline selective reduction, putting the matter "in God's hands".  Couples that decide they won't wait any longer to conceive naturally have taken the power out of "God's hands" when they seek artificial means of having children.  If this is their mentality to begin with, why not give the healthiest embryos the benefit of being carried to term?  

Let's all think about the choices we make (even the little ones) and how they will affect others and the world at large instead of only concentrating on getting our own personal gratification as instantaneously as possible.