Our national fascination with Nadya Suleman (aka “Octomom”) continues. I think we are drawn to all multiple births, so I guess it’s logical that we’d be more engrossed in the ultimate of all multiple births—octuplets. This fascination is fueled by the tinge of horror because Suleman actively attempted to have eight children by having eight (or six embryos as she claimed in the past) embryos transferred. All the other cases of super multiples (6+) that I know of were the unintended consequence of taking ovulatory stimulating injectible drugs with IUIs (artificial insemination).
I read an article recently that asserted that one consequence of our national fascination with Octomom is the increased awareness of the risks of multiple births and an increase in patients opting for single embryo transfer. Oh, if only it were true!!
The CDC reports that the twin birth rate rose 76 percent from 1980 to 2009, while triplets and higher-order multiple births rose a staggering 315 percent. Certainly there has been increased awareness that the ultimate goal of infertility treatment is one healthy baby, but I’m not so sure that we’ve convinced most patients that their best chance of success is with single embryo transfer. The risk associated with twin births is totally downplayed in our society. Few people know that 60% of twins are born premature, with an increased risk of death, cerebral palsy, mental retardation, lung problems, eye and ear impairments, and learning disabilities. Or maybe the real truth is that most people “know” the risk on some level, but believe that it won’t happen to them. They want to believe that they will somehow be able to control their pregnancy by eating just right, moving just right, sleeping just right, and thinking just right so that they and their children will be in the 40%. The problem, of course, is almost 100% of moms pregnant with twins from fertility treatment believe this, and only 4 out of 10 will be right.
We have a solution to this problem of twin births from IVF, especially for younger women (35 and under)–single embryo transfer. The problem is that only around seven percent of women under 35 choose an elective single-embryo transfer. I see this in the people I talk with in our large online community as well. The problem is multifaceted…the desperation to get pregnant, the perception of decreased success rate when using only one embryo, plus the ever present issue of cost.
Most patients by the time they reach the infertility clinic for IVF are emotionally and financially tapped out. They just want to be parents. Period. It’s a hard sell to get them to transfer only one embryo when they can up their odds by transferring two and have an instant family. So, what are the odds of getting a baby when only one embryo is transferred?
Three recent metal analyses found that birth rates after fresh embryo transfer of one cleavage stage (day 3) embryo were 26% compared to 43% for double fresh embryo transfer. When blastocyst stage (day 5) embryos were used, one study found that the ongoing pregnancy rate for single fresh embryo transfer was 61% versus 76% for double fresh embryo blastocyst transfer. The twin rate, however, for these double blastocyst transfers was a frightening 47%, while none of the single blastocyst transfers resulted in twins.
The problem with most studies of single embryo transfer is that they only look at the first fresh transfer. Assuming that most people electing to transfer one embryo have frozen embryos remaining, it is important to assess the birth rate after one fresh and one frozen cycle. In other words compare the results from transferring two embryos at two different times versus transferring two embryos at one time. In one well designed double-blind, randomized multi-center study of 661 patients under age 36, the birth rate of cleavage stage (day 3) embryos did not differ significantly between two single embryo transfers (one fresh, followed by one frozen) and one double embryo transfer. Of course, the cost of one fresh and one frozen transfer is usually more than the cost of one double transfer, but not significantly more at most clinics.
As much as I want to believe that there is an upside to Octomom, I’m not so sure that it is happening. As I said above the vast majority of patients do not elect to transfer only one embryo unless it is strongly encouraged by their infertility clinic, and the sad fact is that only about 100 existing clinics in the US and Canada are making this push. Anecdotally, I hear that the clinics that require patients to watch a video on the risks of twin pregnancies have a much greater success with patients choosing the more conservative single embryo transfer. It would also help if fertility clinics would make the cost of two single embryo transfers (one fresh and one frozen) the same as one double embryo transfer.
Image credit: NY Daily News
@Marianne Milton: I hope you didn’t misunderstand me to say that I think the Duggars are more admirable or laudable b/c they DON’t take assistance. That is not the case at all. I just know that many critics ASSUME that they do and they’ve been very clear that they haven’t nor do they need to. I was clarifying that they differ from Suleman in that they do not “depend” on assistance as a previous poster had stated.
We, in fact, do use state assistance for our special needs child and will as long as she qualifies. It’s a support and a resource that has helped many a time in the four years she’s been home. We are grateful to live in a state that recognizes her need as important to support, regardless of income or financial status.
Whether Suleman chose to implant such a high rate of multiples or not, she has them. She is living with the consequences of her choice and her medical team’s choices/actions. That’s over and done with now. What I’d like to see is MENTORING and EDUCATING and COACHING done now for her and for her kids to turn their lives around and improve their present and their future. The current gov’t system doesn’t really provide that but it’s exactly what she needs, whether she continues to need the subsidies/assistance or not.
I agree with most of what you say, Tracy O’Mara Whitney, except that it’s no crime to take government subsidies for the benefit of children, in my opinion. In fact, most developed countries, except the U.S., supply them automatically to parents, because their governments recognize that ensuring children a safe, healthy, and loving upbringing is crucial to their country’s best interests—that nurturing and educating children really does take a village, and is not solely a personal act. But, other than that quibble, I couldn’t agree with you more: I especially admire how the older children help to take care of the younger ones: I think that lots of future parents would be well-served by having that kind of caretaking practice in their youth, if only to discourage them to become parents too young but it’s such hard work—LOL. As the oldest daughter of 4 siblings, who also did a good deal of outside babysitting in high school and college, I *KNEW* I wasn’t ready for the full-time job of parenting in my 20s and 30s. I got all my freedom-loving years in before I was ready to settle down and devote myself to the endless (sometimes exhausting, sometimes maddening needs) of little ones. I’m not saying this is the only route to good parenthood, but the practice at caretaking opened up my eyes to what it was really about. No romantic illusions there!
Another reason I think that the Duggars are unfairly criticized is their whole philosophy of parenting. Shelter longer than most of culture, nurture family relationships as priority over outside relationships, partner the olders with the youngers, comunity outreach/service, etc. Much more traditional, hearkening back to the early years of families going out on their own to settle new land and requiring dependence upon each other, all of which flies in the face of America’s more recent cultural shift to utter independence, push your kids to grow up, etc.
For the record, there is NO evidence or documentation to support the statements that the Duggars use subsidies and Gov. programs to feed and care for those children. They have been quite open about the fact that they can afford to do this without gov’t intervention and remain debt free at the same time.
I’d much rather see them used as a role model to families who desire a lot of kids, for how to run a smooth and peaceful home that produces responsible young people who know how to reach out and care for those around them and take good care of themselves and their family.
As for Suleman, I feel terribly for her. She got caught in a bad situation, with a very difficult outcome, and has had no wise counsel, guidance or management for how to turn it around and redeem, it if you will, for her and her kids. I would love to see a wise mentor or life coach come along side her to support her as she learns some kind of moral compass and give her some life skills about decision making, parenting, budgeting, and career choices. She needs help, not all the judgement and criticism she faces.
Personally, I think someone like a Michelle Duggar would be an excellent “coach” for her to escape the media, hunker down and re-learn how to be a grown up mom.
In fairness, the Duggers do in fact receive a host of criticism. The fact that the are a fundamentalist christian family leaving their reproductive rights “to the Lord” angers a lot of people (people were brutal when they lost their last baby).
I agree it was wrong of her to plan, the woman needs mental help. I hope she has been getting it.
But what I am saying is why do we feel as if we can judge, if a mother is not somehow meeting those perfect “conditions”? Plenty of women have unplanned pregnancies, and might not have all the things society sees as essential for raising a child, but that does not mean the child should be removed, or the mother condemmed. Maybe we need to better support women with planned and unplanned pregnancies alike. In my experience the one thing the child does need is his or her mother. If we are caring for and helping the mother, then the child will benefit.
I agree about the unsavory job opportunities being offered to her (not sure she has accepted any of them) but then again, why is no one giving her a show on TLC or something? I mean look at Kate+8, she had (as we now know) an unstable personality and marriage and twins already, when they transfered way too many embryos and ended up with six more… but since she was “legit” ie-married, then we consider all that drama and poor choices entertainment, and “OK”. Let the viewers lavish toys, clothing, vacations and what have you on them. Also, if one wants to go by the logic of other multiple baby makers like the Duggars, then we should see it ok that Nadya has “as many as the Lord sees fit to provide”… right? I just don’t like the two sided logic, because I really believe it is rooted in the way our society puts down ALL single moms, no matter how crazy they might really be, and that is a HUGE part of what feeds babies into the warped system of adoption. How else would I be raising a child who would have been FINE with his bio mom?
i think, lately, anyway, the condemnation comes from her supporting her kids by starring in porn and dancing in topless strip clubs.
So people like the Duggars or adoptive parents (single?) who adopt many kids somehow don’t have a choice? Honestly I think all the condemnation comes from her being a single, bio mother.
Read it and I definitely agree with your point when my husband and I were considering ivf we were encouraged to do only a double transfer the clinic policy would only allow a maximum of two
My understanding is that she lives on government subsidies as well. However, regardless of the economic situation, I think it has more to do with her ability to parent all of those children effectively. She had a choice regarding having 8 children at one time, those children did not have a choice. I wish her nothing but the best, as I know it is her children who will ultimately suffere the consequences, if she does not succeed.
What I want to know is… why does society treat her so horribly, but we praise people (who are married) and have multiple kids, like the Duggers, and people (who adopt multiple kids) are held out as great examples, even when they use subsidies and Gov. programs to feed and care for those children… but Nadya we simply hate on.
Actually the TRUTH is,given her track record upto the day that Dr. Kamrava TRANSFERRED 12 embryos, only 12.5%, ie only 6 of the 47 embryos she had TRANSFERRED eventually became a child. 2 more may have implanted but the pgs were chemical and ectopic.She had an implantation rate of about 12.5% – 1 in 8. Statistically she could have expected 1.5 babies out of 12 embryos.The last cycle where she transferred 8 embryos was a NEGATIVE. Go figure.
I repeat Embryos are TRANSFERRED, NOT IMPLANTED.
http://s3.documentcloud.org/documents/97259/michael-kamrava-medical-board-of-california.pdf
http://s3.documentcloud.org/documents/97259/michael-kamrava-medical-board-of-california.pdf
I’m not sure how I feel about the ethics or “rightness” of choosing 14 times (and make no mistake–given her track record it was no accident that most or all the embryos she asked to have transferred would eventually become a child) to bring a child into the world that you have no way to support. It does seem wrong to me to just assume that the government will support your family. I understand poor decision making; I understand how someone can “accidentally on purpose” (to quote one of my kids) end up with 1 or 2 kids w/o having thought through all the ramifications, but given the sheer scope of Suleman’s actions, I guess I don’t have a hard time saying that although it may not be a crime, it sure feels wrong on all levels. I don’t mean that now that those 14 kids are here that they don’t deserve our support. They do. They are children and they need support. Their mom is not capable, so we have to step up. But I still judge her poorly for having made the decision to put them in this position.
Dawn,
Do you know what percentage of fertility-assisted multiples are the result of IVF and what percentage are the result of ovulation medication alone? I became pregnant with twins with injectibles/IUI. We were definitely not trying for multiples, as we knew the risks. Our babies were born at 28 weeks, 3 months early. They are doing awesome, but need lots of physical and developmental therapy. But there was no way that we could afford to do IVF (in order to control for the risk of multiples), as we we struggling with no insurance coverage even to pay for the treatment costs of ovulation induction. I wonder if this is a problem many couples face.
It is a problem MANY couples face. The irony is that I have no doubt that you personally have spent far more already on your children’s medical care than you would have ever spent on an IVF cycle and your insurance company has probably spent 10X + what they would have spent. To me, this is one of the strongest arguments for insurance coverage for infertility treatment which includes at least 2-3 rounds of IVF. I am glad they survived and are doing OK.
I don’t know the exact statistics off the top of my head, but I know that the vast majority of triplets and almost all higher order multiples are from injectible ovulatory stimulating drugs with IUI. Not sure about the stats on twins, though.
On the other hand, I’m all for bringing awareness to the risk of multiples with fertility treatment. I’m just not sure her example is really serving as a cautionary tale since it is so far out there.
I can’t speak for others, but my problem is that she actively choose to incur the risk of having 8 children at once. Humans are not meant to be born in litters and she risked their health for reasons that are not clear. Further, she actively chose to bring 14 kids into this world without having the financial or emotional means to raise them. She was already unable to support her 6 kids and admitted that she had her hands full, especially since at least 2 of her first six kids have special needs, before she had EIGHT embryos transferred. I wish her the best, but I worry about all of her children. Even if she wants to do her very best in raising them, I wonder how she’ll be able to do it. Most orphanages wouldn’t allow a 1:14 ratio with children that young.
Deb, I think you’d enjoy a blog I wrote shortly after the octuplet’s birth–Are We Judging the Octuplet Mom Too Harshly? http://bit.ly/NOgjsx Most if not all other larger order multiples are an “accident” of fertility treatment. No embryos were transferred. The woman took ovulatory stimulating drugs and then had an artificial insemination. It is harder to control the number of fetuses which will result. Suleman’s 8 children were intentional. She asked to have six or eight (depending on what you read) embryos transferred. She had to ASK to have them transferred knowing full well with her history that she would be at extremely high risk for a higher order multiple birth. Now, I do think that many of the other large order multiple birth we read about also probably result from unnecessary risk taking, so your point is well taken that we have something of a double standard.
Deb, it seems to me that huge families, such as the Duggars, differ in two important ways from the octuplet story. They grew over time rather than all at once. The lives of the children were not endangered by a large order multiple birth, and each child was allowed the attention an infant needs to develop into an emotionally healthy adult. Also, the Duggars can afford to raise their nineteen children. They are debt free, and provide their children with the extras we associate with a proper childhood. I’m not saying it would be for me, nor that I think the kids are getting the type of attention that I would consider essential for parenting, but I don’t judge for the above reasons.
I agree with the need to support her and not belittle her now that the children are here. In general, I try really hard not to judge people b/c I fundamentally believe that we all live in glass houses, so to speak. I certainly know I do. So, I guess I agree with you on the the judgement part. But, I also believe that planning (not accidentally having it happen to you, but actively planning) a higher order multiple pregnancy is akin to child abuse. And some things deserve our condemnation. Now that the children are here, they and their mom need our support.
Lorraine, that’s a good point. The Duggars do get lots of criticism, but somehow it seem tamer than the judgement heaped on Suleman. I don’t watch their show or really follow them much in the “news” but it doesn’t surprise me that they catch a lot of flack.
I think the problem most people see with this is that it was planned despite the fact that she could not care for (financially or emotionally) the children she already had. Hoping for a reality show, to profit off your kids, is about the WORST plan I can think of for finding the means to raise them. One should be able to raise their children (financially but also otherwise) BEFORE having another, let alone 8 others. I am the child of a fantastic single mother. She struggled and sacrificed to raise my brother and me–with no support financially and no thought of using us to profit. No one is giving her a medal or following her around with a camera. THAT, folks, is a REAL mom! And for whatever it’s worth, I think Kate Gosselin is just as vile as Octomom (or the Duggars, or anyone that uses their kids as means of forwarding their “acting” career).
Another reason I think that the Duggars are unfairly criticized is their whole philosophy of parenting. Shelter longer than most of culture, nurture family relationships as priority over outside relationships, partner the olders with the youngers, comunity outreach/service, etc. Much more traditional, hearkening back to the early years of families going out on their own to settle new land and requiring dependence upon each other, all of which flies in the face of America’s more recent cultural shift to utter independence, push your kids to grow up, etc.
For the record, there is NO evidence or documentation to support the statements that the Duggars use subsidies and Gov. programs to feed and care for those children. They have been quite open about the fact that they can afford to do this without gov’t intervention and remain debt free at the same time.
I’d much rather see them used as a role model to families who desire a lot of kids, for how to run a smooth and peaceful home that produces responsible young people who know how to reach out and care for those around them and take good care of themselves and their family.
As for Suleman, I feel terribly for her. She got caught in a bad situation, with a very difficult outcome, and has had no wise counsel, guidance or management for how to turn it around and redeem, it if you will, for her and her kids. I would love to see a wise mentor or life coach come along side her to support her as she learns some kind of moral compass and give her some life skills about decision making, parenting, budgeting, and career choices. She needs help, not all the judgement and criticism she faces.
Personally, I think someone like a Michelle Duggar would be an excellent “coach” for her to escape the media, hunker down and re-learn how to be a grown up mom.