This story of the octuplets has caught fire, which at least makes me feel less freakish for my fascination. True to my prediction in last week’s blog, I’ve been reading everything I can find, although I haven’t stooped to The National Enquire–yet. An editorial on Time titled “Calling a Truce on the Octuplet Mom” by one of my favorite columnists, Nancy Gibbs, caught my attention. Ms. Gibbs questioned why our society was vilifying this mother while celebrating other large families such as the Gosselins (family with twins and septuplets of the reality TV show Jon and Kate Plus Eight fame) and the Duggars (family with 18 kids of the reality TV show 17 Kids and Counting fame). It’s a valid question.
In the past, high order multiple births were an accident of infertility treatment. All the cases I know of resulted from a woman taking strong ovulation inducing drugs and then either having sex or being inseminated with sperm injected directly into her uterus. This procedure, known as an IUI with injectibles, is an inexact science. The ovaries are stimulated to produce multiple eggs, but it is not always possible to know the quality or maturity of the eggs produced, and thus, it is impossible to accurately predict how many eggs will be fertilized. I feel compelled to point out that cautious, responsible doctors seldom produce the conception of over three or four babies using this technique, but nonetheless, the parents of these large order multiples are seen as the victims of medical science. Most of us are suckers for plucky stories of people making the best of a bad situation, especially when these stories involve cute babies. It’s easy to root for these families because they are graciously coping with the hand they were dealt. Nadya Suleman, the octuplet mom, appears to be the dealer in her story by insisting on the transfer of six embryos because she wanted a large family.
As to mega families by choice like the Duggars, I’m not so sure “celebrate” is the correct verb choice. I think our fascination is more of the “thank goodness it’s not me” variety. Watching the logistical challenges of such large families makes our problem of how to get Suzy to soccer practice at the same time Johnny has piano lessons and dinner needs to be started seem manageable. 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 eighteen children. They are debt free, and provide their children with the extras we associate with a proper childhood. Ms. Suleman is an unemployed woman living off of her nearly bankrupt parents. I think any family that continues to have children they can’t afford would be judged the same.
But here’s the uncomfortable point: I do think we are applying a double standard. I suspect that if we scratch the surface of the other quintuplet, septuplet, sextuplet, and octuplet births, we’d see that those parents also consciously took risks. They likely knew before they went through the IUI that there was a risk of too many eggs being fertilized. True, their gamble was less egregious than Ms. Suleman’s who actually had six embryos transferred upping the odds of large order multiples, but it’s only a matter of degrees. In these huge mega families by choice, such as the Duggars, I wonder how much individual attention the children really get. The average spacing of children in the Duggar family is eighteen months (yes, I went to their website to get this fact, but it was only for research purposes). That’s a lot of children in a relatively short period of time. A couple of years ago, I read two biographies about the Gilbreth family made famous in the book Cheaper by the Dozen. Apparently the reality of being raised in a crowd is different from the fictionalized portrayal in the books and movies, and not as much fun.
Ms. Suleman thinks she is being unfairly judged because she intentionally had children as a single woman with no father in the picture. She may be right, in part. An editorial this week in The Atlanta Journal-Constitution lambasted not only Ms. Suleman for being selfish, but all single parents who chose this path as well. I think this broad condemnation of all “single parents by choice” is misplaced. Through my work and consulting, I know plenty of single parents who responsibly chose parenthood without a partner because no partner was available, and they knew their life would not be complete without a child. Some adopted and some conceived, but the vast majority are totally invested in being a parent. The research that was touted in the editorial was based on single parents created by the accident of divorce or birth control, not on parents who consciously choose and prepare for single parenthood. Don’t we all become parents for inherently selfish reasons—we want to parent, we want to see parts of ourselves in the next generation, we want to do a good/better job than _____(take your choice: our mother, our sister, the rest of the world)? The urge to procreate is no more selfish in a single person than in a married couple. (Check out the Creating a Family show on Single Parenthood by Choice where we discuss the pros and cons and how to responsibly choose this option.)
But again, Ms. Suleman’s story is far from the typical single woman that wants to become a parent. It is irresponsible to keep having children that you can’t support financially or emotionally. This is a far cry from a single parent with a steady job, with reasonable work hours, and an extensive support system having one or two kids.
I have also been troubled by casting this story as the “pro-life” use of IVF. Some have suggested that Ms. Suleman’s request to have all six embryos transferred was in response to ethical or religious concerns about not transferring all embryos that were created. I have worked with a number of infertility patients that are trying to decide if IVF is an option for them given their religious beliefs that life begins at the moment an egg is fertilized. I believe that IVF is absolutely an option for them if they carefully think through beforehand the decisions they will have to make at every step.
The most important decision they have to make is how many eggs they should fertilize. One option is only to fertilize the number of eggs they are willing to transfer fresh at that time. Another option is to fertilize enough eggs so that they can transfer a few fresh and freeze the rest for a later attempt for a second child or first child if the first IVF cycle failed. Using frozen embryos is much less expensive and is easier on the woman’s body, but before deciding on this option, they need to evaluate the risk to embryos from cyropreservation and the options available to them if they have embryos left over after they have reached their preferred family size. The “solution” to ethical and religious concerns with IVF is never to transfer all the embryos at once. This is not only ludicrous, it is highly disrespectful of life.
There are still a lot of questions about the story being told. I find it highly unlikely that six embryos were transferred with each of her five precious pregnancies, as she has claimed. It is hard to imagine that six embryos would result in four singleton births and one twin birth in a woman in her twenties. It seems more likely that Ms. Suleman intentionally upped the ante to increase the odds of a multiple birth. Of course, I’ve been wrong in this story before, and not much would surprise me. I also wonder how an unemployed woman could afford six IVF cycles when fresh cycles run about $15,000 each and are seldom covered by insurance.
The truth is that none of this is my business if it just affects Ms. Suleman. I have justified my voyeurism because this story is being used to judge the choices of others. This collateral damage troubles me. The infertile, the single parents by choice, and the pro-life infertility patients are casually lumped in with Ms. Suleman, and similarly tarred as selfish and irresponsible. It is possible to use infertility treatment responsibly; it is possible to choose single parenthood responsibly; and it is possible to use IVF and still believe life begins at conception.
So in answer to the question posed by Nancy Gibbs of why judge Ms. Suleman and not others with large families, I think she is being judged more harshly because of the intentionality of her actions, and the almost defiant attitude towards the risk to her children. I hope I am proved wrong and that somehow she too is a victim of medical science, but for now, it’s hard to sympathize with a woman who could be so cavalier with the lives of not only these eight children, but also with the quality of life of her other six children, three of whom receive disability benefits. Sticking with the cliché theme I’ve got going here, under the facts that are currently available, our societal knee-jerk reaction is more apt to be along the lines of “you’ve made your bed, now lie in it.” Unfortunately, she shares her bed with 14 others who had nothing to do with its making. I thought Anna’s comment on last week’s blog summed it up well: these children are already here now, and they and their mother need our support.