Five little babies—a set of quintuplets– are clinging to life in a neonatal intensive care unit in Dallas. They were born as the result of “infertility shots” at 27 weeks, 5 days gestation with birth weights ranging from 1 pound, 12 ounces to 2 pounds, 11 ounces.  The pictures of these fragile infants break my heart–both for their suffering as well as for their parents, Gavin and Carrie Jones. Although all five babies are alive, they are far from out of the woods. In their short life, they have already been diagnosed with and undergone:

  • Ductus arteriosis- a heart disorder
  • Collapsed lung
  • Surgery to install a central line catheter
  • Fear over brain bleeds
  • Breathing problems
  • Ventilators
  • Apnea
  • Fluid on the lungs
  • Infection
  • Repeated attempts to install IV lines, resulting in blown veins

The survival of these babies is uncertain. And the sad truth is that even if they live, many children of higher order multiple births struggle for life with issues such cerebral palsy, learning disabilities, lung/breathing problems, vision problems, and developmental delays. If you are of the praying sort, please include these babies and this family in your prayers. In particular, please pray for Seth, who is not doing well and heading in the wrong direction.

Much has been made of the quote from the parents that they laughed when they saw the sonogram. Some people have interpreted that to mean that the parents were flippantly laughing in the funny ha-ha sort of way, but I’m certain they meant it in the “OMGosh, what are you going to do other than laugh” sort of way. But the dad’s statement to the press that it was a complete surprise had me scratching my head. How in this day of modern medicine and ready availability of medical information could someone taking fertility shots have been surprised by the conception of higher order multiples?


I was curious enough and felt bad enough for this couple to find their blog. As I read their pregnancy journey, I celebrated their good weeks, weight gains, and well wishes, and shared their bad weeks, pregnancy complications, and premature birth. They are missionaries for Wycliffe, a bible translation ministry, in Papua New Guinea. (They were on an extended furlough in the US when they underwent fertility treatment.) I’ve known several Wycliffe missionaries and liked all of them. They seem to be an adventurous, fun, and open-minded lot, and the Joneses are no exception. It made me feel all the worse for them because I really liked them.

As I read their blog and listened to their press conference (see below), I realized how little they understand about fertility treatment. Keep in mind that this is an educated couple. Both are college graduates; the dad has advanced training as a helicopter pilot/instructor, and the mom has finished all the course work for a doctorate in public health. If they could make the following statements, what does it say about the understanding of the general public?

  • Humanly/physically speaking, this should not have been able to happen. (We didn’t do in-vitro.) From their blog.
  • “We didn’t even do IVF, I was just taking shots.” (From the mom at the press conference below.)
  • “I didn’t realize how much the shots would affect the output of eggs.” (From the mom at the press conference.)

This misunderstanding is perpetuated by the press. One of the reporters at the press conference said: “When I hear quintuplets I think of IVF.” And in a recent article about a 48 year old Australian woman who is expecting quintuplets any day, the journalist assumed that the babies were conceived naturally since the mother “had not used IVF”.

{Sigh} Almost all higher order multiple births result from injectable ovulatory stimulating drugs (“fertility shots”) combined with either intrauterine insemination (artificial insemination) or intercourse, not IVF. The only exception I know of is Nadya “Octomom” Suleman, and that case involved an emotionally unstable woman and a highly irresponsible doctor.

All children are blessings, and all births worthy of celebration, so I hope you will not take this wrong when I say that I think this birth is a needless tragedy causing untold suffering to these five innocent children and to their parents. Without question it is a failure of infertility medicine. I worry that this fact may get overlooked in all the media excitement over quintuplets and our national obsession with multiple births.


How in the world could an educated couple not understand the risks? And much more to the point–how in the world could a fertility clinic not make sure they fully understood the risk before the procedure and not monitor them more carefully to prevent it? I don’t know the details of their specific case, and the mom has alluded to the fact that a sonographer made a mistake, but given the extremely high risk for multiple births from injectable gonadotropins, multiple backup monitoring should have been in place to prevent a single mistake from having such catastrophic affect, and the parents should have been thoroughly prepared that even with careful monitoring, quintuplets could result.

In January of this year (2012) we did a Creating a Family show on how to weigh which form of fertility treatment you should choose considering success rate, cost, and risk of multiple births—Clomid, Medicated IUI, or Straight to IVF?  It was a really good show, if I do say so myself. Here’s a very brief summary of the relative risks of multiple births with different fertility treatments. Keep in mind that the natural twin rate in the US is roughly 1%.

Clomiphene Citrate (brand names Clomid or Serophene) and Letrozole (brand name Femara)

Clomiphene citrate and letrozole work on the woman’s brain to make her body ovulate. The risk of twins is approximately 8-10% for clomiphene citrate and slightly lower for letrozole. The risk of higher order multiples is extremely low. These drugs are taken as pills, are relatively inexpensive, and are most effective for women who are not ovulating.

Intrauterine Insemination (IUI) with Injectable Gonadotropins (brand names include Bravelle, Follistim, Gonal-F, Menopur, and Repronex)

Gonadotropins are fertility medications given through shots that directly stimulate the ovaries to produce eggs, and can be used with artificial insemination (IUI) or in vitro fertilization (IVF). When used with IUI, the goal is to stimulate the ovaries just enough to produce two to three eggs, and not more. Unfortunately, doctors have little control over the number of eggs that will mature with these fertility shots. As a result, some reproductive endocrinologists believe the risk of higher order multiples is simply too high, and they do not perform this procedure. Other fertility doctors think that this procedure can be done safely IF extreme caution is taken, including:

  • Extensive pre-assessment of the woman’s egg reserves.
  • Very conservative dosage of the gonadotropins, especially with the first cycle.
  • Intense monitoring with blood tests and sonograms.
  • An agreement with the patient to cancel the cycle if more than 2 to 3 eggs mature.

The last point is often the sticker. Most fertility patients do not have insurance coverage for fertility treatment and opt for IUI with injectable gonadotropins because it is less expensive than IVF. However, by the time the woman has reached the point in the IUI cycle that the doctor is able to tell how many eggs have matured, she has already spent about $2,500-4,000 on the fertility medications and likely another $2,000-3,000 on monitoring and clinic costs. In other words, she has already spent $7,000 (or more). Throwing that much money down the drain is a tough pill to swallow for someone who chose this risky path in order to save money. It puts unbelievable pressure on the doctor to not cancel the cycle and tempts many a patient to go home and have unprotected sex if the doctor does cancel the cycle.

The exact risk for multiple births from a medicated IUI cycle is hard to give because it depends on so many factors: skill and attitude of clinic doing the procedure, careful monitoring, doctor’s willingness to cancel the procedure, and the patient’s willingness to not risk sex. As I said above, almost all the higher order multiples you have heard about resulted from this procedure.

Another reason that the multiple birth risk is hard to predict, is that most patients when faced with a higher order multiple pregnancy as a result of this procedure opt to selectively reduce the pregnancy. Some doctors will not perform an IUI with injectable gonadotropins unless the patient agrees in advance to selectively reduce if more than twins are conceived. The decision of what to do when faced with a higher order multiple pregnancy is excruciating for most patients.

In Vitro Fertilization (IVF)

Gonadotropins are also used with IVF, but the risk of higher order multiples is low because the doctor is in control of how many embryos are transferred to the woman’s uterus. Reputable clinics are very conservative with the number of embryos, and there is a strong push in the fertility medical community to only transfer one embryo in women under 40. Yes, it is possible for naturally occurring twins to occur once the embryos are transferred thus resulting in unexpected triplets or quadruplets, but this is by far the exception.

I didn’t write this blog to beat up on the Jones family. I don’t really know what happened in their case. What’s done is done, and I’m praying like crazy for those precious babies and their parents.  But another one of my prayers is that awareness of their misfortune might prevent another family from this suffering.


Image credit: Gavin & Carrie’s Blog