By now you’ve probably heard that another set of sextuplets have been born. The three boys and three girls were born in Pennsylvania on June 1 10 weeks premature. Births are supposed to make you feel happy, but this one left me feeling intensely sad. Oh don’t get me wrong, all new life is a precious gift, and these fragile babies are no exception, but their birth was most likely a failure of modern medicine.
The babies, weighing from 1 pound, 1 ounce to 2 pounds, 5 ounces, are in the Neonatal Intensive Care Unit (NICU) in critical condition with an uncertain prognosis. At least at this time , all six are still alive, and I pray they will escape the typical disabilities associated with multiple births and premature births.
It has not been reported yet, but I can almost guarantee that the sextuplets were most likely conceived through an intrauterine insemination cycle (IUI, also known as “artificial insemination”) using injectable ovulatory stimulating drugs. Before Octomom, I would have said it was almost impossible for a mega multiple birth to result from IVF, but she and her doctor (and I use that term loosely) proved me wrong. However, chances are really good that these sextuplets came from an IUI gone wrong.
Great care must be taken with artificial insemination using injectable ovulatory stimulating drugs. This procedure is more art than science since it is impossible to know ahead of time how many eggs will be stimulated. If sonograms reveal too many mature egg follicles, then both doctor and patient have to be willing to either cancel the cycle (and avoid intercourse) or change it to an IVF cycle to reduce the risk of higher order multiples. Unfortunately, not all doctors and patients are willing to cancel. Although the actual number of higher order multiple birth is not large (about 46 quintuplets or greater are born each year), I believe that the actual number of quint and greater pregnancies is much larger. From my experience, most patients when faced with triplets, quadruplets, quintuplets, sextuplets, septuplets, and heaven help them, octuplets opt to selectively reduce the pregnancy to twins in order to give at least two babies a fighting chance at normal development. Without getting into a moral discussion of fetal reduction, I strongly believe that all reasonable steps should be taken prior to conception to avoid the need for selective reduction.
Like it or not, money dictates a lot of decisions in infertility. IUI with injectable infertility drugs is more risky than IVF, but a whole lot less expensive. Although I think the only responsible approach is to abandon an artificial insemination cycle if too many eggs mature, I understand how hard this is after the patient has spent so much money on the medication. And remember, most people are paying for these treatments out of pocket. Doctors absolutely must explain this risk to their patients before they agree to the IUI and then should insist that the cycle be canceled or converted to an IVF. Easy to say, hard to do when this may be their only chance to conceive.
I pray that these six babies escape the typical health complication of multiple gestation and premature birth. They are already beginning their life in the NICU in critical condition. They are at an much much greater risk for cerebral palsy, developmental delays, and lung , eye, and heart conditions. We should want better for our children. I recently saw a video of the McCaughey septuplets. These seven children have had a host of health complication throughout their lives, and two of the children, Alexis and Nathan, have developmental delays and cerebral palsy. In the video when asked what she wanted for her 13th birthday, Alexis said, “I just want more friends at school and I just want people to know that I’m just a regular girl.” Oh course that’s what she wants. It’s also what she deserves.
Human beings are not meant to be born in multiples. The uterus is designed to carry one, or at the most, two babies to term. After birth, babies needs one on one (or one on two) adult attention to thrive. I once interviewed a mom of triplets who said you could always tell a house with triplets because there was always someone crying. If it wasn’t one of the babies, it was her because she knew she wasn’t able to fully meet the needs of all three.
I want infertility treatment to be available to all who need it, and I want to avoid too-restrictive governmental regulation. In order for this to happen, the infertility medical community needs to do a better job of regulating itself to avoid another sextuplet birth.
Image credit: wonderwebby
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An IVF cycle can easily be controlled for the number of embryos put back in. A RE can cancel an IUI cycle – but I’ve seen enough women on forums who still go on to have timed intercourse rather than lose the cycle. Since you have your drugs up front, you can easily trigger yourself.
It’s all so fuzzy – you can have good follies forming and get low egg numbers in those follies. I did an IVF cycle with 78 tiny follies ( before stimulation). I ended up getting 44 follies containing a total of 32 eggs. I took 15 and had them fertilized, and got 6 embryos. So for someone who sees 6 eggs forming, does it mean 6 embryos? It’s possible only some or even none of them will fertilize and successfully implant. It’s a crappy gambling numbers game and the cycles are expensive as hell. So it doesn’t surprise me that we see these octomoms.
As for doing more cycles if we had insurance… the stimming drugs have their own risks. The cycles are difficult to tolerate. I’m not sure I’d subject myself to more IVF cycles if it was cheaper for me…
Thanks for the post, Dawn. The more I think about the impossible choices that out-of-pocket customers (like me) face with infertility treatment, the angrier I get.
I am part of a couple with azoospermia. I’m 34 and there is no indication of sub-fertility in me (though you never know!). We have decided to use donor sperm and our doctor has recommended IUI with one week of Letrozole to induce ovulation and one injection of HCG to release the egg(s). Is this considered ‘IUI with injectables’? I am frightened by all this talk of multiples and I am now thinking of a lot more questions I should have asked my doctor.
S, I’m not a doctor and don’t know the specifics of your case. Letrozle in not an injectable gonadotropin, but it is an ovulatory stimulant. I suspect your doctor is suggesting this protocol because it is easier to predict exactly when to do the IUI and it is easier to schedule during a convenient time. He/she might also be trying to save you money on sperm and doctor’s fees by upping the odds of success.
We’ve done a number of shows where we talk about Letrozole and Clomid and the risk of multiples. I don’t remember exactly, but the risk is not huge. On the other hand, one has to wonder if the risk would be greater when used on a fertile woman, such as yourself. I don’t know the answer to that. If it were me, I’d wonder why they were suggesting ovulatory stimulation at all since there is no evidence that you are infertile. Just because it is more convenient would not be a good enough reason for me. You have to be willing however to go through a couple of IUIs, but even when conceiving without any intervention it takes the majority of couples a couple of months. Good luck with your decision. It’s not too late to schedule another visit with your doctor to ask more questions.
Longtime lurker, figured I should probably finally post something. My husband and I pursued fertility treatments as far as our insurance would cover and are currently having to wait and re-organize finances as we consider out next step (which is very likely adoption, we are still in the stage of wanting to educate ourselves and thus me reading you!) ANYWAY, I remember every cycle we would monitor to see how many eggs would mature, and I never responded well to the medication. If for some reason I had had a huge response and been facing multiple eggs I think we would have canceled since we knew we didn’t want to be in a position having to face selectively reducing… but it is so true, couples need to think about these issues before pursuing fertility treatments. I also believe that if we had developed 6 or more eggs my doctor would have refused to continue the cycle, even if I wanted to pursue it.
It is so true, that besides couples talking about these issues before pursuing treatment, that perhaps they wouldn’t try such high doses of medications if they knew they had a number of cycles to try via government health laws.
Bleeding Tulip-It’s true that desperation often clouds judgement. That’s why the infertility medical community has to step up. And also why infertility should be treated by insurance as the disease it is, which would require them to cover at least some treatment.
I too agree with Dawn. It’s the responsibility of the Reproductive Endocrinologist to determine if going forward with IUI is too risky depending on the individual’s response to OI. My RE would not allow us to move forward with IUI if more than 4 eggs appeared to be maturing and even then it depended on the stage of maturity. It was easy to see via the ultrasound how many were maturing and at what stage.
We got pregnant after every trial but unfortunately have experienced 7 consecutive miscarriages. Three were conceived via IUI and/or OI/IUI treatments and four were conceived naturally. We are in the process of adopting domestically to build our family.
Michelle, I’m so sorry to hear of your losses. How tragic for you and your husband. I wish you a quick and hassle free adoption. (Yes, that is possible.) I also know many doctors that would cancel the IUI cycle if too many eggs matured. Unfortunately, I know that some couples are so desperate for a family, that they would have intercourse anyway.
As someone hoping to start IUIs later this year, I have to agree. I know that I would be stretched to provide safely for twins; anything beyond twins would be impossible. And I think that would be the case for 99% of families out there. Responsible parents have to ask themselves what’s best for their future children – and money issues aside, is taking the risk of such a high order multiple birth when you know you have chosen not to selectively reduce fair to your future children?
It’s a hard call and I feel sorry for any parents put in that position. Hopefully the infertility clinics and REs are doing a good job of making sure their patients are fully educated on all the risks up front and not just the potential reward of having a baby.
Cyndi, I love how your phrased that: we need to be ” fully educated on all the risks up front and not just the potential reward of having a baby”. I couldn’t agree more.
I really couldn’t agree more. You really hit the nail on the head when discussing even though the cycle may be dangerous, the cost involved is a powerful motivator to continue. If insurance companies covered IF treatment, it wouldn’t be so hard to convert high-risk IUI to IVF. I ultimately went to IVF after high-risk IUI. I conceived twins, and the complications of a twin pregnancy are high enough. I dont judge the people who choose to go ahead and risk supermultiples or do not selectively reduce, but I blame a broken insurance system that treats infertility like it is cosmetic so that people are forced to face such high risks.
Michelle, thanks so much for pointing out the insurance connection.
Dawn, I completely agree with all of your statements. When the Octomom story originally broke, I sent a barrage of emails to friends and family, explaining that it couldn’t possibly be an IVF birth. Wow, was I shocked.
As for this latest case of HOM, I too, would assume it was an IUI with injectables, gone horribly wrong. I would also assume that we’re going to continue to see this trend until insurance companies step in and begin covering such medical procedures. As someone who’s paid OOP for 5 IVF cycles (3 fresh, 2 frozen) and knows first hand how expensive infertility treatment is, it’s unfortunate to think that either this couple or their RE, chose money over medical prudence.
Best wishes to those tiny babies.
C-Well said! I think the unspoken truth is that there are many more higher order multiples conceived than most people would possibly believe. Most patients choose to selectively reduce to give a two of the babies a fighting chance.