Octuplets and Infertility EthicsAs a society, we seem obsessed with multiple births. I’m just as bad as the rest. My greatest desire from age six to ten was to own a set of quintuplet dolls, complete with matching bassinets and layettes. I never got the dolls, but that didn’t stop me from pretending that my mismatched set of four assorted dolls and one stuffed dog were my very own quints. I’m almost ashamed to admit my obsession with the octuplet story this past week. The difference is that my fascination is now tinged with horror. It’s like a sore in your mouth: you know you should leave it alone, but your tongue, seemingly with a will of its own, continues to prod and poke. From the very first newscast with the beaming doctors almost tripping over their exuberance, I have been fascinated and heart sick–equal parts attraction and revulsion.

My response, of course, has nothing to do with those eight innocent babies. They are the victims in this whole sad story. I thank God that they are all alive, and continue to pray for them through their ordeal of survival. But every other aspect of this bizarre story leaves me with an almost overwhelming feeling of sadness. Quite a change from my youthful desire.

At this point, we don’t know much other than rumors. We “know” that octuplets were born to Nadya Suleman, a 33 year old single woman with six older children (7, 6,5, 3, 2, 2) who lives with her parents. Apparently one of the older children has autism. Reputable news sources have reported that her mother says that all fourteen children were conceived through infertility treatment from the same sperm donor. Although these same sources report that they were conceived through in vitro fertilization (IVF), I am not convinced. Those unfamiliar with infertility tend to assume all treatment is IVF, but the grandmother said that the octuplets were from frozen embryos, so who knows. I still think that it is more likely that the mother used injectible ovulation stimulating drugs and then either had sex or had an IUI (intra-uterine insemination where sperm is released directly into the uterus). I simply can’t imagine a doctor transferring eight embryos into a 33 year old woman with a proven conception track record. Then again, I can’t imagine doing an IUI if the sonogram showed that many mature egg follicles. But, in many ways it doesn’t matter. Whatever form of infertility treatment was used, the conception of eight embryos is a tragedy.

When I first heard the news reports that octuplets had been born, I was irritated at the celebratory atmosphere in the media and by the hospital staff. I hate the glamorization of something so fraught with danger. I had to keep reminding myself that indeed their live birth was a moment to celebrate, just as is their continued survival. But the circus environment seems totally inappropriate for what I see as such a monumental failure. It was only after the revelations of the mother’s marital and financial status, as well as the existence of her six older children, that the media tide shifted, but I still think they are missing the boat.

This story is sad on so many different levels. First and foremost is that these children are far from out of the woods. It looks like they will survive, but survival shouldn’t be the end goal—a healthy life is what we are aiming for, and the odds are stacked against them. Almost all multiples (including twins) are born premature, as were these octuplets, and the risks of prematurity are huge and surprisingly long lasting. A study published last year in the Journal of the American Medical Association found that premature babies had diminished long-term survival and fertility, and women born preterm were at increased risk of having preterm offspring. As expected, babies born early were more likely to die during the first year of life compared with babies born at term. Unexpectedly, their increased risk of death persisted as they aged, and can last a lifetime. A study published last month in the New England Journal of Medicine found that health risks increase significantly for babies born even just a few weeks before term. In addition to health risks, children born premature are more likely to have ADD and other learning disabilities, according to Dr. Edward Hallowell on the Creating a Family show.

In addition to premature birth, it is expected that these babies were malnourished in utero. Doctors say it is not possible for a woman to consume enough calories and nutrition to adequately sustain eight fetuses, even with good prenatal medical care. Much research, some of which I summarize on the Adoption Research page, has shown that prenatal malnutrition often results in health and learning issues throughout life. The bottom line is that although it now looks like all eight babies will live, it will be a long time before we know the quality of their lives.

The part of this tale that depresses me the most, assuming all eight survive without life altering disabilities, is the potential damage to their emotional health. How in the world can one person, or even a couple, provide the nurturing these eight precious children (plus their six older siblings) will require to grow into emotionally healthy adults. In nature, the number of young produced by a species is indirectly proportionate to the amount of care the young need. Humans usually have one baby at a time because our young are a needy lot. Research has shown that infants need consistent and prompt care for optimal emotional development. In addition to this very basic “need”, each and every child “deserves” to have their toes counted, their bellies kissed, and their brilliance assessed. Unhurried cuddling should be a birthright. Regardless of Ms. Suleman’s best intentions, with eight infants, there will be precious little time for gazing into each child’s eyes with rapture.

A while back, I was consulting with a couple with four year old triplets about their options for what to do with their leftover frozen embryos. The wife told me that you could always tell which house had triplets because of the constant sound of crying. I said that would be the case in any house with young children, but she disagreed. She had made a point of noticing that parents of singletons were more quickly able to take care of their child’s needs and even anticipate them in advance, and thus their children cried less. Her frustration and guilt over being unable to do this was the hardest part of parenting multiples, and she only had three.

I have visited and helped in orphanages throughout the world, and in all cases except one, which I blogged about here, they were better staffed than what will likely be the case for this family. I imagine that people will volunteer to help with the babies when they come home, and although this round-robin of volunteers can help with the actual physical care, infants need consistency in caregivers in order to form the necessary bonds of attachment. Coordinating volunteers and making sure that they work with the same babies each day will be a logistical nightmare. Finding volunteers to handle the night shift for long periods of time is also daunting. Volunteers tend to dwindle as the babies grow older. Most parents of large order multiples are doing it on their own with only family support after the first year. It is certainly possible to parent large order multiples, but it is far from ideal.

I am in no way anti big families. I know that they can and do work well. But the children in most large families are spaced every few years so that the new child usually has at least a year or two of one on one care. Also, older siblings step into the role of additional caregivers for the younger children. The older children in this family are barely out of infancy themselves.

Another reason this story saddens me is the fallout I anticipate for others who are suffering with infertility. As this case unfortunately illustrates, infertility treatment is largely unregulated in the US. We’ve seen countless reproductive endocrinologists on TV this week expressing disgust with this woman’s doctor (assuming she just didn’t buy the medication on the black market) and saying that established medical guidelines had likely been violated. If this pregnancy resulted from IVF, then this is undoubtedly true, but guidelines are just that—guides, not laws. There is no penalty for failing to follow a guideline, other than a malpractice lawsuit or perhaps, if egregious enough, loss of a medical license. Also, as I was surprised to learn on the Creating a Family show, which serendipitously was on multiple births in infertility treatment, there are no guidelines for controlling multiple births when the treatment is an IUI.

There is a saying in law that “bad facts make for bad law”. When presented with really tough facts, juries, judges and legislators want to do right for the individuals involved. Often the laws or judicial precedent that results, although good for the individuals, isn’t good for the majority because they were aimed to remedy the exception, not the rule. The facts in this case are truly difficult—humans are not meant to have eight children at once. It is not good for the kids, for the mom, for the family, and probably for society. But octuplets are the very rare exception in infertility treatment. I am not against greater regulation of the infertility business, but I don’t know if it’s wise to require doctors to withhold treatment based on marital status, wealth, or the number of older children. We need to be very careful to not let the difficult facts of this case control the direction of any regulations.

The octuplets’ mother now has an agent and is shopping a book and media deal. Oh joy! Nadya Plus Fourteen coming soon to a theater or cable channel near you. I truly hope she gets top dollar for feeding our obsession with multiple births. I’m not sure it is possible to do a good job of single-handedly raising this many children at once, but money can only help. If this past week is any indication, I’ll be first in line to buy the People Magazine with the first pictures, or at the least, I’ll be sneaking peaks while I wait in the grocery line. I just hope we don’t lose site of the tragedy amidst all the hoopla.

P.S. If you are interested in the problems with multiples birth, why they happen in infertility treatment, and new developments in treatment that will reduce the likelihood of multiples, listen to the January 14 Creating a Family show. My guests were Dr. Robert Stillman, the medical director of one of the largest infertility clinics in the US and a leading researcher on the issue of multiple births, and Kelly Damron, a mom of IVF twins and author of Tiny Toes. We are planning a show soon on how to safely do IUIs with injectibles. If you want to receive notice of upcoming shows, email me.


Image credit: www.foxnews.com