Sunday, June 24, 2007

A devil's bargain for the infertile - Fertility treatments are causing more multiple births, leading to risks for mothers and newborns

A devil's bargain for the infertile - Fertility treatments are causing more multiple births, leading to risks for mothers and newborns, and leaving couples with a stark choice: have many babies or none
By Gladys B. White, adjunct professor of liberal studies at Georgetown University
Copyright © 2007, Chicago Tribune
Published June 24, 2007

This month the United States witnessed two sextuplet births within a 24-hour period. Although such news generally is received with rejoicing, the reality is that multiple births of this magnitude are an unacceptable feature of infertility treatment. Multiple births represent a violation of the classic ethical imperative in medicine to, above all, do no harm.

When an infertile individual or couple seek infertility services in order to build a family, they do so with the goal of one or perhaps two healthy babies in mind. Unfortunately and increasingly, the rigors of infertility treatment are resulting in increasing numbers of twins and triplets across the population and dramatic instances of super multiple births, that is quadruplets and more. It long has been recognized that high levels of multiple births have been a feature of infertility treatment at least as far back as the birth of Louise Brown in 1978. It's also known that multiples always face prematurity and low birth weight at the time of delivery.

It is prematurity and low birth weight that stack the odds against these smallest members of the human community. This is unfair, unnecessary and often comes as a surprise to the individual or couple who are seeking just one or two healthy babies. The two sextuplet births of last week bear out these tragic realities.

In Arizona, the Masche sextuplets, three boys and three girls, were born 10 weeks early, all but one weighed less than 3 pounds, and five of the six were placed on ventilators immediately after birth. To make matters worse, it was reported a day later that the mother, Jenny Masche, almost died of heart failure just after the births due to the dramatic drop in the huge volume of blood that she was carrying during the pregnancy. Her physician describes her heart and her blood vessels as having been stretched to a very, very critical level.

This is not surprising. Births of sextuplets or more are purely artifacts of infertility treatment, which simply means that they don't occur naturally. There are good reasons for this. Although women come in all shapes and sizes, it is clear from the standpoint of basic anatomy and physiology that women have reproductive limits and are simply not made to carry such large pregnancies.

In Minnesota, the Morrison sextuplets, four boys and two girls, were born four and a half months early and weighed from 11 ounces to 1 pound, 3 ounces. All of these babies were in critical condition at the time of birth and sadly, as of this writing, three of these babies have died.

Each of these sets of parents wanted their children and did not want to opt for the management strategy that reproductive endocrinologists are offering to women who find themselves pregnant with multiples, namely selective reduction or the deliberate termination of the lives of one or more fetuses in utero. Infertile couples themselves are often unwittingly undertaking treatment for infertility without realizing the stark choices that await them if the woman becomes pregnant with more than one fetus. This possibility is often underemphasized at the outset of treatment.

It is no surprise that individuals who are seeking to build their families are going to be reluctant to terminate the lives of one or more of their fetuses once the pregnancy is under way. The option of selective reduction is becoming a standard of care in infertility treatment, and it is simply a non-starter for most individuals for many reasons including deeply held ethical and religious objections. Equally problematic are the life prospects of multiple fetuses born prematurely. It is simply not fair to offer infertile couples this devil's bargain; that is, you may have many babies or none.

Reproductive endocrinologists know how to do better by cautioning couples to avoid intercourse in the presence of a large number of ripening ovarian follicles resulting from the use of fertility drugs, and by transferring only one embryo in the case of treatment with in vitro fertilization. They can and should do better. Will society insist that they do?


Gladys B. White, an adjunct professor of liberal studies at Georgetown University, is a former executive director of the National Advisory Board on Ethics in Reproduction.


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