Sunday, June 17, 2007

Septuplets

The birth of two sets of septuplets within hours of each other last week reminded me of the time a couple of years ago when an internist colleague of mine asked me what I thought of the birth of another set of septuplets back then. I sighed and replied, " It's a failure of modern medicine."

That is certainly still true today. Modern treatments for infertility have helped many childless couples conceive, but until we lick this problem of higher order multiple births we cannot consider our work with infertility a success. The septuplets in Arizona were apparently born at about 30 weeks. Most of those kids should do fairly well, although raising six kids at once will still be tremendous undertaking. But the Minnesota septuplets show how truly bad the results of our infertility treatment can be sometimes.

Those kids were born at 22 weeks gestation, weighing between 11 ounces and 19 ounces, or about 330 grams and 570 grams. Personally, I don't usually resuscitate 22 weekers, and I certainly wouldn't go all out on a 330 gram 22 weeker, but when you've got a combination premium/celebrity pregnancy like this, I guess you do some things you wouldn't normally do.

The latest Vermont Oxford Network data shows that the survival chances for a 22 weeker are eight per cent. For a 330 gram 22 weeker the chances are basically nil. The chances of all six surviving, if you figure each one has an eight per cent chance, is 0.00002 percent. The survivors each have at least a 50% chance of having moderate to severe impairment.

Is anybody proud of this? Do the infertility doctors think they're doing a good job with this? Do they realize how much this will affect the lives of these parents and kids? I doubt it, because if they did, I think they would do a better job of preventing such multiple pregnancies. I also think the parents are not fully aware of the risks as well or they would not accept the risk of having quads, quints, or septuplets.

I'm not up on all the latest infertility treatments, but I'm sure we can do a better job of preventing such multiples. In the early days of in vitro fertilization, doctors used to implant 5 or six fertilized eggs into the mother in the hope that one or two would survive. Unfortunately, that meant that occasionally 4 or 5 would survive. Fortunately, I'm pretty sure there are now limits as to how many fertilized eggs are put in. However, we still can get multiples from other types of infertility treatments such as those that cause many eggs to come from the ovary at once, although I suspect that with close monitoring we could tell the couple when too many eggs are ovulating so they shouldn't have sex because of the high risk of multiple births.

Money used to play a role in this, and maybe still does. In the early days of in vitro fertilization, several eggs were put in at once partly because it was cheaper to put 6 eggs in at once versus 3 eggs twice. Of course, the post natal costs of a set of quads or quints dwarfs the money saved by doing one high order implantation versus two lower order ones, but our medical economics system has never been set up to take advantage of those kinds of savings.

I don't think the media helps at all either, making each birth of quints or septuplets into a Good Housekeeping warm and fuzzy moment. It's time the press started treating such high order multiple births like the iatrogenic disasters they are.

57 Comments:

Blogger SuperStenoGirl said...

Bravo!

10:16 PM  
Anonymous Anonymous said...

Sextuplets = 6 babies

Septuplets = 7 babies

10:22 PM  
Blogger Lin said...

Thank you. I agree 100%.

10:27 PM  
Blogger Twins x two said...

Both of my sets of twins were because of fertility meds (not in vitro). I got pregnant with my first set on a drug called repronex. When it came time to fertilize I had 4 eggs ready. My husband and I took the risk. We figured 4 wouldn't be too bad. Luckily we only fertilized 2.
My 2nd set of twins were also because of drugs. We got pregnant on a drug called follistim. This time we had 5 eggs ready. The 2nd time around we had a different OB and before he would allow me to take the HCG shot to drop the eggs I had to agree to selective reduction - anything over triplets. I do not agree with abortion, so I had a REALLY HARD time with agreeing to this, but I didn't want to waste what we had - time, money, eggs ready.....So I prayed, and prayed and luckily we only ended up with twins - again.

10:44 PM  
Blogger Sarabeth said...

Well said.

11:05 PM  
Blogger 23wktwins'mommy said...

The "Morrison six" have a blog if anyone is interested. http://morrison6.com/
I really feel for the Morrisons, but I too wonder if these families know what kind of serious risk they are putting their unborn children through when they undergo fertility treatment that doesn't protect against high order multiples.
I did not conceive my twins with any form of fertility drugs, but, seeing how fragile pregnancy is first hand, I would never consent to any fertility treatment (if that became necessary) that would give me a chance at having high order multiples.
ND, I believe you are correct, there is a way to protect against situations like these. I'm not 100% sure how this works, but a family member was expalining it to me, because they were going to try it and did not want any multiples whatsoever. They had a window of a couple of days were they would implant one and see if it took, and if not try the other. I guess they had three, but all three wouldn't be put in at once. I could be wrong about the details, but I do know for sure their fetility Dr ensured them that they would have a singleton pregnancy with their procedure.
I just feel so incredibly sad for this family. I know they believed they were doing the right thing by not chosing selective reduction, but now they are facing a great chance that all six will die most likely because of that choice. (I believe three boys have passed away already.)
I reflected on this very subject on my blog, and I can understand how difficult that choice would have been. I don't know what I would have done had that been me. But I do know I would have protected against that, so a choice would not have been necessary.
I guess I would like to see a change in fertility treatment that would help elliviate such high order multiples. While I can't deny that I find the Discovery Health coverage on these pregnancies and births interesting, it is far too risky and often results in devastating outcomes.
I know I would do just about anything to ensure I didn't deliver prematurely again, and I wonder if these families have any idea what preemies go through in the NICU and after? Perhaps educating them on this should be a part of the process familes must go through if they chose not to engage in fertility treatments that guard against high order multiples. And I'm not talking about selective reduction here, but rather, some of the examples ND mentioned in this post.
And I have a random question for ND, what is the earliest gestation you have ever resuscitated? How about for twins? Thanks.

11:47 PM  
Anonymous Emmie (Better Make It A Double) said...

Not to be too nit-picky, but the term you intend, I believe, is *transfer* not *implant*. Implantation is what's hoped for, but all the medical folks can do is transfer the embryos and hope they implant, not accomplish the actual implantation. I basically agree with you, but from reading more about the Morrisons, it seems that what happened to them was a real fluke. A much more common problem is the too-high rate of twins and triplets from fertility treatments. We did IVF and had a very rocky twin pregnancy followed by a NICU stay for both boys. We were pretty clueless about what twins could mean, and I think that the fertility clinic could have done a much better job of informing us of the risks. I love our boys deeply and wouldn't trade them for the world, but I think it will be a good day when single embryo transfers in good IVF candidates are the standard.

12:17 AM  
Anonymous Anonymous said...

I Think it depends on the doctors in some cases. I did fertility treatments for 3 years before I got pregnant, and the RE we used would only let us drop eggs (or agree to transfer) no more than 3 at a time... he told us anything more than a single pregnancy was a failure in his eyes because of increased risk... I wound up with twins who happened to come at 24 weeks due to incompetant cervix.
Money probably does play a part in alot of it also, and i agree about the media as well.

12:18 AM  
Anonymous saddened said...

While I feel for people who wish to become parents, but can not without major medical interventions, I have difficulty, like you, in seeing these many multiple births as a good thing. The surviving babies (if any do in these cases) will suffer at great cost to everyone else. The parents will "put their trust in God," conveniently overlooking the likelihood that God never meant for them to have children since they couldn't do it naturally, as if this is any more than a medical experiment. This seems much more like an example of American hubris that ability. It will be tragic if all the children die, but the blame falls on the parents, who were advised to abort all but two of the foetuses to increase the odds of a term, healthy pregnancy.

12:30 AM  
Blogger Emma B. said...

Almost all sets of higher-order multiples (four or more) are conceived using injectible gonadotropins such as Repronex or Follistim and intrauterine insemination -- not, as you noted, IVF, where it is rare to transfer back more than three embryos.

IUI is commonly used as a starting point for infertility treatment because it's half the cost or less of an IVF cycle, and it's less physically difficult on the patient. When you're paying the entire cost out of pocket, $2-4K vs $10-12K seems like a no-brainer. High-order multiples get a lot of press, but they happen in less than 1% of cycles, and nobody thinks that they're going to be in that tiny little percentage.

Realistically speaking, it's not possible to completely eliminate the risk of high-order multiples when doing IUI. Doctors can measure ovarian follicles and make educated guesses at how many mature eggs will be released, but it's hardly an exact science. Ultrasound can't always tell how many fetuses are present until later in the first trimester, and counting follicles is a lot harder than that. The Morrison sextuplets appear to have been the result of just such an error, not of irresponsible behavior on their or their doctors' parts.

I think there is a general recognition among reproductive endocrinologists that multiples are bad, and high-order multiples are really really bad. Certainly, I was counseled to that effect before my IUI, and I was not the least bit shocked to find myself expecting twins (and what may have been a triplet lost very early). They do what they can to reduce the odds, but short of refusing to perform IUI altogether, there's only so much they can do.

12:31 AM  
Anonymous Anonymous said...

To add to Emma's comment, I have also heard of higher order multiples resulting from cancelled IUIs where the doctor basically said, "AAAH! You have too many follicles! No IUI and for heaven's sake don't have sex!" And the parents had sex.

12:35 AM  
Anonymous Anonymous said...

Please, as a doctor bone up on your terminology, "transferred" not "implanted" is what gives people a false view of IVF. You of all people know that doctors aren't miracle workers and that no one can "implant" an embryo other than an act of nature. As far as single embryo transfer goes, try paying upwards of $12,000 for an IVF cycle and only put one egg back in the basket. Also having to undergo multiple cycles of infertility drugs severely increases the risk of cancer in the mother. Its the doctors who want the press that throw back whole bunches or who medicate without strict monitoring.

1:24 AM  
Anonymous Liz said...

IMHO (and that of an infertile woman), high order multiples are not a cure for infertility. For a doctor to allow an iui to proceed with numerous follicles presenting on the ultrasound, shame on them. If the parents were told not to have sex and then did so shame on them.

If someone produces as many as 6 follicles and can have 6 embryos implant, how much of an infertility problem do they really have?

When I was a healthy 12 year old taking Clomid and going through IUI's I had on a good month 2 follicles.

Fast forward 6 years to 37 and I asked the RE to transfer 3 embryos 4 days ago. He knows my history, has had the reduction talk and agreed. Are triplets my goal? Nope. Just trying to get around a translocation.

I hope the media stops hyping these stories but more so I hope doctors and their patients stop acting like this problem isn't one.

2:48 AM  
Anonymous Liz said...

That would be a healthy 32 year old (too late to be typing...) at 12 I probably still believed the stork delivered babies!! :)

2:51 AM  
Blogger MeghatronsMom said...

Well said!

I too believe the media sensationalizes these things & never really covers the bad. In the case of the Septuplets born in Iowa, two of them have ongoing issues. Each time you read about them in Good Housekeeping, it is only briefly mentioned. No where does the media talk of the hundreds of thousands of dollars in medical care and then the ongoing money needed for therapy, specialists appointments, equipment. I guess that once you have that many children, you can get medicaid since your income/family member ratio just inversed itself. I only have one child and can not believe the hours we have spent in therapy & appointments and the money we pay out, even with good insurance.

8:32 AM  
Anonymous Wendyxx said...

Sorry off topicm, but what a lovely surprise your back :-)))

9:05 AM  
Blogger The Dunn Family said...

Ya know what is a problem, the fact that insurance will pay tens of thousands of dollars for a NICU stay, but they won't cover fertility treatments. We had to come up with 20K to be able to have a baby. So first I was praying for it to work, and then I was praying for it to be twins. I can't imagine if the doctor had told me they would only put one in, and then it didn't work and we couldn't afford to do it again. If the insurance company covered fertility treatments, I completely would have tried just putting one in. Since it was our first IVF cycle, the doctor wouldn't put in more than two, because he didn't know how I would respond. We were lucky enough to get the twins I wanted, and I was able to carry to 36w3d, no NICU time. I know that everyone isn't that lucky. I'm not saying that I think high order multiples are ever good, but the insurance companies should be stepping up beforehand to make it easier for infertile couples so they don't have to deal with the consequences and cost after the fact.

9:06 AM  
Blogger Julia said...

ND I completely agree. Doing compressions on a newly delivered 22 weeker while the mom screamed us on in the background is one of the hardest things I have ever had to do as a nurse. I felt that it was wrong and did voice my opinion to the doctor, who said that if the baby couldn't be intubated in 2 tries or less we would stop rescuscitation. The baby could not be intubated (at that particular hospital the smallest ET tubes we carried were 2.5) and was given to the mother to hold. That doctor went up 10 steps in respect in my book for refusing to continue.

on another note, I don't blame you at all for not using the "correct" terms Re: IVF, it isn't your specialty.

9:22 AM  
Blogger Magpie said...

Great post.

In my experience and understanding, IVF clinics usually have age-based rules as to how many embryos they'll transfer. In my case, at age 42, we transfered five and ended up with one. For a younger person, the rule is no more than two.

10:13 AM  
Anonymous Dianne said...

It's been a long time since I looked at this, but haven't studies of IVF demonstrated that transfering 1 embryo is nearly as effective in producing a pregnancy as transfering multiples (with, of course, a much lower chance of multiple births...though identical twins are never out of the question.) In fact, I thought that the standard, at least in some places, was to transfer a single embryo and just do it again if the first didn't implant.

As far as IUI multiples, isn't that what selective abortion is for? Even if you are anti-abortion for abortions of "convenience"...people aren't evolved for that many multiple births and saving some of the embryos strikes me as better than letting them all suffer and probably die as premature infants.

10:17 AM  
Anonymous BrooklynGirl said...

I'm another IVF patient who just wants to echo what others have said.

In the U.S., there are not currently laws about how many embryos can be transferred at once. Many clinics do have age-based guidelines, but I believe very strongly that ultimately the choice of how many embryos to transfer is something that should rest with the patient and her doctor.

At age 34, I transferred 3 embryos and a singleton pregnancy resulted (ASRM guidelines suggested that at my age, we should consider transferring 1 or at most 2 embryos). I did sit up nights worrying about the possibility of triplets, but there was also a financial consideration: my cycle was not covered by insurance and at $13,000 per attempt (3 years ago), I needed to be aggressive.

I do think stories like this are very sad and, as you say, represent a failure of medicine rather than a success.

10:25 AM  
Blogger Emma B. said...

Liz, as an IVFer, you should know that the number of follicles produced when taking gonadotropins has nothing whatsoever to do with how infertile you are. Clomid doesn't work at all for many women, and they have to skip straight to injectible FSH, which stimulates the ovaries much more aggressively.

10:27 AM  
Anonymous chris and vic said...

In this discussion, I am missing that there are babies and kids out there who need to be taken in as foster kids and/or adopted.

Is this fact/ was this fact a consideration for any of the infertile couples/women who have responded?

Long time ago I read a book by Chair Potok (The Chosen, perhaps), where this line comes from: "He is the father of the child who fathers it." Likewise, we are the parents of the child because we do the parenting-work of raising the child. The biological set-up--having intercourse, conceiving, pregnancy and labor/delivery--seem less of a priority to me . . .

To those who reply that we won't know what we're getting, genetically, if we foster/adopt a child, I concede that issue. But I happen to believe that NURTURE is just as important as NATURE in the way a child turns out . . .

Please enlighten me if you considered and rejected the idea of fostering/adoption---and your reasons.
Thanks
Chris and Vic
P.S. I have done both--had biological children and fostered/adopted. I have NOT been unable to have biological children, so I do not understand that issue first-hand. I also take care of preemies in an NICU, and I see the heartache at that end of the process---that is, how painful it is for parents to be worried about their tiny/sick kids and the long and iffy haul they have in the NICU and after.
chris and vic

11:22 AM  
Anonymous Anonymous said...

First off, to answer the question on adoption, I did IVF because we wanted our own biological children as newborns. With adoption you often don't get the children until they are much older. And if you were able to have your own biological children, then please don't judge why others feel such a deep need to do the same as to turn to fertility treatment. Unless you have been there and done that, you really cannot understand.

I think that going ahead with a cycle that could potentially produce so many babies was a selfish, stupid thing for these people to do. Shame on the RE, shame on them. Maybe prior to moving forward with so many viable eggs, couples should be forced to see the tiniest, sickest preemies first.

But I also think that if insurance companies figured out that covering strictly controlled infertility treatment cycles would be less expensive than the long term care of preemies, these problems could be avoided.

11:46 AM  
Anonymous Liz said...

Emma,
I do understand the point you make, but given how many implanted I wonder if there were given a complex infertility diaganosis or if they had been trying for a year and went straight to injectables (which does happen)

12:22 PM  
Blogger Sara said...

This comment has been removed by the author.

12:49 PM  
Blogger Sara said...

The Morrisons did not go forward knowing they had six mature eggs. They did not ignore doctor's advice and have sex. They were told that there were 2 mature eggs, and apparently the specialists were wrong about that - there were probably 10. Not that everyone needs to spend their time reading their blog as I just did, but really, before we judge their decision, we should at least know of what we speak. I believe Neonatal Doc was right, that this was a terrible failure of modern medicine.

And as a grieving mom of a 25-weeker who did not survive, I am terrified and sad for this family, whatever I think about decisions that got them here. 3 graves, possibly more? I cannot imagine.

12:51 PM  
Blogger Emma B. said...

Liz, I still don't think the number of embryos to implant is any indicator of "how infertile" they were. The ability to ovulate, the quality of eggs, and uterine conditions are all completely separate. In a young woman, it's just as likely that she has PCOS and Clomid didn't work for her. (My money's on PCOS here -- it would explain how the doctors got the follicle count so wrong.)

To "saddened" and "Chris and Vic": just once, I would like to see a mainstream discussion of infertility issues where nobody brought up the "God's will" canard or declared that we should all just adopt. I'd be dead several times over, and so would my daughters if we all relied on God's will. Taking drugs to ovulate is pretty small potatoes compared to most of modern medicine. If you want to bring God into it, well, that's who determines how many of those eggs fertilize, implant, and survive the first few weeks of a pregnancy.

As for adopting, I can guarantee that every single infertile couple out there has been told that approximately a million times -- it's usually the first thing well-meaning but uneducated friends and relatives say, and we get sick of hearing it very quickly. Unless you yourself are an adoptive parent and want to share your experience, it is almost always the wrong thing to say. Given that we have researched infertility enough to put ourselves through treatment, it's kind of insulting to imply that adoption hasn't even occurred to us as a possible alternative.

12:55 PM  
Anonymous midlife mommy said...

I completely agree with you. My husband and I underwent fertility treatments for over four years, beginning with Clomid, moving through injections, IVF with my eggs, and finally IVF with donor eggs. My doctor wouldn't have dreamed of transferring so many embryos. The rule was no more than two if the eggs were from a woman in her 20's; four if the eggs were from a woman in her 30's, and six if the eggs were from a woman in her 40's. They also monitored me very closely when I was using stims to make sure that only a minimal amount of follicles were ripe before a trigger shot. The goal was always a singleton, playing the statistical odds. We ended up with a singleton after transferring three embryos (donor mom was 31 at the time of donation).

1:10 PM  
Blogger Emma B. said...

And to hog the comments a little more and answer Chris and Vic's question, we chose to try for a biological child because the infertility process can often be cheaper and easier than the adoption process, and it offers a greater shot at normalcy.

Once you get pregnant through infertility, you are in the same boat as any woman who's conceived naturally. My memories of my pregnancy, the girls' birth, and their infancy are incalculably precious. If you erased all those memories and dropped them into my life as nine-month-old strangers, it would be a staggering loss. I'd love the babies just as much going forward, and I probably wouldn't feel that loss so keenly over time, but I think it would remain a lifelong regret, that I missed out on the beginning of their lives.

Yes, it's better to adopt than never to become a mother at all, but I wanted the whole shebang if I could have it. I believed I had a reasonable shot at a successful pregnancy, and was fortunate enough to be proven right.

1:16 PM  
Anonymous cheddar said...

I would like to repeat Emma B.'s first comment and point out that higher order multiples (especially more than quadruplets) do not come from IVF. Neonataldoc, you went directly from a discussion of the problems with higher-order multiples resulting from infertility treatments to several paragraphs of discussion of IVF. This is misleading.
Sextuplets are more likely to come from poorly monitored IUIs. In the stories of the Minnesota couple, I haven't yet read any explanation of why they were led to believe that there were only two follicles when there were actually ten. It is the regular ob/gyns dabbling in infertility treatment that typically create these problems.
Patients doing IVF under the care of an infertility specialist are more likely to face the decision of whether to reduce a triplet pregnancy to twins - these patients don't get pregnant with 6 babies.

1:29 PM  
Anonymous Christina said...

I have been thinking about infertility lately as one of my friends just started Clomid. I'm just wondering what is the exact definition of infertility? I understand that in some cases there is a clear physical diagnosis (PCOS for example) but it seems that in many cases there is no direct cause that can be named. So then how do infertility doctors diagnose their patients? Reading the Morrison's blog they say that they tried for a year to conceive and were unable to. So then they started drugs. (Perhaps there was a definate diagnosis- they do not specify.) Is this standard practice? Isn't conception a bit of a craps shoot in a way- with that small window of time for egg to meet sperm? Does trying for a year and failing make you diagnosably "infertile"?
We've all heard stories of people who tried for years, then became pregnant after they stopped fertility treatments. So then are they infertile, or not? I know one woman who was told her eggs were of terrible quality and she would never be able to conceive. Well- it did take 12 years of marriage, but she has two beautiful, naturally conceived boys.

I say all this with respect and total sympathy for people struggling with infertility, and I am NOT trying to say they should "just stop stressing about it" or whatever other patronizing advice I am sure they regularly receive. I totally understand the deep desire to have your own child. I am just commenting that there is obviously some other factors involved that infertility research has not been able to quantify...and I am just curious how infertility specialists diagnose people. And also curious to know if there were no available treatments for infertility, does anybody know roughly what percentage of couples would never be able to conceive a child over the course of their reproductive life?
Sorry if I am getting a bit off the main topic- I have been thinking about this lately to try to understand my friend's situation.

1:37 PM  
Blogger L.B. said...

You make a great point that seems to be obvious on the surface. Yet we continue to see increasing numbers of multiple births.
Someone brought up the point of doing a reduction in the case of multiples but that puts parents in a horrible position. The solution is to start with fewer babies, not to end with fewer.
Someone else suggested adoption or foster parenting instead of assisted reproduction. I do not believe that we should question the motives of someone that wants to have their own baby. Is there really something wrong with that? Let's not forget, adoption also requires a substantial amount of cash.

2:50 PM  
Blogger Eva said...

Please don't use the incorrect terminology of "implanting" embryos. They are simply transferred.

Also, clearly someone screwed up in these cases. Either the doctors didn't monitor the patients closely enough for hyperstimulation, or they were monitored and the parents had unprotected sex despite the risks. This is never the intended outcome of assisted reproductive technology.

9:04 PM  
Anonymous Anonymous said...

>I also think the parents are not fully aware of the risks as well or they would not accept the risk of having quads, quints, or septuplets.

My twins were conceived naturally however I have a number of friends who conceived using assisted reproduction techniques. Honestly, they were so keen to become parents I don't think any of them would have baulked at the *idea* of twins, triplets or even more, even having had the risks explained to them. They would have seen more than one baby as a dream come true.

1:47 AM  
Blogger DementedM said...

I've been following both stories closely since these HOM create the stereotype by which I am defined by as I undergo infertility treatment.

The 30 week babies, the treatment was completely inappropriate. This couple had conceived naturally twice in less than a year, although with early miscarriages.

The miscarriages are an indication for further testing (i.e. possible luteal phase defect) and monitoring, but do not warrant the full onslaught of infertility treatments. The doctors that made that treatment decision, based on what I know, were irresponsible and unethical.

These HOM could've easily been prevented with better care decisions.

As for the Morrisons, they had an, from what I can tell, an unmonitored fertility cycle. No one knew how many follicles they had. While this may be the current standard of care, it is unethical and needlessly puts lives at risk.

And again, we have preventable HOM if only the fertility docs would step up and police themselves. If only patients understood their treatment and its risks.

Moreover, what really irks me, is HOM are celebrated in the media. It's like winning the lottery.

Meanwhile, I ensured my treatments were ethical and appropriate resulting in a pregnancy with ONE child and no one wants to give me a free car.

M

9:48 AM  
Blogger neonataldoc said...

1. Thanks to all who corrected my terminology. I'll try to do better in the future.

2. The insurance coverage thing is a real problem. Sure, let's cover infertility treatments - but is anyone lining up to pay higher premiums so we can do that?

3. Re adoption: The desire to have your own offspring is so innate that I don't think we can expect infertile couples to just accept adoption as the answer.

4. Christina, I seem to remember from medical school that for couples having regular sex, about 90% should conceive within six months. (Please, people, no jokes about irregular sex!)

5. Dementedm - no new car, but how about a pat on the back for taking the issue into your own hands? Way to go.

8:24 PM  
Anonymous Anonymous said...

What does HOM stand for?

4:56 PM  
Blogger Kim said...

HOM=Higher Order Multiples (more than twins)

Chris & Vic--if you so believe that people ought to adopt, why did you have biological children? I agree with ND that the desire to have your own offspring is innate for most people. Should a person who has a medical issue preventing them from conceiving on their own not be helped by the medical profession? Should a person with a bacterial infection not be prescribed antibiotics? It's a big can of worms you open up when you insist that people with certain medical diagnoses not be granted treatment.

11:09 PM  
Anonymous Shawna said...

Christina, I believe that if you have had appropriately-timed intercourse with no birth control for a year and have not conceived, you are considered "infertile" in the technical sense of the word. Most doctors would, at that point, start some sort of investigation into why you haven't conceived, either themselves or by referring you to a specialist. That having been said, if you are older (mid-thirties on up usually, though there's no hard-and-fast rule) many doctors will suggest you seek medical advice and possibly testing and intervention after 6 months.

4:21 PM  
Anonymous Anonymous said...

I am from Mpls/St Paul area and have fertility problems (PCOS). We went a year (actually longer-thought we were just lucky), then started testing. The tests alone took some months-for both me & my spouse. And to get in to a good fertility clinic took almost a year.
I was on clomid during this process--nothing happened. I didn't ovulate at all. When we FINALLY got to see the fert doc, he discussed reduction, & then we started with injectables. I had internal ultrasounds every day from day 15 of my cycle until we did the ovulation shot. Even then they checked the number of eggs. We used IUI -- and got pregnant with a single (third attempt). They had me come back for an ultrasound at 5 wks pregnant (3 weeks after conception) to verify the number of eggs. They said it's the most accurate at that stage. My docs did an internal ultrasound again. There was no way to miss the one baby (looked like a blinking comet!)
I am sorry, and I feel really sad for the Morrisons, but from reading their blog, they did not go through anything like I did -- there is no way the docs could have missed that many eggs doing routine INTERNAL ultrasounds. They counted and sized the eggs each time. If it looked out of whack, they rechecked. I can't even fanthom reduction, but I am now an advocate of it to insure the quality of life for the babies!
I am blessed with our two children, but we went to great lenghts to ensure that we found responsible docs to help us. My reg OBGYN would not have anything to do with any fert drugs beyond Clomid -- which is a good thing!

4:46 PM  
Anonymous Anonymous said...

I think God controls ultimately how many you have. My first set quintuplets were fraternal, weighed over 25lbs and resulted from an experimental birth control drug gone wrong, (or RIGHT, depending on your point of view!). Six years later, when I finally got the courage to even THINK about getting preg again, I ferverently prayed, "God, please let there be only ONE egg!!!" Unbeknownst to me, my 5 six year olds were praying, "Dear God, Please let there be one for each of us to hold!" I then had five identical girls!---shortly after the first set's 7th birthday! [By the way, it's MUCH harder carrying identicals than fraternals!] My heart and prayers go out to families of supertwins everywhere during the pregnancies and the early years. I still think reduction is unacceptable. I don't know all the answers, but there's got to be ways of safely keeping the moms preg longer. Pray Mr Perinatologist, that's what got us through, Pray.

9:05 AM  
Anonymous Anonymous said...

It is not the fault of the fertility clinic. When the first ultrasound is performed, they have the option of reduction. If they want reduction, they go with that, if not, it's their choice. I have triplets from fertility as well as twins and a single boy. It was MY choice. They offered reduction, I said no and now they're all healthy.

3:23 PM  
Anonymous Anonymous said...

5 identical girls? The only ones were ever the Danone Quints. Right???????

3:26 PM  
Anonymous Kate Gosselin said...

My girls (twins) were conceived with fertility. I had sextuplets with fertility drugs too! (3 girls, 3 boys) We were offered reduction, but refused. If God wanted is to have seven, we would have had all seven (one didn't develop) God wanted us to have 6 so we had six!

3:28 PM  
Anonymous Anonymous said...

Some parents want multiples. Those very parents do know about the risks of their children, and seem to be taking very good care of them. I think everything you just wrote is your oppinion, and yours only. Yes, there are some people that agree with this, but there are also some that do not.

And BTW Anonymous was write.
Sextuplets is 6 babies NOT seven.

6:03 PM  
Anonymous Anonymous said...

The Identical quints, haha, TROLL. Why is it that trolls are obsessed with multiple births?

Kate Gosselin, you really disgust me. Fertility treatments like you undertook are irresponsible and ultimately it is the innocent babies who suffer. You mentioned that 'If God wanted is to have seven, we would have had all seven (one didn't develop) God wanted us to have 6 so we had six!'
No, my dear lady, as another poster mentioned, you were infertile so God didn't want you to have ANY children going by YOUR logic. Does it make you feel good to bleed your community and family dry, taking advantage of them to assist you in providing and raising your 'litter' of children?

Did you ever stop to think that perhaps HOM births are frowned upon for a reason? Any woman who says she will happily try to get pregnant with the help of fertility drugs with HOMs knowing the increased risks to the babies is a complete lunatic, more obsessed with their own desires than what is best for their children.

6:32 AM  
Anonymous Anonymous said...

my daughter just found out she is pregnant with 4 babies from using repronex. we don't want to abort one of them, but we are concerned for her health and the babies. i don't know what she will decide, but i am thankful for the comments i have read. i see there are good and bad stories concerning multi births. i hope no matter what she decides, hers turns out to be one of the good success stories. thanks

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1:13 PM  
Anonymous Anonymous said...

I hold physicians in high regard as I will soon be a practicing physician in the near future. However, Neonatal Doc, I am shocked at your lack of articulation of medical terminology as well as your lack of concern and respect for patients. Any pregnancy is most definitely a blessing from above; therefore, I am furious for you to refer to a pregnancy (even a HOM) as a disaster. It also more disturbing to me that you actually admit to taking a different method of treatment in regards to a patients status. I would hate to have you as my neonatologist as I am no celebrity, but would yet desire tbe same medical intervention for my child as you would give these "celebrity" parents/babies of HOM. It seems as if that is being just as hypocrital as when the media glamorizes such HOM. You're just like them I suppose. This blog and your comments prove why more stringent measures and qualifications are needed for our physicians. I know you are busy and this blog was probably rushed; however, remember that with those letters behind your name you represent all of us professionals. Consider this constructive criticism from a colleague.

I am also no stranger to the problems affecting infertile couples as I will be starting treatments soon. I am not hoping for multiples, however I doubt that if this happened selective fetal reduction would probably be out of question. As a physician that is charged with doing no harm, this would be quite ironic of me condoning harming innocent babies that did not ask to be in that predicament. The health care system has to first come to respect infertility as a medical diagnosis that is deemed worthy of treament. Then, and only then, will things like HOM be decreased when infertile couples are given the financial support they need from insurance companies to undergo treatment. Until then, many infertile couples would rather opt multiples (atleast twins) for the price of $10,000).

3:23 AM  
Anonymous Büyü said...

While I feel for people who wish to become parents, but can not without major medical interventions, I have difficulty, like you, in seeing these many multiple births as a good thing. The surviving babies (if any do in these cases) will suffer at great cost to everyone else. The parents will "put their trust in God," conveniently overlooking the likelihood that God never meant for them to have children since they couldn't do it naturally, as if this is any more than a medical experiment. This seems much more like an example of American hubris that ability. It will be tragic if all the children die, but the blame falls on the parents, who were advised to abort all but two of the foetuses to increase the odds of a term, healthy pregnancy.

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