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Midwest Today, Spring 1999

E T H I C S 


When Fertility Therapy Runs Amok

Debating the ethics and dangers of multiple births


The fact that science can now manipulate human reproduction to the extent of causing one woman to carry six, seven or even eight babies has sparked a renewed de-bate over the ethics of medically-assisted and extremely high-risk pregnancies.

First there was the much-hyped arrival just over a year ago of the McCaughey septuplets in Iowa. The birth of seven babies to Ken and Bobbi McCaughey was a miracle, to be sure. But it was also a media event, making national headlines and garnering them invitations to appear on shows like "Oprah." It prompted offers from Hollywood, a book deal, the hiring of an agent, and even the signing of a New York-based photo agency (SYGMA) through which the McCaugheys demanded Midwest Today pay $700 for just one photo of their family (No deal).

The McCaugheys previously had one young daughter and lived in a crackerbox of a house in Carlisle, Iowa -- just outside of Des Moines. Like a lot of couples who have trouble conceiving, the McCaugheys turned to medical science for help. Needless to say, the treatment was effective. But was it wise?

Who picks up the tab when a couple demands the right to have more children but does not have the financial means to pay for their births or support them?

The cost for the delivery of twins is estimated to be ten times more than the birth of a single baby. The routine birth of triplets can cost around $100,000.

For Bobbi McCaughey, who was hospitalized in the final months so doctors could closely monitor her condition, her hospital bill was astronomical.

The McCaugheys had insurance, and a fund to help them with expenses was set up at a local bank. They were enriched beyond imagining when they were given a luxurious and spacious new home, a van for transporting the babies, lifetime supplies of diapers and other essentials, thousands of dollars in private donations and various other material things that make their lives more comfortable. But reports indicate that the hospital bill ran as much as $1 million. Has it been paid? We were unable to find out.

A disturbing aspect to this story is that the miracle of these multible births of babies that - thank God - were healthy, has glamorized the use of fertility drugs.

Instead, say medical ethicists, more attention should be focused on the power and responsibility of being able to enhance fertility. The amazing technologies that enable women such as the one in Houston who gave birth to eight babies a few months ago raises the specter of there being too much of a good thing.

Jeffery Kahn, p.h.d., m.p.h., is director of the Center for Bioethics at the University of Minnesota. He wonders, "Should we limit the maximum number of multiple births in a given pregnancy, and if so, how? What are parents' and physicians' responsibilities for making sure that these limits are respected?"

Many couples have trouble conceiving

Infertility affects 7.1% of married couples with women of child-bearing age. That does not include 5.8% of married couples who have trouble conceiving or carrying a pregnancy to term.

Somewhere along the line, some people have gotten the idea that having a baby is an inalienable right, just like the right to life, liberty and the pursuit of happiness. The desperation that some couples feel about not being able to conceive finds relief in the various (very expensive) fertility therapies which are now available.

But a recent study in New York criticized infertility treatments that produce so-called high-order pregnancies - those of three or more babies who are prone to problems like retardation and blindness. It said many women are not adequately informed about the risks of fertility treatment, the costs or the treatments' low success rates.

Getting pregnant through the use of fertility techniques is not a sure thing. Only about 20% of women undergoing such therapy will get pregnant in a given month. Many have to go back again and again.
Nevertheless, in the last two decades, there has been a marked increase in the number of multiple births in the United States. In 1971, there were 1,034 births involving three or more children. By 1994, that number had jumped to 4,594.

The Centers for Disease Control and Prevention attributes the number to older women trying to get pregnant with the help of fertility techniques after delaying pregnancy for years.

Of overriding concern, say ethicists, should be that being pregnant with so many babies forces women to make difficult moral and ethical decisions.

"They have to choose between three conflicting values -- their own health, in having to carry so many fetuses; the health of their fetuses; and the moral values of whether or not you have to abort one or more of those fetuses," said Larry Gostin of Georgetown University.

Doctors say the healthy McCaughey septuplets were the exception rather than the rule. Many premature babies, such as the Houston octuplets, are much smaller and face grave dangers.

And, says Gostin, "Many of these children are going to have profound handicaps throughout their lives -- both physical and mental handicaps."

More babies, more risk

The health risks to both pregnant women and babies increase exponentially with additional fetuses. Reflects Dr. Kahn, "Unlike animals like dogs or cats that have litters, women aren't made to carry such numbers of offspring through the nine months of gestation it takes to go from fertilization to live birth."

He notes that "There just isn't enough room, nutrition, or oxygen to go around for so many fetuses, as the months of bed rest and the tenuous medical courses of the two most recent cases attest."

As the death of one of the Houston octuplets shows, even if all the babies are born alive, they have long odds to overcome. Because they are so underdeveloped, they face the same treatment issues as other premature infants, including long and extremely expensive stays in the intensive care unit (the estimate for the Houston octuplets is $2 million), and that is only in the short-term.

Medical progress or medical failure?

Physicians using fertility-enhancing techniques know that fertility drugs can cause many eggs to be ovulated at once. Many or all of those eggs can be fertilized to create the freakish possibility of multiple fetuses. The consequence is either extraordinarily risky pregnancies, or the need for horribly difficult decisions about "selective reduction" -- performing abortions to reduce high multiple pregnancies to safer twins or triplets.

But relatively low-tech ultrasound can be used to determine how many eggs are being ovulated by a woman after taking fertility drugs. When it is clear that a large number of eggs are being produced, physicians can and do counsel patients to avoid having unprotected sex until the next cycle, with (hopefully) fewer eggs. Says Dr. Jeffrey Kahn, "With available technology, there is no excuse for unexpected cases of high multiple pregnancies, and when they do occur it should be viewed as a failure of medical care rather than a success of reproductive technology."

Concludes Dr. Kahn, "We must question the medical care provided by physicians who allow octuplet pregnancies to occur, and the judgment of prospective parents who are willing to take such high-stakes gambles with the lives and health of their offspring. The risk of harm to mothers and children must be weighed against extremely long odds that such pregnancies will end with thriving babies.

Note: Our print edition also has a lengthy interview with Bobbi McCaughey, mother of the Iowa septuplets. To obtain a copy, send $5 to Midwest Today, Panora, Iowa, 50216.

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