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Midwest Today, Spring 1999
By NAOMI LENOX
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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