Multiple Births Rare After Taking Drug : Fertility Experts Say That Most Patients Deliver a Single Child

Patti Frustaci had received doses of the drug Perganol in the course of fertility therapy at a West Los Angeles clinic last fall and the resulting multiple pregnancy was a matter of concern for some experts in infertility.

“It is important that people should not be afraid of Perganol because of what happened today,” Dr. Sergio Stone, director of the UC Irvine Medical Center’s division of reproductive endocrinology and infertility, said Tuesday. He said that in his three years of treating 20 to 25 patients a month with Perganol, there had been no multiple births.

And the manufacturer of the drug was “not very pleased” by news of the multiple pregnancy, according to a spokesman for Ares-Serono Inc. of Boston.

“It’s not something we wish to happen. It doesn’t happen that often anymore and when it does, it’s not good news to us,” said Erol Caglarcan, the spokesman.

Among patients treated with Perganol who became pregnant, he said, 80% had a single child, 15% had twins and 5% had three or more babies.

Frustaci, 30, gave birth to septuplets at a hospital in Orange on Tuesday morning, but the last of the seven, all delivered by Caesarean section, was stillborn. The six tiny surviving infants were listed in critical but stable condition and were doing well for their size, spokesmen said. (Story in Part I, Page 1.)

Largest in World

Caglarcan said his firm is the largest manufacturer of fertility products in the world, turning out three drugs for treatment of women with ovulatory problems, as well as diagnostic and monitoring equipment used in the therapy.

A majority of ovulatory problems can be treated successfully with a drug such as Ares-Serono’s Serophene, according to Caglarcan. Serophene, administered in tablet form, increases the output of a pituitary hormone known as gonadotropin, which in turn stimulates the maturation of an ovarian follicle or egg.

If this therapy fails, Caglarcan said, treatment can be escalated to the use of Perganol, which is actually a gonadotropin hormone itself that has been extracted from the urine of post-menopausal women. Perganol, which has been produced since 1970, is administered by shots.

Regardless of which of those drugs in taken, a third hormone known as human chorionic gonadotropin (hCG) must be administered afterward to trigger ovulation.

It is during the interval between a patient’s receiving either Serophene or Perganol and hCG, usually at least one day, that a decision can be made on whether to terminate the therapy for that cycle, a decision that is often based on the number of eggs present, according to Stone of the UCI Medical Center.

“The most important thing is to monitor the patient very closely,” Stone said. “And modern technology lets us do that. Using ultrasound, we can look into the uterus to see how many eggs there are and how they are growing.

“The reason we’ve had no multiple births is that with ultrasound we know how many eggs there are. We can tell a patient, ‘Listen, you have four eggs. Do you want us to go ahead (with hCG)?’

“The patient may decide to go ahead because, of those four eggs, maybe only one will result in a pregnancy. But at least we know how many there are.” Dr. Jaroslav J. Marik of the Tyler Medical Clinic in West Los Angeles, where Patti Frustaci underwent therapy, declined to discuss the Frustaci case Tuesday, saying, “I cannot discuss the medical problems of my patient unless I have her permission.”

Son Born in 1984

After three years of unsuccessfully trying to have children, the Frustacis had a son in March, 1984, after the mother had undergone Perganol therapy.

She returned to the fertility treatment at Tyler Medical Clinic five months later, her husband Sam said Tuesday, because “we weren’t aware she was going to conceive as quickly as she did. . . . We didn’t know if it would be another three years.”

Dr. Martin Feldman of Orange, the obstetrician who has treated Patti Frustaci during her pregnancy and performed Tuesday’s Caesarean section delivery, said he was not aware of the details of the woman’s infertility treatment.

When he first saw her, she was nine weeks pregnant. “We had seven babies to deal with and I was not concerned with the details of their conception,” Feldman said.

Feldman said he does infertility therapy and prescribes the drugs used. “Thousands upon thousands of women have gotten pregnant who otherwise would not have” thanks to those drugs, he said.

Times staff writer Kristina Lindgren contributed to this story.