Frustaci Doctor Defends the Use of Fertility Drug

Times Staff Writer

The obstetrician who delivered septuplets to Sam and Patti Frustaci believes that the three survivors should be regarded as the medical triumph of a pregnancy that "nobody would have given a damn for."

Further, said Dr. Martin Feldman of Orange in a recent interview, widespread criticism of Pergonal, the fertility drug that created the Frustaci pregnancy, is "totally unwarranted."

Feldman, who did not begin to treat Mrs. Frustaci until more than two months into the pregnancy, said that rather than making a moral issue of the use or possible misuse of the drug, the experience should be used to create greater public awareness of the importance of careful administration and monitoring of Pergonal treatments.

"The fact is, we started out expecting to get nothing and we got three (survivors) and we should, in a sense, be proud of ourselves . . . and not look at this as being a great, great tragedy."

'Defied All the Odds'

Continued Feldman: "Whether you call it (the conception of seven babies) a mistake, whether you call it a complication of Pergonal . . . we all know it shouldn't have happened, but that's only one side of the story. The second side is that it did happen, that the patient did not terminate the pregnancy, that we all felt that the odds were that she was not going to make it to any point.

"But she defied all the odds and did (make it) and now has three children that will most likely make it, and that's a positive side of it. I don't think this could have happened years back and that we've reached the point that we could salvage at least part of this pregnancy."

On Wednesday, Patricia Ann Frustaci, the first born of the seven babies who were delivered at St. Joseph Hospital on May 21, will be released from the Childrens Hospital of Orange County. Her brothers, Stephen Earl and Richard Charles, are expected to join her at the family's Riverside home as soon as their weight reaches between 4 1/2 and 5 pounds. (More details are expected to be disclosed Wednesday.) The babies were all under two pounds at birth.

For all the Frustacis, it will be a new start.

Pessimism Not Misplaced

For Feldman, it will be a reminder of times when things weren't quite so certain . . . and of January, when he first examined Patti Frustaci and consulted medical colleagues for their input on a multiple birth.

"I don't think that anyone absolutely came out and said that this is a hopeless situation," Feldman said. "But I think everyone kind of just rolled their eyes and threw their hands up in the air and said that the chances of this getting to any point of viability where we would have a chance of salvaging one or more babies was very remote."

Their pessimism was not misplaced:

--Feldman acknowledged that shortly after diagnosing septuplets, he felt that aborting the pregnancy was "the main alternative . . . the most reasonable and feasible."

--During her final days of pregnancy, Patti Frustaci developed hypertension. Kidney and liver functions were affected and there were respiratory difficulties. "She was having problems with breathing because of the fact that her abdomen had become so large and was pushing up on the diaphragm and her lung capacity was about one-third of what it should be."

--The decision to remove the septuplets by Caesarean section was dictated by Patti Frustaci "getting progressively sicker" and her overall condition that "had just gotten to the point where we were now fearful that something might happen to her . . . and I think that would have been the real tragedy."

--Feldman lived with the daily fear that Patti Frustaci would become a maternal death. "I used to go to bed at night worrying about this, that toward the end that we were going to lose the mother . . . and I didn't find anything going on during the day to make me change my mind."

--After the births, "there were times . . . when the kids were sick, when we didn't know what was going on, when I actually, at moments, wished that the whole thing had never happened."

--And on June 6, when James Martin Frustaci died, Feldman said he wept for the 16-day-old baby that had been named for him. "That was it. That was the end. I'd had it after that. It just hit me very, very hard, much harder than those things normally would bother me . . . because I had become very, very emotionally involved in the whole case, both with the Frustacis and with the babies and with the nurses and the whole situation."

Ovulation Induced

Patti Frustaci, a 30-year-old English teacher, gave birth after a seven-month pregnancy. One of the premature infants was stillborn. Three others died before June 9.

To commence that pregnancy, she had been injected with Pergonal, a drug widely used to induce ovulation, by Dr. Jaroslav Marik, 51, a co-director of the Tyler Medical Center in West Los Angeles.

Marik, citing physician-patient confidentiality, has repeatedly declined to discuss details of the Frustaci case. Other fertility specialists, however, have said that an ultrasound examination of Patti Frustaci shortly after the drug was administered in November should have shown the existence of seven or more mature eggs. That would have indicated the likelihood of a multiple birth.

At that early stage, they said, she would have had two choices: discontinue the cycle and await a month where only one or two eggs matured, or undergo a second injection to release the eggs for fertilization--with the risk of a multiple birth.

"I can only tell you that according to her (Patti Frustaci), on the day she came in, she had had no previous ultrasound examinations during the pregnancy," Feldman said.

That was in January when she was more than two months pregnant.

Ultrasound Scan

"I scanned her in my office," he explained. "I saw at least three sacs. I thought there were more but the picture was very confusing . . . because there were overlapping images. Not being an expert ultrasonographer, I felt that we needed a clear understanding, I thought that we needed it right away, and I sent her that day across the street to the ultrasound department at St. Joseph's."

With the diagnosis of septuplets, Feldman, 43, discussed prospects with the Frustacis. The "very obvious alternative," he said, was to terminate the pregnancy. Then there was the possibility of "selectively trying to decrease the number (of fetuses) . . . and, number three, just take your chances and carry on."

Patti Frustaci elected to continue the pregnancy.

On March 21, in the 20th week of pregnancy, she entered the hospital. There would be eight weeks of complete bed rest, ultrasound monitoring, medication to prevent uterine contraction and a minor surgery that literally tied off her cervix to better withstand the weight of seven fetuses.

"The biggest fear was that she would go into premature labor simply because of the number of fetuses we were dealing with . . . when we would be unable to salvage any of the infants," Feldman said. "We're talking about, oh, anytime prior to about 23 or 24 weeks when I think the outcome for them would have been very bad.

"I always sort of pictured myself as being up in the middle of the night . . . in a delivery room delivering these just totally premature infants and having them all subsequently die and that would be the end of it."

But that didn't happen. Feldman said his patient always believed that her pregnancy would stretch to 28 weeks. And that did happen.

What Might Have Been

Could the pregnancy have been continued and the births delayed as a better guarantee of survival?

"Well, what would have happened from a maternal standpoint is that we would have risked the possibility of her suddenly getting much sicker, possibly to the point where she would have have faced the possibility of sudden death . . . "

"But the second thing is, if you're willing to take that risk, what would we have gained from the fetal side? And that's where I feel we would have gained nothing.

"I think that these babies were severely crowded, that this condition was snowballing as each one got bigger and it could have worked to our disadvantage, very definitely, by exposing her to much greater risks while accomplishing very little for the pregnancy."

The deliveries, said Feldman, were completed in three minutes as "the easiest part of the whole affair." He was surprised that one baby was stillborn because "indications were that all seven were alive." He also was optimistic for the six survivors.

"Now, looking back, I think that was very naive because I should have realized, first of all, that the birth weights would have been far lower than expected for that particular point in pregnancy.

"Also, I should have realized that not only would the birth weights be lower but that there would be a lot of variation between the babies.

Media calls to Feldman have ended now. There will, of course, be his medical paper on the experience. He also will remain close to the Frustacis because "they have become a big part of my life . . . and I will always be attached to them to some degree."

He will continue to speak his faith in fertility drugs, the positive aspects of the Frustaci experience, and the use of ultrasound examinations he considers "obligatory" for monitoring chemically induced pregnancies.

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