Quints for Mother, Disabled Father Raise Concern About Medicine

Doctors at a fertility clinic dealt Joyce and Roger Bowman five cards. The couple ended up with a full house.

The Bowman quintuplets are doing fine, but questions are being raised about the wisdom of implanting five fertilized eggs in their mother, especially when their father is a quadriplegic.

Roger Bowman of Richland, who uses a wheelchair since a 1981 motorcycle accident, says he’ll be able to help when the babies are released from a Spokane hospital late this month or early September.

“I can easily lift the kids,” said Bowman, 37, an engineer at the Hanford nuclear reservation.

All four of his limbs were damaged in the crash 15 years ago, but Bowman says he is a “lower-level” quadriplegic, retaining some use of his arms and hands. He plays tennis and coaches a wheelchair basketball team.

Bowman’s disability was an issue at the University of Washington Medical Center fertility clinic where the quints were conceived.

“I am more concerned for this couple because of Mr. Bowman’s handicap,” said Dr. Nancy Klein, the clinic director. “Physically, it is more difficult for him to care for the children.”

But the clinic staff decided that the Bowmans could handle the situation.

“They are very intelligent, very motivated,” Klein said. “If anyone can make a success out of this, they will.”

After an earlier attempt at in vitro fertilization ended in miscarriage, the Bowmans adopted a baby boy, now 6. They withdrew their application for a second adoption after deciding to try another in vitro procedure.

Joyce, 39, was impregnated at the Seattle clinic last fall with a relatively new technique called Intracytoplasmic Sperm Injection. In that procedure, a single sperm is injected into an egg and the fertilized egg is implanted in the womb. In the Bowmans’ case, the eggs and sperm were their own.

Multiple implants are common to improve the odds. About two-thirds of those undergoing the procedure do not achieve pregnancy. In the 18 months the procedure has been offered at the University of Washington, 52 women became pregnant and 84 did not conceive.

And multiple implants make financial sense. The Bowmans paid nearly $15,000 for the procedure, which is not covered by their health insurance.

Five eggs were implanted in Joyce. Four took hold, one of which split into twins, accounting for five babies--four girls and a boy.

“We’ve upped their percentage,” Bowman quipped.

The Bowmans were offered the option of aborting some of the fetuses but declined.

On June 20, the five babies were delivered by caesarean section at Spokane’s Sacred Heart Medical Center. The underweight infants were placed in the neonatal intensive-care unit.

The boy, Clint Eugene, weighed 3 pounds, 12 ounces at birth. The girls are Rachelle Elizabeth, who weighed 2 pounds, 11 ounces; Randi Michelle, 3 pounds, 8 ounces; Sierra Nicole, 2 pounds, 5 ounces; Danielle Marie, 2 pounds, 1 ounce. Rachelle and Danielle are the identical twins.

After the births, one of the team of delivering doctors said it may be time for fertility clinics to begin restraining themselves.

“We are getting better with assisted reproduction,” Dr. Richard Kates said. “We may need to cut back on the amount of eggs placed, because of other issues.”

Those issues include the $300,000 cost of delivering the quints and providing them with special care until they are released from the hospital, and the strain on any couple looking after five babies.

The Bowmans’ medical bills will be covered by his health insurance from his job at Westinghouse Hanford Co., which operates Hanford for the U.S. Energy Department.

The couple has also been pursuing donations. They’ve been given cribs and car seats. The makers of Similac donated a year’s worth of formula. Welch’s, which has operations in central Washington’s orchard country, has offered free juice when the babies are old enough. Numerous people have donated clothes.

They hope to find a free supply of disposable diapers.

“We talked about using a diaper service,” Joyce said, but the notion of keeping the soiled diapers of five babies around the house in pails “was overwhelming.”

Klein said the clinic will reevaluate its guidelines in light of the quints’ birth.

“In this case, we were too successful,” she said. “We’ve never seen it before in our program.”

Joyce was considered a low risk for multiple births because of her age and previous miscarriage, Klein said. As success rates improve, “we are having to modify the number of embryos transferred,” she said.

Potential parents are advised that multiple births are a possibility, Klein said.

“They are also told the possibility is very small,” she said.

“We went in knowing there was a chance all five would take,” Roger Bowman said.

Doctors at fertility clinics are reluctant to impose any arbitrary restrictions on the number of eggs implanted or the people eligible for their services, said Dr. Al Jonsen, chairman of the National Advisory Board on Ethics and Reproduction.

“There are various problems that come up, like who are worthy parents who ought to have children,” said Jonsen, also head of the University of Washington’s medical ethics department. “The idea of judging people being worthy or unworthy parents has implications I think are pretty horrifying.”

So the general rule is that anyone who can pay for fertility-clinic services can have them, he said, noting that those seeking such services are usually comfortable financially and able to provide for multiple children.

When the Bowmans take their five newborns home to Richland, about 100 miles southwest of Spokane, they’ll have help. They’re enlisting friends and family to pitch in with chores such as grocery shopping.

And a young couple--Joyce’s niece and the niece’s husband--will move into their five-bedroom home and offer backup in exchange for room and board.

“She will help me out during the night shift, so I can get a little more sleep,” Joyce said.

Adopted son Matthew, their only other child, starts the first grade at the end of August and the family wants to get started on its new routines, she said.

“We need to get things back to normal,” Joyce said.