Joy, and Serious Issues Too

As the four boys and three girls were born Wednesday, they were pronounced about as healthy as babies arriving nine weeks premature can be. With each hour the medical bulletins became sunnier; for the parents, Kenny and Bobbi McCaughey of Carlisle, Iowa, it must finally be sinking in. These are expected to be the world’s first known surviving septuplets.

The word “miracle” applies, though Mrs. McCaughey’s youth (29), apparent good health and willingness to take to her bed no doubt helped. So did the medical team of 40 who assisted in the caesarean birth. But this, of course, was a miracle created partly by medicine itself--the fertility drugs that the new mother took to help her become pregnant. And this medical frontier has created a slew of ethical and medical issues that need addressing.

Fertility drugs that boost a woman’s egg production are expensive. Their administration is complicated and demanding. The temptation is to induce the production of multiple eggs, raising the odds that at least one will result in pregnancy. Too often, there are more.

“Everyone is distressed about the multiple rates in our field,” says Dr. Karen Durinzi at Kaiser Permanente Los Angeles. Sometimes there are honest mistakes, she says, but generally “it is the physician’s responsibility to be sure that the patient does not produce seven or eight eggs” and to halt the treatment cycle if she does.

The medical costs, the stress on families and physical danger to the mother of even triplets or quadruplets are well documented. The last septuplet birth was in California in 1985; one was stillborn, three died and the surviving children faced long-term medical complications. For such reasons many couples quietly abort one or more of multiple embryos.

The McCaugheys, who declined to abort, have reason to rejoice. But fertility specialists need to keep asking questions of themselves about the promises they make, the drugs they administer and the ultimate costs of rising multiple births.