Multiple Births Pose Cost, Health Concerns

Even as it strains the imagination, the extraordinary birth of eight babies to a 27-year-old woman in Houston not only poses a heavy challenge to the infants’ doctors but also feeds into a larger social quandary about the extreme costs of high multiple births brought on by fertility drugs.

Doctors on Sunday expressed wonder at what appeared to be the largest multiple birth in the United States, but they also emphasized that the tiny infants face an uncertain future.

The infants are all substantially smaller than the Iowa septuplets born last year, who defied many medical expectations by surviving. But the Houston infants spent at least 30 weeks in the womb, which many doctors regard as a gestation limit that improves a premature infant’s prospects significantly.

“At 30 weeks, a premature baby has a good chance of survival,” said Dr. Leonel Guajardo, a neonatologist at Miller Children’s Hospital in Long Beach. But he acknowledged that the guideline was based on single premature births, whereas high multiple births present many complications.

Generally, he said, the care of such premature infants, who are kept in closely monitored incubators, includes intravenous feeding and breathing through a tube attached to a respirator.

Crucial to their survival will be getting through the next few days without grave medical complications, including lung problems and bleeding in the head, which can cause long-term physical and mental impairment, he said.

“Premature babies that go past three days of life and don’t have major head bleeds and their respiratory situation is improving have a much better chance of surviving,” he said. “The first three days are the most critical.”

In addition, such premature babies are also more at risk than other newborns of life-threatening infections, due to their virtually nonexistent immunity, he said.

Another major risk is blindness or vision impairment associated with maladaptive growth of nerve cells triggered by exposure to oxygen. But doctors are more on guard against that problem than they were in the past and can treat it with lasers, among other approaches, he said.

To fertility experts, the Houston octuplets represent not a triumph but a failure of their specialty. “The risk here is tremendous with these kids, of death as well as severe neurological impairment. So there’s just no reason to do this,” said Dr. Alan DeCherney, chairman of obstetrics and gynecology at UCLA and editor in chief of the journal Fertility and Sterility.

He estimated that caring for eight premature babies would cost half a million dollars from delivery to the time they went home.

The incident hurts the profession too, he said. “It makes it seem that [fertility specialists] are careless. And it frightens our patients that this could happen to them.”

He and other fertility specialists pointed out that doctors have techniques for limiting the number of eggs that can become fertilized in the womb when several are produced in response to fertility drugs.

The mother, Nkem Chukwu, reportedly took two hormone-based fertility drugs, follicle stimulating hormone and human chorionic gonadotropin hormone, to produce several eggs.

Dr. Jirair Konialian, medical director of the Northridge Center for Reproductive Medicine, said it was “reckless” for a doctor not to monitor egg production more closely to reduce the chances of such a high multiple birth. Egg production can be monitored with intravaginal ultrasound, he said.