Multiples as a Complication

Recently a woman in California delivered an Octuplet – 8 babies in one pregnancy. By the way, she is not our patient and we do not know who her doctor is. Without getting too emotionally involved, we would attempt to present (neutrally) the debates between constitutional/human rights believers vs. ethicist about multiples for many years, and here are some of the key arguments:
Human rights advocates
  • the right to procreate is a natural right as well as a constitutional right
  • the women has right to control her body, at least in the first trimester when she is attempting to become pregnant
Ethicist
  • having multiples greater than triplets puts the health of the babies, as well as the mother at great risk for premature births, birth defects from premature births, pregnancy complications, etc, and tax payers would have to share the bill if the mother cannot afford to pay for them
  • What about the children’s rights? Luckily they were healthy, but having eight fetuses at the same time put them in greater danger for lifelong health problems than singletons and twins.
What would a fertility practice like us have done for her?
First of all, the circumstances surrounding how she got pregnant seem to be unclear at this point, but we doubt she became pregnant with any reputable fertility center here in Southern California.  Our practice shares the view with American Society for Reproductive Medicine and other ethical fertility physicians that multiples greater than twins is a serious complication to fertility treatments. Main reason is its impact on the health of the babies and of the mother. Typically, one additional fetus would reduce the gestational age by two weeks.  For example, normal gestational age is 40 weeks for a singleton, 38 weeks for twins, 36 weeks for triplets, and so on.
We are very careful in our practice to help patients avoid multiples by providing patient education, better selection of embryos, limiting the number of embryo transferred, etc.  We’ve been fortunate to have very minimal number of multiples greater than twins, and that’s not with luck but careful practice!  As a result, we are able to achieve high pregnancy success rates with low number of embryos transferred per cycle. In some cases, we do single embryo transfers. Some possible scenarios where the doctor has less control over the number of fetuses would be in cases where the second embryo naturally divided and produced an identical twin, or if the embryos were of poor quality so a higher number was transferred due to the chance of them implanting is very very low.  Sometimes, insemination (low-tech Assisted Reproductive Technology) allows the physician less control over how many eggs will fertilize and implant (as in the case of “Kate” of “Jon & Kate”).  However, if there were more than three large follicles observed, our doctor is likely to not even proceed with the insemination at all, in order to prevent high multiples.
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