by Lori Andrews

When octuplets were born at Kaiser Permanente Bellflower Medical Center in California, the doctor overseeing the 46 health care professionals in the delivery room called the event "marvelous" and described the mother as "courageous."  But was the event really marvelous?  Or was it a public health nightmare of fertility treatments gone awry?

Between 1980 and 2003, the number of higher-order multiples (triplets or more) increased four-fold.  The prime culprits responsible for this rise in multiples are fertility drugs and in vitro fertilization (IVF).  While other countries regulate the number of embryos that can be transferred to a woman during an in vitro fertilization treatment, the U.S. does not.  As a consequence, one in three in vitro fertilization births involves multiples. 

But high tech IVF causes only a minority of the cases of multiple births.  Family physicians and obstetricians who are not infertility specialists are increasingly prescribing fertility drugs.  When these high-powered hormonal stimulants began to be used 40 years ago, they were only prescribed to childless women whose ovaries did not function.  But now they are given to women who are merely impatient.  And some doctors fail to adequately monitor the women.  Appropriate care means blood tests and ultrasounds to determine how many eggs a patient is producing.  If the number is too high, the doctor can decline to administer the additional hormones necessary to release the eggs or, if the eggs are released, can tell the woman not to have sex so that she won’t create multiple fetuses.  Yet some doctors don’t adequately warn women of the danger of multiples.  Some clinics’ informed consent forms warn of remote risks (such as the likelihood the lab will have a power failure or a labor dispute), but not of the common risks of multiple births. 

One problem is that the doctors who are responsible for the prescription of the fertility drugs or the use of IVF usually do not deliver the babies and see the damage.  In my non-fiction book, The Clone Age: Adventures in the New World of Reproductive Technology, I quote an IVF doctor who said about triplets and quadruplets, "What do you mean you’re not happy?  This is everything you wanted and then some."

But even pregnancies of twins or triplets are dangerous to the mother and the child.  If the mom carries more than two fetuses, she is more likely to develop blood clots and diabetes.  Children born as multiples are six times more likely than single babies to be born prematurely.  The California octuplets were nine weeks early.  As the March of Dimes points out, "Premature babies are at risk of serious health problems during the newborn period, as well as lasting disabilities and death."

And think of the challenges of raising eight children.  Any normal activity—breast-feeding, potty training, even leaving the house—is raised to the level of complexity of a military exercise.  

When the California octuplets were born, people were stunned to learn that the mother already had six children.  Some people suggested that she shouldn’t have been allowed to have more.  But the U.S. Constitution’s right to liberty gives people the right to make decisions about whether or not to bear children.  However, women also have a right to adequate information upon which to base those decisions.  Physicians need to provide better information to women about the risks to their health and that of the babies in multiple pregnancies.  Doctors also need to do more to assure that fertility drugs and in vitro fertilization are used in ways that minimize the likelihood of a multiple birth.