Monthly Archives: February 2009

Bioethical conundrums sometimes come in multiples

lotsababies!By now, you have all probably heard about Nadya Suleman, the California woman who gave birth to a set of surviving octuplets last week.  It is important to make this distinction, as another set of octuplets was born in the US in 1998, however, one of the babies died a week after birth due to heart and lung failure.  Suleman’s octuplets were born at 30 weeks gestation, 10 weeks short of a normal full-term pregnancy.  When babies are born at such an early developmental stage, a plethora of health problems can (and often do) result, including breathing problems due to underdeveloped lungs, feeding problems due to an underdeveloped gastrointestinal tract, kidney damage, and brain damage leading to developmental delays.

The fact that the infants are 10 weeks premature is one of many issues surrounding this mother and her newborn babies, and one that is critical to the survival of these children.  The path that led to the birth of these children is what is more troubling, and what requires closer examination.

Little is known about what medical interventions Suleman may have pursued in order to conceive.  It is thought that she turned to IVF–in vitro fertilization–in order to have the 6 children she had prior to the octuplets’ arrival.  When used, IVF can help infertile couples to conceive children they may not have otherwise been able to have.  It is important to note that there are many causes of infertility–blockage of the Fallopian tubes and low sperm count, to name a couple.  Usually, when doctors perform IVF, a low number of embryos are transferred to the mother’s uterus in the hopes that at least one will embed itself in the uterine wall and a fetus will develop there.  Whether Suleman had IVF performed, or was taking fertility drugs in order to stimulate her ovaries to produce more follicles prior to ovulation is not yet known.  Had she conceived via IVF, the likelihood of a doctor transferring 8 embryos at one time would seem low.  Another possibility is that Suleman took fertility drugs that caused her ovaries to overproduce mature follicles containing eggs, and then was artificially inseminated.  This would have caused her to release more eggs than normal during ovulation–instead of 1 or 2 eggs, her ovaries could have released from 8 to 10 eggs.  However, if this woman’s fallopian tubes were blocked (as her mother claims), the likelihood of her getting pregnant via this route seems unlikely.  It should be noted, though, that if a woman undergoes IVF, her doctor will treat her with medications that will stimulate her ovaries to overproduce mature follicles–basically sending the ovaries into meiosis overdrive.

Here’s where the conundrum comes in.

Would a fertility doctor, knowing that there are established guidelines for the number of embryos to be transferred at once, knowingly transfer more than the recommended number of embryos?  Assume that the doctor is aware of the risks of multiple births to both the mother and fetuses.  In Suleman’s case, she was informed that she was carrying 7 babies (the 8th baby was not known about until delivery), and was advised to undergo selective reduction, a procedure that reduces the number of fetuses in the uterus in the case of multiple pregnancies.  She refused the procedure, and made the decision to try and carry all the fetuses to term, which did not happen, as they were born 10 weeks premature.

It is thought that selective reduction increases the overall health of both the mother and the remaining fetuses, however, the procedure is controversial as it does take the life of a fetus.  The procedure does increase the chance that the surviving fetuses will develop more fully, and without the major health problems that are often present in multiple births.

For all the unknowns in this particular case, there are some pretty solid “knowns” that have been verified:

The mother already has 6 other children–1 of whom is autistic–that were also conceived using IVF.  All of the children are under the age of 7.

The mother lives in a small home she shares with her parents.  She is unemployed, and declared bankruptcy two years ago.

Many reproductive medicine specialists do not find this event something to celebrate, as it represents a potential misuse of available reproductive technologies and therapies.

So, I ask, BioSpacers, what say you?   There’s a lot of science involved in bringing 8 lives into the world simultaneously, and a lot of bioethical questions that can be asked about accomplishing such a task.  I will leave it up to you to ask those questions as a way to facilitate discussion.  Because this particular topic has the potential to generate a lot of strong feelings one way or the other, let’s remember the Forum Decorum when posting responses.