2

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.


2

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.


1

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.


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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.


4

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:


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


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


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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.

Posted by scienceguru on February 5, 2009
Tags bioethics, dilemmas dilemmas!, discuss, reproduction

Total comments on this page: 45

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Chris Latiolais on paragraph 1:

How could this many babies grow inside of a person. I would imagine that many babies would cause the uterus to explode. That woman basically gave birth to a baseball team, as long as they were to play without a center fielder.

February 5, 2009 6:48 pm
Melyssa Son on whole page :

I think that this is extremely unethical. Not only was the life of the mother risked by carrying eight babies, but also there is a high chance of birth defects in the babies. Furthermore, as the mother is not in a financial position to support 14 children, much less have the time to give them the individual attention they need.

February 5, 2009 7:31 pm
camden on paragraph 6:

In general, it may seem unethical for selective reduction. But, in Suleman’s case, I think it is better if she had chosen to undergo selective reduction. I can easily point out a few reasons why she should have undergone selective reduction. As stated in paragraph 6, reducing the number of fetus would help increase the health of the remaining babies. The article pointed out that she is unemployed which means she will not able to provide them with the basic necessities. She is a single mom and there is no way she can take care of 14 kids on her own and spend quality time with them. Also, she does not even have a big enough house for all her 14 children to live in.

February 5, 2009 8:18 pm
Brandon Pekarek on paragraph 5:

I have no idea what made the doctor transfer more than the established amount of embryos at once. This whole story seems like its missing some information. What doctor would do something like this knowing the risks to the fetuses and the mother? It does seem like almost a miracle in some way though, that none of the babies have died and none of them killed the mother.

February 5, 2009 8:51 pm
Krishan Gupta on paragraph 11:

This really is quite a bad idea. Not only can the mom clearly not afford to take care of these kids, but they are likely to be severely underdeveloped. This also disrupts evolution due to the synthetic pregnancy. The doctors really should have performed a sort of background check to ensure she was capable.

February 6, 2009 10:10 am
sarah wesner on paragraph 1:

I recently watched a program on a women who had octuplets and she had to be in the hospital bed for the last three months of her pregnancy so that the doctors could monitor her health. Is the higher fertility rate of women really good for them? or is this inability to survive an example of the weakening of the human body that is steadily getting worse?

February 6, 2009 10:49 am
Sara Betterton on paragraph 11:

This raises serious ethical questions both scientifically and morally. The woman already has six children who all live in a small house with her parents. Now she is a single mother of fourteen children total with no source of secure income and a small living space. What kind of life will these children have under their mother? What on earth posessed her, unemployed, unmarried, and dependant on her parents, to have children in the first place, let alone six? Now she has eight? Why on earth would a doctor allow the fertilization of so many eggs especially to a woman who has already given birth to sextuplets via IVF? The reason behind either is unclear, and frankly, I think the doctor and the mother should undergo a rigorous character analyzation and background checks.

February 6, 2009 1:18 pm
Alyssa Munk on paragraph 5:

The doctor should not have been allowed to transfer that many embryos. It puts too many lives at risk. Instead of having “established guidelines” and a “recommended number” of embryos, there should be an exact embryo number that cannot be exceeded under any circumstances.

February 6, 2009 2:46 pm
Jon-Michael Evans :

Alyssa, while I concede your point, I feel you are jumping to conclusions. The reason there are “guidelines” and “recommended numbers” is because that every womans body handles pregnancy in a different way. If the maximum was fixed at say 4 embryos and a woman came in with perfect health, no history or risk of ectopic pregnancy or ovarian sists, fully capable of carrying and (financially) supporting 5 then there should be no reason for her to only recieve 4 just because its the most they can give. When women undergo IVF they know and are advised of every risk they are taking so while I agree that in this particular case 8 was way too many for Ms. Suleman I do not agree that there should be and overall limit set.

February 8, 2009 10:41 am
Katie Haning on paragraph 5:

It seems that the mother’s possible attempt at becoming a famous child expert has failed. Because of the controversy and lack of good judgement by all parties involved, it does not appear that this woman will be getting any endorsements. She might get a visit from Child Protective Services, though.

I think that public reaction to the IVF birth of octuplets would be entirely different if the home had two parents who tried to have kids and simply couldn’t. Would the IVF doctor still be questioned because he or she transferred more than the recommended number of embryos? I doubt it. I think we would all be focused on celebrating the miracle of life with the family.

February 6, 2009 3:09 pm
Jen on paragraph 5:

Selective reduction comes across as a very sensitive and controversial issue. It is one of the more unpleasant aspects of fertility medicine — sometimes referred to as “half-abortions.” Although this process seems highly unethical, Suleman should have considered both the short-term and long-term effects, seeing as how it would have increased her overall health as well as the health of the remaining fetuses.

February 6, 2009 5:24 pm
Jen on paragraph 6:

Multiple pregnancies are already at a higher risk of birth defects than single pregnancies, let alone a pregnancy that surpasses the established guidelines for the number of embryos transferred all at once. Suleman should have taken this into serious consideration, especially since this is her second multiple pregnancy.

February 6, 2009 5:34 pm
Jen on paragraph 11:

The concepts of natural selection and survival of the fittest pertain to this story. Suleman is interfering with natural selection, and is not letting it run its course. Also, the definition of being biologically “fit” has to do with producing viable offspring that can also produce viable offspring. However, by taking chances with multiple pregnancies, she is increasing the risk of birth defects, possibly effecting both immediate and gradual outcomes of both scientific concepts.

February 6, 2009 5:50 pm
Jen on whole page :

Risk the health of all…or take the lives of some?

The question presented definitely caught my attention in one of the linked articles. This is undoubtedly one of the toughest choices women in a multiple pregnancy must face. Basically, do you risk the health of all the fetuses, relying on the slim chance that all will be viable without any birth defects…or take matters into your own hands, determining the fate of the fetuses yourself to be on the safe side, not risking possible birth defects?

February 6, 2009 7:03 pm
Rebecca on whole page :

I believe this was a mistake by doctors, after all she wouldn’t have this many children if it wasn’t for her doctors decisions. She must have been on some kind of fertility treatment and was not supervised as closely as she needed to be. Also just a question I thought of, why was she trying to get pregnent again if she already has 6 children to take care of especially in her financial and housing situation. It doesn’t seem fair to these children and they will grow up in a situation where they will not recieve the amount of attention they need.

February 7, 2009 8:34 am
Austin Henke!- 09 on paragraph 11:

Wow, having one healthy baby is something in itself! but do moms get like an adrenline rush from having kids, seriously if you cant put up the kid for 18 years at the very least, the kid is not going to be better off. 14 in a small house sounds like the nursery rythme about the little old lady who lives in the shoe. I seem to recall her going mad! Then if the baby is not healthy,then what special care divided over 14 times. Impossible! I dont believe she should have ever considered more. 6 was pushing it. I hope the doctor tried to discourage her, and did not just see the dollar bills sailing on his boat.

February 7, 2009 10:12 am
Hannah Gardner on whole page :

Ok, on a different note- I am curious what kind of doctor would in his right mind implant 7 embryos when he fully well knows the chances of those embryos developing into fetuses is good. Also, the doctor should have noticed- “Oh hey, this woman has 6 other children at home. Maybe I should determine why it is she wants more.”
I honestly think Nadya Suleman needs mental evaluation- wanting that many children without a care to the consequences indicates severe mental issues to me.

February 7, 2009 10:41 am
Alicia Crosswhite on whole page :

What I don’t understand is how the mother paid for IVF, that is a very costly procedure and take that and add it to prenatal vitamins, sonograms, and common doctor visits. Some people in a poor financial state would and could be willing to skip over any of the listed (not recommended), but with seven known heart beats and the fact that all eight survived, it is pretty unlikely the mother missed any of the steps. The financial crisis is not even the first concern one should look at (her single lifestyle and reliance on a bankrupt family). Certainly, there are millions of people that are in a financial crunch and still reproduce. The possibility that the doctor inserted eight fertilized eggs (because none of the eight children were from the same embryo) is extremely unethical and the fact that the mother consented to that number is unbelievable. No offense to anyone else, but it sure seems like she is after the money and the odd recognition. Interest in stirring up controversy is not a well rounded reason to be willing to bypass biological standards.

February 7, 2009 11:20 am
Kathryn Davis on paragraph 11:

First off, I think she is not a very bright woman. I think her decision to not do selective reduction was selfish, and I think her decision to even conceive more children is absurd. She has no where near the amount of money to provide, and has no need to want more kids due to the 7 she has at home. Secondly, my mom’s friend had a lot of difficulty getting pregnant and had her child 10 weeks early. She was 3 pounds and smaller than a loaf of bread. The mother has had to take extra leave to watch over her and Sienna, the baby girl, didn’t leave the hospital for over 1 month. Does this mother that now has 14 kids have that kind of time? Does she have that motivation? I think it will be hard for her, and I wish she would of thought before. I also blame the doctor for not using his ethics and doing a background check. I hope the children are all right.

February 7, 2009 11:36 am
Tiffany on paragraph 11:

I suppose that the solipsistic nature of human beings overtakes them every so often and leads them to commit remarkably dim-witted decisions. For instance, I believe conceiving eight children is incredibly unscrupulous because her primary motive was to attain fame and fortune. If she decides to have children she must be willing to raise her children and teach them first-class morals and values to subsist in this world, as this is her foremost responsibility in being a parent.

February 7, 2009 11:49 am
Rachel Trahan on whole page :

In my opinion this woman has gone completely bonkers. If she lives with her parents, she doesn’t have a job, she has six kids already, she claimed bankrupcy two years ago, then what in the world makes her think that she will be able to support eight kids?! Why would she choose to get pregnant in the first place, whether it was IVF or some other form of pregnancy inducing hormones? I think the mental stability of this woman needs to be brought into question.

February 7, 2009 11:54 am
jesse on whole page :

We as a society often decide what is normal and what is not, needless to say, this is not normal. But I think that the mother who gave birth to the octuplets deserves society’s unbiased respect to pursue what she views as happiness and fulfillment. And if we are to judge her course of action based solely on social background and financial status, then we are missing what is important.

February 7, 2009 2:24 pm
jesse on paragraph 11:

I think Darwin would be proud of her, she has defeated natural selection’s greatest restraint, infertility. The mother has also gained national attention, and has benefited generously, as she is richer financially, from all the interviews for which she and her family is and will be paid, and the numerous endorsements she will get from diaper and baby products corporations. So, according to society’s norms, her pregnancy was unethical, but according to her financial disposition, her pregnancy was very ethical.

February 7, 2009 2:31 pm
jesse on paragraph 6:

i think the selective reduction procedure could be ethical if it were performed on a mother who had been infertile her whole life and has no children, but I definitely don’t think it is ethically sound for a woman who already has 6 children to under go selective reduction.

February 7, 2009 2:46 pm
jesse on paragraph 2:

Some infants who are born premature have severe organ underdevelopment, but some premature infants have no organ underdevelopment. This is a perfect example of natural selection in modern society, as only the babies who survive to adulthood pass their genes on, those who do not, decrease their family’s genes in the gene pool of society.

February 7, 2009 2:52 pm
jesse on paragraph 9:

So, she is supported by the state’s and federal government’s money, tax money which we, Americans, pay 1/3 of income to. And in our economic downturn, she takes government aid to support her overabundance of children, when those same government aid could be used to support a working unemployed family. I wonder how much money she gets from the government for having 14 kids?

February 7, 2009 2:59 pm
Andrea Grbavac on paragraph 10:

I definitely think it’s reckless on the mother’s part to endanger herself as well as her babies by doing a higher-order multiple birth.
Since these babies are at a much higher risk in developing respiratory distress, organ damage, and other developmental issues, I find it unethical to disregard such possibilities, as the consequence could easily be a child with major complications.

February 7, 2009 3:48 pm
Jen on paragraph 6:

People perceive selective reduction differently, and form opinions based on various platforms. However, Suleman should have looked into this procedure more, especially since she was advised to go through with it. Selective reduction is a controversial topic; there is no way to know how many multiple pregnancies start out as triplets or more and are reduced to something more manageable. “Manageable” seems like quite the word to mention; how is Suleman going to be able to manage these children [physically and emotionally] seeing as how she is unemployed and lives with her parents in a home that is hardly large enough for 14 children?

February 7, 2009 4:06 pm
Jennifer Abohosh on paragraph 5:

When I first heard you talk about this in class, it was interesting to me that the doctor suggested that the mother undergo slective reduction. This to me, seems like he was promoting abortion to try and cover up the mistake he had made by outnumbering the amount of embryos transferred at once.

February 7, 2009 4:08 pm
Kelly Doyle :

That’s an interesting thought. I’m sure that the doctor did probably freak out when he heard that she was pregnant with eight children, as it is an insane number of kids.
But I doubt he would just recommend it simply to cover his rear. I’d suggest it to the lady too, if I’d had the chance to talk to her before it was too late.

February 7, 2009 9:34 pm
David Kern on whole page :

This is ridiculous, crazy, and stupid. I think that eventually this will turn into a disaster. I think eventually that the mother and the doctor will be found out if the doctor did this process unsafe. I don’t see how this could be safe, I think that it happened like this so they could get media coverage. I mean your risking everything, both the mother and the doctor.

February 7, 2009 7:25 pm
Andrew Kim on whole page :

Stop. Lets backtrack here for a minute, for most people will focus on either the babies conditions, the mothers reasons or a combination of the two, however my question is how were the babies delivered? For if Suleman already had six children before, assuming that all were underdone by a natural, vaginal birth, it may seem possible but highly unlikely that the babies were delivered naturally. Why? The mortality chance is much higher when there are more fetuses in a womb. in the case with twins, there is around a time gap that occurs around 3 to 5 minutes (maybe longer) that lies between each natural birth. The chance of suffocation is enough due to the immense amount of umbilical cords inside the uterus. The caesarian route seems more advised but still its seems improbable to have that many children removed at a quick succession without having atleast one baby have breathing complications. It seems like the mothers body may have become disfigured after this birth.

February 7, 2009 7:31 pm
Mike Mansell on paragraph 3:

I was watching the today show because they had a special on this before school. They said that at most they will put two embryo’s within the woman’s uturous and that this was against normal medical protocal and under supervision should never had occured, especially when she already had six other kids she had to provide for.

February 7, 2009 7:46 pm
Andrew Kim on whole page :

Another note on the queerness of this operation was that the unusual success rate of the babies delivery. For there are an immense amount of risks that occur when only 1 child is being born. The list ranges from a breech baby, Prolapsed Cord (umbilical cord out first), eclampsia, merconium and especially miscarriage. Few of these conditions do not apply, for the babies were premature and probably delivered via caesarian, yet the mother could have undergone through eclampsia which would have poisoned her system with eight times the potency. also had there been merconium in the embryonic sac then the majority of the children would have died just by the sheer number of babies to staff who need to suction out the toxin. Whether this is a good miracle or not, the success shows just how crazy people can get and still achieve good results.

February 7, 2009 7:51 pm
Mike Mansell on paragraph 11:

I strongly disagree with this mothers opinion because first off she doesn’t have the money to supply for the needs of the children. Another thing that was brought up on the today show was the fact that it would cost over 800,000 dollars for the infants in the first year of life and that doesn’t include all the medical crap that she has to pay for. Second of all the house is a piece of trash that wouldn’t suit the seven people in my family. I have no idea how she was planning on taking care of her kids while in the situation she’s in. I think that it was extremely irresponsible on her part.

February 7, 2009 7:51 pm
Gabe on whole page :

They shouldn’t be doing this. I don’t believe that the doctor should increasing the risk of death to these human beings… It is unbelievable to conceive seven babies in one pregnancy in the past… If that mother wants more babies she should just adopt or do it normally

February 7, 2009 7:58 pm
Kelly Doyle on whole page :

I can’t help but think that this woman is a little off. She’s told the news different stories; she’s claimed that her childhood was a wreck, and then corrected herself to say it was very happy. I believe she’s went back to the first story now, saying that that’s why she’s had so many kids.
The doctors should not have let her go through with it, should have deemed her incapable of making rational decisions or something. Because frankly, to think you can take care of 14 kids, and actually give them all motherly attention, is crazy.

February 7, 2009 9:31 pm
christina on paragraph 11:

just as everyone is appalled at this woman’s endeavor to have the octoplets, i am also utterly shocked. I am just so confused as to why anyone in their right mind (<<maybe she is not in her right mind!) would choose to have eight babies on top six other children without the means to support them. Maybe the woman was indeed thinking the money would start pouring in if she had the octoplets instead of just choosing to stay content with her six children. After having made the impossible possible, this woman’s story will certainly open others’ eyes to in vitro and other such fertility treatments.

February 7, 2009 10:04 pm
Paul Nguyen on paragraph 11:

The idea to have 8 more kids is ridiculous. First of all, she already has 6 kids and taking on more as a single mother with no job and support system would bring into question the safety of the children. How would the children be fed with no money from a unemployed mother? She has blatantly misused medicine that is very helpful in many Americans today. Her decisions unfortunately will mostly affect her 14 children and not her.

February 7, 2009 10:40 pm
audria c on whole page :

I personally wouldn’t choose as Suleman did- not even think about more children after 6- but Jesse does have a point about it being her choice. However, it’s not just about the mother- there are 14 lives to consider. Yes, the thought of taking away a life is sad, but what about the life it would have to live: possible health concerns and sharing attention with 13 other squabbling siblings when that’s hard with even 2 children. She said she would drop anything to take care of her children, but what good what that do with no money to support the love?

February 7, 2009 11:51 pm
Gabrielle on paragraph 2:

I am suprised she was able to carry them for so long. The average gastion for twins is like 36 weeks or something like that. You would think that having eight babys over two, would caused the infants to be much more premature, just because of lack of space and the strain on the mother’s body.

Not only must have those conditions cause problems for the children, it much have been very draining on the mother. Women have problems with carrying a single child. Multipuls are noturious for causing health problems. I am shocked that she risked her own health let alone the health of her unborn children.

February 8, 2009 8:21 am
Santoshi Ramachandran on whole page :

Apparently there has been a lot of discussion on the news of her being lonely and that her loneliness is what caused her to try to get pregnant again. I agree with Kelly and most of the people here that Nadya Suleman is a little off. The fact that she put herself and the infants at risk just proves how incapable she is of taking care of the children. She has no job, she is living with her parents, and she already has 6 other children to take care of. There is very slim chance that she will be able to take care of all her children financially or emotionally. In her drive to be the mother of a plethora of children, she is going to end up causing all of them distress in some ways or another.

February 8, 2009 9:13 am
Santoshi Ramachandran on paragraph 5:

I agree with Kelly that the main reason the doctor would have probably asked Nadya to undergo a reduction is because he was concerned about the possible damages this pregnancy could do to the mother and her infants. There are just so many risks involved in multiple births for everyone that he would have asked her for the reduction to prevent multiple deaths.

February 8, 2009 9:22 am
Santoshi Ramachandran on paragraph 11:

It is completely crazy, irresponsible and sad. I feel so sorry for all her kids for having to put up with a mother who will disregard her health and the health of her children just to achieve her childhood dream of having a big family. I think all this commotion about the octuplets would have been different if Nadya had been capable of taking care of the children. Everyone is just scared of what will happen to the kids emotionally because financially they might be taken care of since Nadya has gotten everything from book offers to TV offers. I just hope that Nadya has a big enough family now to satisfy her.

February 8, 2009 9:33 am
Mayra Ramirez on whole page :

I am utterly perplexed as to why a mother, obviously understanding her current financial and household instability, would want to bring eight children into the world risking their lives as well as her own. If fame and fortune were behind Suleman’s motives, then she has no right whatsoever to want to teach others how to be proper mothers. The fact that a doctor, knowing the potential medical problems that could develop in the babies and the mother, could have possibly performed in vitro implanting eight embryos even under the limiting established guidelines is extremely unethical. Did he/she not understand that the mother was completely incapable of providing the physical and emotional needs to all 14 of the children? If he shares the same possible motives as Suleman’s, then he has no right to practice medicine. Where exactly are the parents in all of this? Couldn’t they have tried to stop their daughter from continuing this extremely irresponsible act? It seems to me that all parties were involved in this foolish behavior.

February 8, 2009 9:46 am

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