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| EIGHT IS ENOUGH? | |
 December 23, 1998 
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ELIZABETH FARNSWORTH: The story of eight babies born in Texas this first. All eight of the world's first known set of octuplets to be born alive are still in critical condition today at this Houston hospital. The parents have insisted on privacy and there are no pictures yet babies, but headlines have heralded the births. A girl was born vaginally December 8th, and she is now breathing on her own. The remaining seven were born by cesarean section Sunday. They are sedated and on ventilators. On Monday, the babies' pediatrician gave an update on their progress. They ranged weighted birth from 10.3 to 26 ounces. DR. PATTI SAVRICK, St. Luke's Episcopal Hospital: But at this gestation age you expect an 85 percent survival rate, and although that is a statistical number - and we don't want to apply it to this group and, you know, cut one or two out - it is a good number to go with. These babies are critically ill, and we do have a lot of hurdles to get over, and there's going to be some ups and downs in the critical course over the first week or two especially. ELIZABETH FARNSWORTH: The babies' mother, 27-year-old Nkem Chukwu was in stable condition after undergoing emergency surgery Tuesday to control bleeding. One of the doctors who assisted at the births to the pregnancy had been very difficult. DR. BRIAN KIRSHON, St. Luke's Episcopal Hospital: Mom is a remarkable woman; she would go to any lengths to prolong this pregnancy and to have gotten the outcome that she had. For the last two weeks essentially Mom has been upside down with her head lower than her feet, with total bed rest, willing to deprive herself of eating if that, in fact, would increase the amount of space available for the babies, willing to make tremendous sacrifices and to go to any lengths to prolong this pregnancy. ELIZABETH FARNSWORTH: According to the New York Times, hospital officials said the fertility drugs taken by Chukwu included one to stimulate ovulation and another to help maintain the pregnancy. Fertility drugs can lead to the production of multiple eggs in the ovaries and, thus, to multiple births. Late last year seven babies, the McCaughey septuplets were born in Iowa. All seven babies are thriving. Another set of septuplets will born in January this year to a Saudi Arabian couple. Those babies are also doing well. ELIZABETH FARNSWORTH: For more now, I'm joined by Dr. Joe Massey, an infertility specialist at Reproductive Biology Associates, an Atlanta-based infertility clinic, and Nancy Dubler, head of the program in bioethics at Montefiore Medical Center in New York. She is also professor of bioethics at the Albert Einstein College of Medicine. Thank you both for being with us. ELIZABETH FARNSWORTH: Dr. Massey, I know there's a lot we don't know because the couple has asked for privacy and their doctor has not really spoken at about what drugs were taken and that sort of thing, but in a case where fertility drugs are taken, what leads to the multiple births? Explain it in more detail. DR. JOE MASSEY, Reproductive Biology Associates: In using these fertility drugs, our objective is to produce an egg and a baby. But many times more than one egg is released, and in some cases more than one egg is fertilized, and implants, and miraculously in this case, if you look at it is a miracle, in fact, have implanted, and we have a very risky situation with these births. ELIZABETH FARNSWORTH: And, Dr. Massey, that's very very unusual, right? DR. JOE MASSEY: This, of course, is very unusual. The reason it's in the news is it's the first time this many babies have survived. Unfortunately, there are occasionally births that are more than triplets, let's say, some of which you don't hear about because they're less news worthy, but it does happen occasionally in this treatment. ELIZABETH FARNSWORTH: When you take the drugs, and there are more -- many eggs produced, does the doctor have a way of knowing that? DR. JOE MASSEY: We always know - in almost every case there is the potential for multiple birth. Whenever -- most of these women, you have to remember, really don't have a choice about taking the drug; they either take the drug, or they don't get pregnant. And if they take these drugs, we deal with multiple eggs in many cases, and the risk is almost always there. We really can't control it as precisely as we would like. ELIZABETH FARNSWORTH: And there is a procedure -- ultrasound -- which you can see how many eggs there are, right? DR. JOE MASSEY: We see how many eggs potentially are developing, but how many actually will be released is not always predictable. ELIZABETH FARNSWORTH: Okay. Professor Dubler, some use the word miracle to describe this and also the septuplets born last year. Would you use that word? NANCY DUBLER, Montefiore Medical Center: Well, I would use miracle, but I might use the adjective "troubling" in front of it. I think that it's always joyous when parents who want babies are able to have them - their own biological babies, and that the technology over the last years that has permitted that happened has been quite miraculous. On the other hand, I think there's some very troubling ethical dilemmas that lurk not so far below the surface. The first is that, indeed, in these multiple births, the interest of the parents in having biological children may in fact conflict with the interests of the babies in being born as healthy as they can be. And that conflict - ELIZABETH FARNSWORTH: How? Explain that more. NANCY DUBLER: Well, there are possibilities of, as I understand it, of doing selective termination if the parents feel that's appropriate for them and it's within their religious tradition. ELIZABETH FARNSWORTH: In other words, if they know there are more than one egg to get rid of some of them? NANCY DUBLER: Well, I gather that they can do that, but they can also, if there are huge numbers of eggs in one cycle, forego the possibility of becoming pregnant in that cycle to reduce their chance of having these multiple births, or to reduce the number of fetuses once they exist is also possibility. ELIZABETH FARNSWORTH: Okay. Before you go on, I want to talk about all these various issues, but let's stay on that just for a minute. Dr. Massey, would one option be - let's say that you have a patient and you see in the ultrasound that there are several eggs, and then you could say don't have intercourse, so that you don't get impregnated at this moment? DR. JOE MASSEY: Yes. There are extreme cases in which we know that the risks for a higher order multiple pregnancy, as we call it, is higher than average, and in those cases typically we count the number of follicles or eggs developing, and we tell the patient that her risk is extremely high, and we think that she should not complete the treatment that cycle. ELIZABETH FARNSWORTH: And let's just get one thing clear. It is very risky for a human to have many babies, right? DR. JOE MASSEY: Really, humans are only supposed to have one baby. Even twins are riskier than normal. ELIZABETH FARNSWORTH: Okay. And just go through a few of the risks for us. DR. JOE MASSEY: Well, prematurity is the big risk. Babies are born with organs that are immature -- primarily the lungs are immature, so that they don't get enough oxygen - but really every organ system is not working as well as it should when the babies are born 10 weeks early - the liver, the kidneys, and the brain is the risk for not getting enough oxygen. ELIZABETH FARNSWORTH: So, Professor Duber, that's what you are talking about, aren't you, when you say that this is so risky for the babies that the parents' right may conflict with the children's right? NANCY DUBLER: Indeed. ELIZABETH FARNSWORTH: Okay. Go ahead with the other issues you are concerned about. NANCY DUBLER: Well, the second issue really involves cost. It's very costly to care for these babies. And, of course, once they're born, under our present health care system, we have the obligation to do the very best that we can for them. But they're extremely expensive. And if one thinks - as I do - that the single greatest ethical dilemma in the American health-care system is the lack of universal access, the lack of access to care for some 43 million uninsured persons, this adds to the cost of the health-care system in ways that probably mean that those individuals will have a greater difficulty in connecting to the system, because hospitals have fixed and global budgets. And managed-care companies have negotiated very low rates. It's unlikely that the hospital will be reimbursed for the real care, the cost of these babies, and therefore it must take those funds from another area in which a socially responsible hospital might try to serve the uninsured. ELIZABETH FARNSWORTH: Dr. Massey, how expensive is it to go through the birth for these babies -- for six or five even -- and to take care of them in the hospital - for what -- three months? Will they be in the hospital three months? DR. JOE MASSEY: We've all read extremely high estimates - as high as $2 million estimated - for these babies - for their total care. We know that a set of triplets can cost $200 -- $200,000 for their total care. It's a very expensive proposition. Fortunately, this is uncommon. There are nurseries full of premature babies all over the country and all over the world, and there's only one set of eight babies in one hospital in the world. This is not the big problem with premature babies in the world. It's one that we need to be diligent about trying to reduce as much as we can, but this problem is not likely to go away completely. ELIZABETH FARNSWORTH: Dr. Massey, as a doctor who works on this, and who sees these babies, some of them quite sick, what do you think the key issue here is, and how would you want to see it dealt with? DR. JOE MASSEY: Well, one of the issues here that was touched on by Dr. Dubler is the question of reduction, which is an unpleasant concept and it's - the option -- once the patient conceives multiple pregnancies - to consider having the pregnancy reduced to - from say five were six or eight to twins is offered to the patients. Unfortunately, this is not something people want to face or to have to do, and it's a very unpleasant solution for very critical problem. There simply is not solution that will make this problem away completely. ELIZABETH FARNSWORTH: And, apparently in this case in Houston, the mother did not want to care rid of any of the -- DR. JOE MASSEY: Right. ELIZABETH FARNSWORTH: -- the fetuses -- even if it might save some of the other ones. DR. JOE MASSEY: Right. Some people think of it as unconscionable not to do a reduction because of the extraordinary risk each of the babies will bear after they're born under these circumstances. So it's really very debatable. ELIZABETH FARNSWORTH: Yes. Professor Dubler, in Germany, doctors are prohibited as of last year from implanting -- this is a different -- slightly different process - but when you do in vitro and implant the eggs back - or the embryos back into the woman -- doctors are prohibited from implanting more than three. Do you think there should be that sort of regulation in dealing with fertilization in this country? NANCY DUBLER: Well, I think it's a very useful goal, to have that sort of policy in mind, but I would hope in America that could arrive at the policy through a discussion in professional organizations, rather than through legislation or regulation. I'm quite wary these days of single-issue health legislation, which falls prey to that kind of single politics that we see in other areas of the country. I do think, though, that it would be responsible for the obstetrics discussion to conceive of that possibility and to help set a standard that would prevent pregnancies that, indeed, would imperil the very fetuses that the parents are trying to nurture. ELIZABETH FARNSWORTH: Dr. Massey, is any of this underway? DR. JOE MASSEY: Well, you couldn't have regulated this particular pregnancy away because those - the pregnancies can be regulated in terms of members of embryos being replaced are in vitro pregnancies. This was a natural pregnancy. It was conceived in her body, and we simply can't control how many eggs will be released and how many will be fertilized and how many will implant, absolutely. We never can control that. You can't legislate it away. ELIZABETH FARNSWORTH: Do you think there have been more multiple births lately? Do you expect may mourn a future? DR. JOE MASSEY: Well, what's happened here is the medical care has enabled some of these babies to survive, so it's gotten the world's attention. This problem has been out there for a long time, and in years past, until recently, only quintuplets really were able to survive. And now you're hearing the occasional case going beyond quintuplets and surviving. So it's very newsworthy. The problem has been there all along, but most of those pregnancies you didn't hear about because those pregnancies were lost. ELIZABETH FARNSWORTH: Well, thank you both very much for being with us. NANCY DUBLER: Thank you. |
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