November 19, 1997
The birth of septuplets in Iowa has raised many questions regarding the use of fertility drugs. Phil Ponce reports.
PHIL PONCE: In six minutes' time seven babies were born at the Iowa Methodist Medical Center, and all are healthy.
SHARON SIMONS, VP, Iowa Methodist Medical Center: Today is an unprecedented day for many people; most of all for the McCaughey family, who is welcoming seven new babies into their family.
PHIL PONCE: Once the mystery of Mother Nature, these days the miracle of birth is sometimes manipulated and multiplied. Twins are no longer unusual; triplets are not the rarity they once were; and dozens of quadruplets are born each year. But the field narrows as the number of babies in on birth rises. To date, there are only 47 sets of quintuplets, five babies born at the same time, in the United States. Among those 47, the Guttensohn Boys. Last year, Eric and Amy Guttensohn gave birth to five sons: Parker, Hunter, Mason, Tanner, and Taylor.
AMY GUTTENSOHN: I mean, the fact that I have five children, apart from the fact that they're quintuplets, blows me away. And, you know, everything's just mind boggling, but, you know, you just take it a day at a time, and actually you take it an hour, a minute at a time. And otherwise you get overwhelmed.
PHIL PONCE: In 1993, the number that held the nation's attention was six. That year Keith and Beck Dilly of Indiana gave birth to the country's first surviving sextuplets, six babies born at once. But even the Dilly babies have company; the Haynor sextuplets. Last March, these six brothers and sisters celebrated their first birthday in Albany, New York. And that same month first-time parents Beverly and Rocco Boniello gave birth to the country's third set of sextuplets, four girls and two boys. The parents decided against a so-called "reduction," in which one or more of the fetuses would have been aborted to increase the survival odds for the others.
ROCCO BONIELLO: We had discussed reduction, but once we saw the heart beats on the ultrasound we couldn't turn back.
PHIL PONCE: Multiple births have quadrupled since the 1970's, with the development of fertility drugs and high technology intervention to help couples have children.
DR. GLADYS WHITE, Ethicist: In the United States today 1/3 of the twins, 3/4 of the triples, and virtually all of the quadruplets and above babies are born as a result of assisted reproductive technologies.
PHIL PONCE: Fertility drugs increase a woman's chances of multiple conception because they stimulate the release of more than one egg at a time. Other techniques include in vitro fertilization. A woman's egg is fertilized in a laboratory and transferred to the uterus to develop naturally. Usually two to four embryos are transferred in each cycle. Karen and Steve Puey wanted a second child and turned to in vitro fertilization. They conceived triplets. Like almost all multiples, they were born premature and underweight and are developmentally delayed.
STEVE PUEY: There has to be something there that could prevent--someone who wants a baby, they don't want sextuplets--they would like another baby. The science has to improve.
PHIL PONCE: Perhaps the most famous case of multiple births, though, was not an act of scientific intervention but of nature. Canada's Dionne quintuplets were born in 1934 and became the focus of international attention through much of their lives. The last set of septuplets--seven babies born at once in this country--was in 1985 to the Frustaci family in Orange, California. One was stillborn, three died within weeks of their birth, and the remaining three suffered medical and developmental problems. Today's babies were born to Bobbi and Kenny McCaughey, who already have one child. A team of more than 40 doctors assisted at the births. At a press conference late this afternoon doctors reported on the babies' condition.
DR. DAVID ALEXANDER, Iowa Methodist Medical Center: Six of the babies are now listed in serious condition and one baby, that's Joel, is now listed in critical condition. All of the babies are being assisted with mechanical ventilation at this time. And I will also add that Mrs. McCaughey, Bobbi, has been reunited with the rest of her family and is visiting with the children now in the neonatal intensive care unit of the Children's Hospital.
DR. PAULA MAHONE, Iowa Methodist Medical Center: From observing this on the first day we met Bobbi I would consider this a miracle and that all the babies are so well grown, so well developed, that this patient did not develop preeclampsia or toxemia; that she had no other medical condition, and it just strikes me as a miracle.
PHIL PONCE: For more on the septuplets and the questions they raise in medical minds we're joined by Dr. Marian Damewood, a reproductive endocrinologist at Greater Baltimore Medical Center. She serves on the board of the American Society for Reproductive Medicine; and Dr. Tia Powell, director of clinical ethics at Columbia Presbyterian Medical Center in New York. And, doctors, welcome both. Dr. Damewood, you just heard Mrs. McCaughey's doctor refer to today's birth as a miracle. Do you agree with that?
DR. MARIAN DAMEWOOD, American Society for Reproductive Medicine: Yes, I do agree. It is a miracle, Phil. Basically, as many of us in fertility specialities feel, it is pushing nature's envelope somewhat because women are really not made physiologically to have these large numbers of multiple births.
PHIL PONCE: And what will doctors be on the lookout for in the next couple of days as far as the condition of the babies?
DR. MARIAN DAMEWOOD: Many of the things that they'll be looking at will be respiratory to make sure that their lung function is favorable. They'll be looking at the circulatory system, and later on for developmental problems or neurologic issues.
PHIL PONCE: And again at this point and the latest information is that six of the babies are in serious condition, one is in critical. How risky is to have this many babies at once?
DR. MARIAN DAMEWOOD: Well, it is very risky. Fortunately, the patient appears to be very well managed and her pregnancy went uneventfully; however, it is very risky for the fetuses and the newborns at present with respect to breathing and neurologic development. And that's the concern that we have at this time.
PHIL PONCE: Dr. Powell, some of your concerns about the risks involved in multiple births like these.
DR. TIA POWELL, Columbia Presbyterian Medical Center: (New York) Well, there are a number of risks. I think I too would call this a miracle, but it makes me a little nervous that we use that kind of language. We get very excited about the birth, this wonderful birth of all these children. I wonder how many people will follow the story a year from now, ten years from now, as these children struggle on perhaps, potentially with some serious problems confronting them.
PHIL PONCE: Is that very common, for there to be some latent problems months or years after a multiple birth?
DR. TIA POWELL: Well, it may not even be so latent. All of these children start out with assisted ventilation, and I hope, as does everybody who is directly involved in their care, that they will go forward and thrive. But that will--that remains to be seen. They do have certainly a difficult road ahead of them now since six are in serious condition and then the seventh, of course, is in critical condition.
PHIL PONCE: Dr. Powell, are you concerned that other couples might see the experience--so far a fairly positive one in Iowa--are you concerned that other couples might see this experience and might be encouraged to, what, take a risk in also having this kind of a pregnancy?
DR. TIA POWELL: Yes. I hate to admit it, but I am concerned that people--people love children certainly. Having children has been an enormously important experience in my life. And I would hate to deny such a thing to somebody else who wants that, but I do think we also love technology. We are a very optimistic country, an optimistic people, and sometimes we are inclined not to weigh as heavily as perhaps we should the risks involved.
PHIL PONCE: Dr. Powell, in the normal scheme of things, how often do multiple births happen, and how can they be--how can they be manipulated, so to speak?
DR. MARIAN DAMEWOOD: I thought you were asking me. Well, multiple births do occur in about 3 to 5 percent of the population in general. The vast majority are twins and a small percentage are triplets; however, as we just saw on the news a few minutes earlier, the large number of multiple births--triplets, quadruplets, and quintuplets--are due to fertility technology.
PHIL PONCE: And to what extent can these technologies actually come up with a specific number? Do people have--is there that much control available right now in terms of the number of fertilized eggs say?
DR. MARIAN DAMEWOOD: Yes, we can control the number of fertilized eggs placed back in an in vitro fertilization patient, for example. Some countries actually have legislation regarding this, such as Great Britain, where only three embryos are allowed to be placed back into a patient to avoid these types of problems; however, the patient here in Iowa had fertility drug therapy without in vitro. There really wasn't as much control as to how many eggs were released in this lady.
PHIL PONCE: So in the case when somebody is getting fertility drugs, as was the case with Mrs .McCaughey, there is less control, and what is the advantage of fertility drugs over in vitro?
DR. MARIAN DAMEWOOD: Well, there is less control. That is a disadvantage. The advantage of fertility drugs over in vitro fertilization is that it's the step before in vitro fertilization in couples that have normal fallopian tubes, and it basically is less risky in general. There's no surgery involved, et cetera; however, the risk of multiples sometimes cannot be controlled. And that's what happened here.
PHIL PONCE: Dr. Powell--now I have it straight where you are--excuse me. Do you think couples get enough counseling in terms of the risks involved and the probability of having multiple births when they're going through either in vitro or fertility drugs?
DR, TIA POWELL: I think across the board counseling has certainly improved over the years, as has our ability to do more new and different things. But it is variable. And it's also very difficult to do. For one thing, doctors notoriously will often use very technical language, and the same is true sometimes of counselors. And for the second thing, people who come to an assisted reproduction specialist desperately want to have children, and they may--even with the best information and the best effort--really only hear what they want to hear. If the McCaugheys--I think the McCaugheys have very likely made a principled decision to continue on with all seven pregnancies, and so far, their luck is holding, which is really wonderful. I'm not sure that every one who is faced with such a large number of multiple births has all the information they need in this very emotional crisis to decide which is the best decision for them to live with and for their children to live with for many, many years.
PHIL PONCE: Dr. Powell, you alluded to the issue of selective termination. How tough of an issue is that for people to handle?
DR. TIA POWELL: Well, I can't imagine really anything tougher. Here are parents who have desperately wanted to have a child. Finally, after getting access to this wonderful new technology, they do get pregnant, only to find that they have--no matter how much you want to parent--probably too much of a good thing--and there is the option of terminating some of the pregnancies. That does increase the probability of survival for the other children, but it's a terrible choice. I think no matter how strongly pro-choice a parent is, it is a terrible thing to feel that you've had to select to allow some of your fetuses to survive at the expense of the loss of others. I can't imagine a worse decision that somebody would have to make.
PHIL PONCE: Dr. Damewood, you had a patient who recently had quintuplets. How did you address this issue of the possibility of selective termination, and what's the nature of that discussion between a doctor and a patient?
DR. MARIAN DAMEWOOD: Yes. As Dr. Powell alluded to, selective termination is a very difficult decision for most patients. And, for example, in the couple that had quintuplets they made it clear from the very beginning that even if they had a large number of multiple births that this would not be an option; therefore, in this particular case we selected a low dose of fertility drugs, but, indeed, this happened anyway, the multiple births of quintuplets. But there are couples that will elect to have selective termination. It's, again, a very difficult decision. It's traumatic to the mother, to the husband, and to the fetuses, and also can result in some complications in pregnancy as well, such as increased bleeding and abdominal pain.
PHIL PONCE: By the way, in the case of the patient you alluded to, how are the five babies doing?
DR. MARIAN DAMEWOOD: Well, everyone's very fortunate. The five children are beautiful children at two and a half years old and doing very, very well.
PHIL PONCE: Are there any medical guidelines that doctors or ethicists, Dr. Powell, can turn to and have a--form the basis of a discussion with patients regarding the number of babies they should attempt to have?
DR, TIA POWELL: Well, it's really not. As Dr. Damewood would suggest, and it's actually ver hard to control if you're using fertility drugs how many pregnancies will result. So it's really not something that you could legislate. I suppose we all wish that you could. But even though we have so many advances in technology there is still an amount of lack of control in getting pregnant by this way, and, indeed, in every aspect of raising children. It is different when you choose to impact eggs, when do in vitro fertilization, and there are other countries, as was noted before, that legislate that. Maybe we should do that. I think in any case the number tends to be dropping in this country without legislation. As our techniques get better, as we are more likely to be able to carry through a pregnancy, I think people are less inclined to implant five and six and seven embryos because most parents really do not want so many children all in one fell swoop.
PHIL PONCE: Dr. Damewood, how about the issue of guidelines?
DR. MARIAN DAMEWOOD: Yes. The American Society for Reproductive Medicine is currently working on guidelines for possibly limiting or suggesting the limitation on the number of embryos to three or four in certain circumstances, and that's being looked at right now in Birmingham, Alabama, where the headquarters is located. I think it's an important point for many in vitro specialists to note that we're not only setting a patient up for multiple births in certain circumstances but also a vast change in the quality of life of the parents, which they may not expect at the time of the positive pregnancy test. But when these fetuses are born, then the change begins.
PHIL PONCE: Dr. Powell, how about that, even in a situation where everybody's fine, all the babies are healthy, some quality of life issues that need to be addressed?