Octuplets' Birth Sparks Fertility Debate
Fertility Experts Question Medical Ethics of Transferring Embryos to California Mom
Guidelines for Embryo Transfers continued...
"There was a breach of ethical propriety here that was absolutely
staggering," he tells WebMD.
Perloe even questions the ethics of treating Suleman at all. "I would
not agree to treat a single mom on disability with six small children at home
SART and the American Society for Reproductive Medicine (ASRM) developed
embryo transfer guidelines several years ago in an effort to reduce the number
of high-order pregnancies, defined as triplets or more.
The guidelines make it clear that high-order pregnancies are an undesirable
consequence of infertility treatment because of the extreme risk to the mother
and her babies.
As a result of efforts to restrict the number of embryos transferred during
IVF, the rate of high-order multiple births has been declining in the U.S.
"I would hate for the public to get the sense that this story is
representative of fertility care," Surrey says. "It is a gross
aberration. High-order pregnancies are now relatively rare, precisely because
we have addressed this issue."
At Massachusetts General Hospital the standard practice is to transfer just
one embryo at a time in women who are considered to have good chances of
Mass General chief of reproductive medicine John Petrozza, MD, tells WebMD
that thanks to this practice the multiple pregnancy rate at the institution is
now among the lowest in the country.
"We want to minimize high-order pregnancies because of the very real
danger of premature delivery, low birth weight, and all the problems that go
along with them," he says.
Medical Concerns for Multiple Births
Medical problems associated with preterm high-order pregnancies can include
cerebral palsy, life-threatening respiratory problems, intestinal problems,
developmental delays, and learning disabilities.
Surrey says the likelihood of an adverse outcome due to low birth weight and
premature birth is seven times higher for twins that for single-gestation
babies and 14 times higher for triplets.
The eight California babies are all breathing on their own, which is a very
good sign, but they were a full 10 weeks early at the time of their birth and
weighed between 1.8 and 3.4 pounds.
Multiple-birth experts say it may be years before the extent of their
medical issues are known.
Maureen A. Doolan Boyle, who is the mother of triplets and the executive
director of the organization Mothers of Super Twins (MOST), tells WebMD that
the average gestational age for triplets is 33 to 34 weeks and the average
gestational age for quadruplets is 31 weeks.
A normal pregnancy lasts about 40 weeks. Babies born before 37 weeks are
She says even premature babies who appear to be quite healthy often have
long-term problems and developmental and learning challenges.
"Any baby born before 37 weeks should be followed for developmental
milestones up until they start school," she says.