USC Fertility


Octuplets born in California: blessing or risky business?

It’s relatively rare that a fertility story makes international headlines. But when a still-unidentified woman gave birth to octuplets in Los Angeles on Monday, those eight babies’ cries were heard around the world.

This is only the second time in history that octuplets have survived more than a few hours, and so it’s no surprise that the media have taken notice. (The last set of octuplets were born 10 years ago in Houston, I remember it only too well.) As it turns out, I have somehow managed to make it into the rolodexes (do people still have these things?) of the several media outlets, and I spent most of the day talking to news organizations.

The Associated Press was first, I spoke to them last night, then twice more today, then theL.A. Times, “ABC Evening News with Charles Gibson”, NPR, KABC and Fox News, unless I have already forgotten someone. (You can even see my appearance on The Today Show… I pasted the video at the bottom of this post. I appear about 2 minutes in to the segment).

The mom of the six boys and two girls has as yet not revealed her identity, nor confirmed that fertility treatment was involved. However, it is probably not necessary, because chances are overwhelming that fertility medications played a major role. What follows is what I attempted to explain during all of these interviews. Most of what I said of course ended up on the cutting room floor, but I hope that the message came through:

It is interesting that most lay media assume that this was an IVF pregnancy. However, with IVF, the eggs are fertilized in the laboratory and then a controlled number of embryos is replaced in the mother-to-be’s uterus. If the patient says that selective reduction is not an option, for religious or philosophical reasons, then we don’t transfer more than 2 (or at most 3) embryos. So how could you end up with eight?

More than likely, this was a case of a patient whose ovaries did not produce eggs on their own. She then needed fertility medications to coax her ovaries into producing eggs, but probably did not need the rest of the IVF process to achieve pregnancy. This works very well for women who do not ovulate.

The downside? It is not possible to control 100% how many eggs are produced and subsequently released when she ovulates. Whether she had an insemination or conceived naturally, somehow eight eggs were released, all fertilized, and all implanted in her uterus, resulting in an octuplet pregnancy.

Eight babies all at once, this is a problem. The uterus is simply not designed to carry this many babies at once. At USC Fertility, she would have been counseled ahead of time. She would have been made to understand the danger of high order multiple gestation, and asked if she would consider selective reduction if this situation arose. If she said that this was not an option, we would steer her toward IVF, and the control over the number of embryos which are replaced at one time. If she indicated that she were willing to accept selective reduction, this procedure would have taken place during the first trimester, and she would have continued with a far less complicated twin pregnancy.

So what can we say about this case? We presume that in the case of these octuplet newborns, their mother was properly counseled by her doctors, that she initially agreed to selective reduction in the event of a high-multiple pregnancy, and that she simply changed her mind and decided to carry what was originally thought to be seven babies—the eighth was a surprise—after becoming pregnant.

If such had been the case at USC Fertility, we would have disagreed with our patient’s decision but would obviously have respected the mother-to-be’s wishes.

Life is not simple, and we know that the choices that all of us make about reproduction, when and how, and with whom and under what circumstances, are all deeply felt, and based on our life experiences, philosophy and culture. We respect these and are here to help our patients make the transition to parenthood in the best way we can.

So far, the eight babies seem to be doing well. This is a testament to the skills of the doctors of Kaiser Bellflower, and Dr. Karen Maples (the chief of OB/GYN at Kaiser, my classmate from UCLA Medical School, and friend from OB/GYN residency). Along with the rest of the world, we await with anticipation as more details surrounding these tiny brothers and sisters become known.

Stay tuned…

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