Focus May Soon Shift To Real World

I can only imagine what Bobbi McCaughey thought of the nickname the hospital team adopted for her birthing: “Operation Snow White.” What were they humming as this 29-year-old lay on the operating table, nearly as many inches wide as she was tall? Mirror, mirror on the wall?

Of course the team was really thinking of the seven “dwarfs,” the premature septuplets that she delivered to national acclaim and wonderment in a holiday feast. Seven babies whose names will become the trivia test of the future: Kenneth, Alexis, Natalie, Kelsey, Brandon, Nathan and oh yes, Joel.

Still, “Operation Show White” said it all. Here we had a Disneyfied story, a reproductive fairy tale with its astonishing happy ending. An ending that was just a beginning.

It’s two weeks now since that heralded birth date. The 15 television trucks that hovered around Des Moines have been reduced to two. The seven babies are breathing on their own in a neonatal intensive care unit where they will remain until at least January.

A different phrase sticks in my mind today, one repeated by a chorus of fertility specialists and ethicists struggling to be both celebratory and cautionary: “They won the lottery.”

The McCaugheys have won - so far - against the longest odds in the whole fertility game. They are the only people to bring seven surviving and apparently healthy babies into the world. They won the lottery with all that implies about bounty and life-changing events. And all it implies about gambling.

“Is it indecent to ask hard questions about this case?” Thomas Murray, an ethicist at Case Western Reserve University, asks out loud. “What we are hoping for is that the children have a good childhood and the parents manage to survive physically and financially.”

We wish them, literally, good luck. But most parents who gamble with multiple births have very different results. So Murray and others must raise some hard questions about treatments that produce far too many of a good thing.

These are just some of the things it is “decent,” even imperative, to ask about multiple pregnancies:

If fertility drugs induce a woman to produce too many eggs in one cycle, wouldn’t it be wiser to wait for another cycle when, in Murray’s words, “the bus was not so full”?

If four or more conceptions do take place, is “selective reduction” more like an abortion or like separating Siamese twins so one can survive?

Who, if anyone, makes the standards, especially the ethical standards, for infertility treatment?

I remember other “players” in this lottery who also made the news. Last year, a British mother on welfare, pregnant with eight fetuses, made a deal with a tabloid. The paper would pay Mandy Allwood for her story, with the fee depending on how many babies survived. She lost them all.

A dozen years ago, a California couple, Patti and Sam Frustaci, gave birth to the first septuplets. That May they were on the cover of People magazine praising God. By October - after four babies died and three survived with multiple problems - they were in court blaming their doctor. Six years after winning $2.7 million, they had twins using the same fertility drug.

There are now hundreds of quadruplets, dozens of quintuplets born every year. But a woman pregnant with quintuplets has a 50 percent chance of losing them all. The babies themselves are 12 times as likely to die in infancy. The list of serious medical problems for many who survive is longer than the hospital bill. For many, there is no happy ending.

Infertility treatment, high-tech baby-making, is by and large an unregulated world in which patients are customers. Couples can buy unrelated gametes, pay for surrogate mothers, harvest sperm from the dead and eggs from young women. A couple who turn to medicine one month to get pregnant can say the next month that the pregnancy is in the hands of God.

At the very least we need a truly informed consent about the health risks to mother and children. We need standards and surer methods to prevent multiple pregnancies - more than triplets - created either with drugs or embryo implants. Especially for couples who cannot contemplate fetal reductions.

The McCaugheys have won the lottery. They have the support system, the public sympathy and maybe even the sense of humor to survive. When President Clinton told Bobbi McCaughey that she’d be a great manager, she countered in a most un-Snow White fashion, “that, or I’ll be in a straitjacket somewhere.”

But in this lottery, losing is not just a norm, it’s a human catastrophe. In this risky world of small people and high rollers, the focus must shift from Disneyworld to the very real world.

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