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Spokane, Washington  Est. May 19, 1883

Octuplets’ birth has doctors debating ethics

Chicago Tribune

CHICAGO – The 30-something patient knew what she wanted: seven frozen embryos transferred to her womb to maximize her chance of getting pregnant.

But her doctor, Dr. David Cohen of the University of Chicago Medical Center, told her he wasn’t comfortable doing that. “It’s too dangerous,” he recalls saying.

It wasn’t an easy conversation. The patient had tried several rounds of in vitro fertilization, unsuccessfully. She said she was running out of patience and money. And she promised she would “selectively reduce” some of the embryos – abort them in utero – if more than a few implanted successfully.

Cohen said he would discuss the matter with colleagues, but he knew his mind was already made up.

“The risks to the mom and to the babies are huge when you carry multiples,” he said. “My obligation is to do what’s best for the mother and the babies that might be born, not to satisfy a patient’s desire.”

Since a single California woman gave birth to octuplets late last month, people have been pondering the ethics of assisted reproduction. How far should a doctor go in helping a woman have a baby? When, if ever, is it appropriate for a doctor to say “I can’t help you”?

The mother of the eight babies, Nadya Suleman, already had six children ages 2 to 7. The eight premature infants are doing much better than expected in the California hospital where they’ll likely be for up to three months.

Fertility experts and bioethicists have expressed disapproval of the professionals who made it possible.

“A medical catastrophe,” fumed Dr. Norbert Gleicher, medical director of the Center for Human Reproduction, based in Chicago and New York. “Professional negligence,” charged Dr. John Lantos, chair of bioethics at the Center for Practical Bioethics in Kansas City, Mo.

“Something went very wrong in the care of this patient,” said Dr. Ralph Kazer, chief of reproductive endocrinology and infertility at Northwestern Memorial Hospital in Chicago.

What troubles the experts most are the health risks to the mother from a multiple pregnancy – pre-eclampsia, hypertension, gestational diabetes, seizures and more – as well as risks for the babies. “Every maternal risk that exists in pregnancy increases as the number of multiples rises,” Gleicher said.

Premature birth, which is virtually inevitable when a woman carries several babies, can have severe health consequences, including respiratory problems, developmental delays, gastrointestinal disorders and conditions such as cerebral palsy.

With a standard for physicians to “first do no harm,” it’s irresponsible to participate in a pregnancy that significantly enhances the chance of premature birth, Gleicher said. Suleman’s babies were born almost nine weeks early.

Of course, premature infants can be perfectly healthy, as can multiple babies born in a single pregnancy. But the risks of adverse outcomes are much higher.

For that reason, the fertility field has moved in recent years toward transferring as few embryos as possible in a single IVF attempt. Voluntary guidelines published in November by leading assisted reproduction organizations call for younger women such as Suleman, 33, to receive no more than two embryos during any single IVF cycle.

Several doctors said a red flag would go up if an unemployed woman with several young children, like Suleman, asked for IVF services. At the very least, they said, they’d seek an assessment from a psychologist. But physicians differ on whether it’s important to evaluate social circumstances and ability to care for an infant.

“We are not trying to intrude on the privacy of our patients, but we feel it is important to verify if a woman has thought this through and has the social supports and means to parent her child,” Gleicher said.

But Dr. Susan Ann Davies of North Shore Fertility said she wouldn’t go beyond asking about insurance coverage and a few other simple questions. “You have to respect someone’s right to reproduce,” she said.