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Calif. Octuplets Raise Concern About Ethics, Fertility

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Calif. Octuplets Raise Concern About Ethics, Fertility

Health Care

Calif. Octuplets Raise Concern About Ethics, Fertility

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MICHEL MARTIN, host:

I'm Michel Martin, and this is Tell Me More from NPR News. Coming up, we present the latest in our series, Tell Me More About African-American History. That's in honor of Black History Month, and we'll have that in just a few minutes.

But first, they say it takes a village to raise a child, but maybe you just need a few moms in your corner. We visit with a diverse group of parents each week for their common sense and savvy parenting advice.

Today, we are going to talk about one mother who is dominating the headlines. She's been called the Octo-mom, Ubermom, and the poster child for everything wrong with our country's framework for assisted reproductive technology.

She's Nadya Suleman. She is 33. She gave birth to eight babies last month, making her now the mother of 14, all under the age of eight, all conceived through in vitro fertilization.

The medical questions are compelling in and of themselves, and there's a whole other layer to this. For her part, Suleman thinks she did nothing wrong, which she explained in her interview with NBC's Ann Curry. Here's a short clip.

(Soundbite of interview)

Ms. NADYA SULEMAN: I took a risk. It's a gamble. And a lot of couples do undergo this procedure, you know, and it's not as controversial because they are couples, so it's more acceptable to society.

MARTIN: We wanted to talk more about this, so we've invited A.B. Stoddard. She's an associate editor on The Hill newspaper in Washington D.C., and like me, she's a twin mom. Also joining us is Dr. Ervin Jones. He is a senior physician and scientific director with the Genetics and IVF Institute. He's a very experienced practitioner and researcher in the field of assisted reproductive technology. He's on the phone with us. Welcome to you both. Thanks so much for joining us.

Ms. ALEXANDRA BRANDON STODDARD (Associate Editor, The Hill Newspaper): Thanks.

Dr. ERVIN JONES (Physician; Scientific Director, Genetics and IVF Institute): Hi, Michel. Thank you for having me on your show.

MARTIN: And Alexandra, I want to start with you. Were you ready for twins? Did you know you were going to have twins, and were you ready for it?

Ms. STODDARD: I did, and I actually was very excited about it, but very concerned about my prenatal care and making sure that my pregnancy was healthy and successful and that I bed-rested enough at the end to take care and prevent premature labor, and I was lucky enough to do so.

MARTIN: Is there a big difference between a multi - now, you have both. You have both twins and you have...

Ms. STODDARD: Another...

MARTIN: A singleton, and was there a big difference? See, I only have the twins, so I have no idea what it's like to have one.

Ms. STODDARD: There was. I mean, I won't go into the physical, you know, details, but it was a different pregnancy and just more - it's much more high risk. You worry about the babies more and they - always the threat of them coming too early.

MARTIN: With the twins.

Ms. STODDARD: With the twins. Right. And then also, interestingly enough, you know, one of my twins was born much bigger than the other and is today 17 pounds and four-and-a-half inches different in size. And when you're carrying them, that's - the major concern is that they are both healthy - not just one, but both - and that they don't come early. When I was pregnant with one, obviously, underwent the same care. But it's just far less risky.

MARTIN: So, well, can I just even ask you, can you even imagine eight?

Ms. STODDARD: No, no, no. It's unthinkable, obviously.

MARTIN: So, Dr. Jones, let's go. For a lot of people it is unthinkable, and so many people wonder - now, I understand this woman has never been in your care, but a lot of people don't understand how one could ethically put a person in the situation of having the possibility of delivering eight babies.

Dr. JONES: It's a very unfortunate situation. Any multiple pregnancy carries increased risk over a singleton pregnancy, even twins. And the higher-order multiples are at tremendous risk for any number of problems. This is a very unfortunate situation. Fortunately, these infants seem to be doing well, but that clearly is not always the case and not the norm with high-order multiple pregnancies.

Ms. STODDARD: I want to ask another question, Dr. Jones. When you - are there any rules in place for when women are undergoing fertility treatments, about their actual health? I know you're not an obstetrician, but - and you're - it's a different step in the process. But if you see a woman, let's say, who doesn't seem to be in good physical shape. Maybe she has blood pressure issues or diabetes or something, is there any kind of discussion, any kind of limitation of how many embryos that woman should be implanting and whether or not that's going to put, ultimately, the babies at risk?

MARTIN: Well, can I - actually, can I just follow up on that? Is there any guideline at all about how many embryos should be implanted?

Dr. JONES: There are guidelines. There are guidelines that were put forth by our society, the American Society for Reproductive Medicine, that limits the number of embryos that should be transferred. Most of us try to follow those guidelines.

One can never predict how many embryos will implant when transferring multiple embryos. However, we know approximately where the risk line is. So, in general, most of us would not transfer more than four embryos under any circumstance. In the case of embryos that have progressed to a late stage, namely the blastocyst stage, which has a higher implantation potential, we will limit the transfer to two embryos, sometimes to one embryo.

That is a decision that has to be made by the physician, by the team and, of course, by the patient. So, to answer your question, yes, there are guidelines about how many embryos should be transferred in IVF.

MARTIN: Can the physician say no if the mother says - Suleman has spoken extensively to NBC's Ann Curry. They've been playing portions of the interview on "The Today Show," and we will hear from her tonight in a full hour on NBC. But she says that she wanted all eight embryos implanted. Could the doctor have said no, given - for any reason?

Dr. JONES: Yes, the doctor could have said no. The first thing that should happen is very careful counseling and explanation of risk in situations such as these, and try to reach a decision with the patient as to how many embryos should be transferred, based upon the knowledge that is available today and based upon calculated risk.

If all of that fails and the patient insists that six or eight embryos be transferred, the doctor always has the right to refuse to transfer that many embryos, and in fact, should refuse to transfer that many embryos.

MARTIN: If you're just joining us, you're listening to Tell Me More from NPR News. I'm speaking with twin mom and reporter A.B. Stoddard and Dr. Ervin Jones, a longtime practitioner and researcher in the field of assisted reproductive technology, about Nadya Suleman and her decision to carry octuplets. Alex, you had a question?

Ms. STODDARD: No, so I - that was - to follow up, if you have a mother Suleman on your hands, doctor, who's saying, I want, I came and I paid you good money, and these treatments have produced in excess of four embryos or two blastocysts, and I want what I want, I want what I'm paying for, you maintain that it is the doctor's right, legal right to say - to put that limit on. Do you think that oftentimes doctors don't want to tussle with these mothers and relent?

Dr. JONES: I think that is true. I believe that if I had been in the situation, the first thing that I would have tried to convince the patient to do is to transfer fewer embryos at one time.

I do not know the details of this case, yet. If those embryos were fresh embryos, there was the opportunity to cryopreserve those embryos and transfer two or three, with a view to transferring the others later, assuming that she would have a successful pregnancy.

In the case that the patient insisted that six embryos be transferred, yes, a physician can refuse to transfer that many embryos. Clearly, there have to be good explanations for that decision, and that decision had to be well-documented. But the physician does not have to transfer that many embryos and subject the patient to this kind of risk because, in fact, clearly the physician is putting himself or herself in a position of doing harm.

MARTIN: Now, are there any - are you worried, Doctor, that - this is a field that is relatively unfettered by regulation, it seems to me. Are you worried now, with all the scrutiny in this case, that there will be a great deal more regulation and outside involvement in your field?

Dr. JONES: Yes, I do have concerns about that, and that would really be unfortunate. Some regulation is good, but what I worry about is that there being strict regulations that would interfere with medical decisions and decisions that are made with patients that could be harmful, in fact.

MARTIN: Like what?

Dr. JONES: Not every - not every pregnancy, for example, not every transfer is a transfer that should carry only one to two embryos. In some cases, you may be dooming that couple to failure because of other factors that - say, poor prognosis.

MARTIN: You know...

Dr. JONES: For example, if the embryos are not progressing very well in the laboratory. If there has been multiple cycle failure in the past, we would like to have the opportunity to try and make the best judgment as to how many embryos should be transferred. That may be three embryos...

MARTIN: I see what you're...

Dr. JONES: Rather than one or two embryos. So, I think for there to be a restriction that says that you can only transfer one embryo would create tremendous problems for the profession, as well as for the patients.

MARTIN: Doctor, we're going to let you go now because we know you're in the middle of rounds, so we appreciate your taking the time to talk to us. Dr. Ervin Jones is a senior physician and scientific director with the Genetics and IVF Institute. He joined us from his office in Fairfax. Thanks so much.

Alexandra, I'm going to talk to you for a couple more minutes, and I - you know, when I thought about this mother, one of the things I thought about is just the basics, like getting out of the house in the event of an emergency. How is she going to get 14 babies, 14 kids out of the house in the event of a fire or something like that? And as a long-time experienced mom of multiples, what are your concerns?

Ms. STODDARD: Well, that is a really frightening thought, Michel, and obviously a good one, a reasonable one. The day-to-day care and feeding and loving of three babies - I mean, my last daughter came 22 months after the twins were born. We had three in diapers, three inadequately verbal, three in cribs, and three in high chairs. We had to call ahead to restaurants if we wanted to come out, even for the cheapest of family meals.

It was - I was afraid sometimes to be alone in a situation. If I went to a restaurant by myself with them or a grocery store, it was hard for me to even go to the bathroom. I mean, there are just logistical nightmares involved with it.

But also, what I learned so rapidly because I had three kids in 22 months, was just how much of you is required to give each one individual attention - whether there were eight born at once or three born in 22 months, how much love each child needs, how much focus and attention, individual one-on-one eye contact and time, and you can't give it when you're running a 14-kid feeding station for eight infants with cribs everywhere. It becomes like an assembly line.

MARTIN: It is interesting, though, it raises all these kinds of uncomfortable questions about who has a right to be involved and even have this conversation. Because as the doctor was saying, you know, would you want somebody to say, gee, you already have these twins, you...

Ms. STODDARD: Right.

MARTIN: Shouldn't have another one, you wouldn't...

Ms. STODDARD: No, I wouldn't...

MARTIN: On the other hand, one does have a sense, if you have that many kids, a lot of people have to be involved. And if a lot of people have to be involved, do they have a right to have something to say about your circumstances?

I remember the babysitter we had when my kids were newborns saying, gee, the next time you have twins, make sure you have family nearby. And I think, gee, I'll try to keep that in mind. But I don't know, I think this is - for some reason, this is a conversation we're going to be having for quite some time. It raises all kinds of important questions. So thanks for being here with us.

Ms. STODDARD: Thanks.

MARTIN: A.B. Stoddard is an associate editor at The Hill newspaper. She's also a mom of twins, and she was kind enough to join us in our studios in Washington. We were also joined earlier by Dr. Ervin Jones. He's a senior physician and scientific director with the Genetics and IVF Institute. He joined us from his office in Fairfax, Virginia. Thanks, Alex.

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