Octuplets' birth raises bioethical questions

The birth of octuplets to a Southern California woman has raised several thorny ethical questions and trained a spotlight on the practice of reproductive medicine.

Six boys and two girls, delivered eight weeks prematurely last week, have become the world's longest surviving octuplets. All are still in a neonatal intensive care unit at a Kaiser Permanente Bellflower Medical Center near Los Angeles. A hospital spokeswoman said Tuesday all eight are doing well.

Yet the infants, who weigh between 1 pound 8 ounces, and 3 pounds 4 ounces, have stirred an ethical debate among practitioners and the public about family planning and test-tube fertilization. Questions about why Nadya Suleman, 33, chose reproductive technology "will be answered in due time," said her spokesman, Michael Furtney.

The American Society for Reproductive Medicine notes that guidelines underlie the use of reproductive technologies. And specialists in the field say they've worked for decades to refine the science behind in vitro fertilization and other assisted techniques.

"Would we ever implant eight embryos? The answer is no," said Dr. Avner Hershlag, of North Shore University Hospital's Center for Human Reproduction in Manhasset, N.Y.

The number of embryos implanted is based on a woman's age and fertility. The younger the patient, Hershlag said, especially those under 35, the fewer fertilized eggs are placed in the uterus. Hershlag said there can be a tug-of-war between doctors and patients over the number of embryos to be implanted. Some patients undergoing fertility therapy want more, especially if infertility has persisted for years.

Doctors argue for fewer, in part because there is a possibility a single egg could split into two after implantation, producing twins. Four splitting into eight would be highly unlikely.

Suleman's mother last week told reporters that doctors implanted far fewer than eight embryos, but they multiplied.

In Suleman's case, it was unclear whether she had IVF at all, added Hershlag. In some fertility treatments, drugs are used to stimulate the ovaries to release a profusion of eggs, "as opposed to the egg of the month," he said. When a multitude of eggs are present, anyone inseminated at that time increases the likelihood of so-called high-order multiples: quadruplets, or more.

Experts say doctors practicing reproductive medicine abide by written standards. "We have clinical practice guidelines that restrict the number of embryos that can be transferred in an IVF cycle. This is to avoid multiple births," said Sean Tipton, spokesman for the reproductive medicine society.

Dr. Shari Brasner, a specialist in Manhattan, said avoiding multiples helps prevent ongoing health problems. "The main goal is trying to prevent higher order multiples because prematurity is still one of the biggest issues we have in medicine. And the cost of a premature baby is incredible."

Furtney said there's no truth to reports Suleman openly sought cash, book contracts and free services. He declined to say why she chose to have so many babies _ she already has six children aged between 2 and 7. All were born via IVF and there is one set of twins. "She's really not yet at a point to discuss that level of detail. But I think within a reasonable amount of time, she will be," he said.


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