Monday, June 18, 2007

Enlightenment?

A commenter on a previous post asks questions. We've never had quints or sextuplets in our NICU, but I have talked to moms of quads who were offered the choice and opted not to reduce.

I, too, am an NICU RN. I don't understand, but I am open to listening, to those--docs, fertility specialists, OR parents--who think that having 6 babies at one time is a good idea.

The mom of the 30-weekers was in trouble after the birth because she had such a large increase in blood volume to support that pregnancy . . . The kids, even at 30 weeks, are still at risk for developmental delays, learning disabilities, and more.


What would entice someone to take such risks? Please enlighten me.


I don't believe that ANYONE thinks having 6 babies at once is a good idea. People want one baby, maybe two. They find that the less risky forms of intervention either don't work (clomid), are out of their price range (IVF), or violate religious precepts (IVF and/or IUI). They opt for one of the follicle stimulating drugs, perhaps with intrauterine insemination, and find that they are pregnant with way more babies than they'd planned for.

If they choose not to selectively reduce, they may lose all the babies -- or the babies may have multiple challenges as a result of prematurity. If they choose to selectively reduce, they may lose all the babies (miscarriage is one of the risks) or the babies may be born very premature as a complication of the selective reduction. Odds of carrying to term do increase with reduction, but there are no guarantees. Either choice is perilous and heart-wrenching.

There is also the religious objection to selective reduction. If you believe, as I do, that life begins at conception, then choosing to reduce may not be an option. I couldn't do it and neither could the moms of quads with whom I've spoken. Some people do make this choice, in spite of their religious beliefs, because they fear that all the babies will die if they do not.

The reason you hear so much about "miracle pregnancies" and "gifts from God" is that the people who decide to reduce almost always decide to maintain their privacy. I understand that choice - although if they were willing to share their experiences, anonymously or otherwise, it might help people to realize just how big a problem there is with the current state of infertility treatment. Women shouldn't have to make the sorts of choices presented by a higher order pregnancy.

Those who choose not to reduce for religious reasons cannot spend their days worrying. They have to hope that their babies will survive -- and possibly thrive. They must rely on their faith to get them through a very challenging experience.

If anyone would like to share their experiences anonymously, they can email me at tiggersdontjump at gmail dot com. Tell me how much or little you would like shared. I am willing to post a composite or actual experiences.

11 comments:

Cindy said...

Any responsible doctor who prescribes fertility drugs will monitor the patient's cycle to look for over stimulation of the ovaries. A responsible doctor will cancel a cycle if too many follicles are maturing to guard against higher order multiples (read the infertility blogs out there - cycles are canceled or converted to IVF all the time because too many eggs are maturing). I took infertility drugs under the supervision of my GYN five years ago and every cycle was monitored to protect my health and protect against higher order multiples.

These women ended up with too many fetuses because their initial care was mismanaged and because of their own religious issues. These cases are avoidable, and are an indication that more regulations are needed in the fertility field.

Judy said...

I know that there has been a great deal of speculation that the cases were mismanaged, but the reporting does not reflect that -- so it's speculation.

In fact, it is entirely possible to have no more than 3 mature follicles and to have one or more of the ova split (before or after fertilization) producing more than 3 babies. I don't think fertility docs are scrapping many cycles with 3 follicles. More than that -- they definitely should.

Cindy said...

Check out http://morrison6.com/ to read The Morrisons telling their own story which includes knowing at least 4 follicles (they ended up with ten follicles) could be released and they were told things looked great. My GYN had a 3 follicle cutoff, but I know other women whose docs have a 2 follicle cutoff.

Check out the Masche personnel blog for their story - http://www.maschemiracles.com. They took unnamed fertility drugs, but based on what they describe, had an IUI with no ultrasound monitoring of follicle production. They also state none of the babies were identical.

I stand by mismanaged for both of these cases.

Also check out this site http://canwemake3.blogspot.com for an interesting read about a women who did have two eggs implant through IVF and one egg divide into triplets (so rare!). She then had the triplets reduced, so is now caring a singleton. A very candid and brave woman for sharing her story.

Judy said...
This comment has been removed by the author.
Judy said...

I looked at the Masche's site. It doesn't sound like they saw a reproductive endocrinologist at all. I hope that's an oversimplification, but the doc who gave them the medications probably won't be talking.

I don't think I'd be willing to use such powerful drugs myself, but I know I would never use them without monitoring. I hope that's not what happened.

I read the Morrison's comments. They say that they were advised that there was a 25% chance of twins and a 3% chance of triplets. They were being seen at an infertility clinic. It makes me wonder who was doing the monitoring and how they managed to go from 4 follicles (only 2 mature) to 10 eggs released. I suppose that's one reason they call this a miracle.

BellaLinda said...

The McCaughey septuplets were born my senior year of high school; very influencing upon me. One of the main reasons I chose not to pursue infertility treatments for my PCOS was readings which indicated a high likelihood of multiples with the drugs that most often work for my condition. Religious beliefs prevent my ever opting for selective reduction--the very thought literally makes me ill--but luckily for everyone's sanity, religious beliefs also prevented me from accepting infertility treatments altogether. My three children--born one at a time--I have no doubt are blessings from God.

Anonymous said...

I came accross your blog when googling for updates on the the Morrison sextuplets, and found this one of the best written and well rounded discussions that I have seen.

I became pregnant with 5 sacs/four heartbeats from my first injectables cycle after 5 failed clomid cycles, many with IUI, and 2.5 years of heartbreaking infertility. There were only 4 follicles, and there was absolultely no discussion off cancelling the cycle, even though we had asked several times if we should consider it, and I was being treated by a board certified reproductive endocrinloglist with a well established infertility clinic, and the cycle was being paid for by my health insurance.

What leads to HOM is actually more complicated than people think...many people assume my babies were IVF babies, however, we would not have put back four. We choose IUI/injectables becuase we did not want to deal with the moral issues of freezing babies (embryos). However, there are clomid quintuplets out there, and many triplet pregnancies from with identicals from two embryo transferes in which one embryo twins. For the most part, the HOM pregnancies that are carried are NOT from particularly risky practices, but are simply bad outcomes that have had good outcomes over and over again.

When we started telling people that we were having quads, it was hard that so many people focused on helping us taking care of the babies, while glossing over how hard the pregnancy would be (we did not consider selective reduction). After seeing our babies heartbeats at 7 weeks and 8.5 weeks, only two had heartbeats at 10.5 weeks, which is actually more common than people realize. However, while many people feel that selective reduction is the answer (which is more risky than spontaneous reduction), your body still "knows" you were pregnant with more, and the placentas have formed, and that can still lead to complications. While they are not often shared, I have come across several stories where after a reduction of quads, the remaining twins are born before viability and often die. More visibility and the actual cost and outcomes of multiples from fertility treatments...carried, spontaneous reductions, and selectively reduced is definately needed.

While I was carrying the quads/quinds, my daughters nueral tube failed to form; I don't know if it was because of the crowded uterine conditions. We were lucky in that despite having no cevix left at 18.5 weeks, through wonderful prayers and excellent perinatalogists my babies were born at 36.5 weeks and my daughter was able to come home with us and died in my arms when she was three days old (anencephaly). My surviving son is almost 2 and brings joy to my life every day.

While I am grateful to have my son, I do struggle with the glorifications with which HOM pregnancies are portrayed, and lack of understanding in the medical community of the underlying causes of infertility (and really focus on doing treatments rather than trying to understand these problems) and the general population of the pain caused by infertility.

Have you ever considered addressing the issue of perinatal hospice in your blog? My babies condition is always terminal, so it was easy to make the decision to choose to hold her and love her rather than to treat her. I don't know what the answer is, and I am glad that I have not been faced with this decision, but it seems like people often feel that to be prolife means to use all medical technology possible while praying for a miracle.

Jane

Jane

Judy said...

Jane,
Thank you for your comments and especially for sharing your experiences. Thank you also for the suggestion to write about perinatal hospice. I think I will do that.

The MSILF said...

I sort of am suspicious of a lot of fertility clinics, that practices aren't always the most ethical, but here, the perinatologists and MFM and fertility people lobbied to have insurance required to pay for more IVF cycles in order to limit the number of embryos. As a spinoff of this, it is now either illegal or considered bad practice by RE societies to do more than 2 embryos transferred at once, unless there is a real reason and history of failure of such approaches.

They managed to convince people by showing that the cost of IVF was astronomically less than the cost of caring for severely impaired babies and children.

I'm not usually a fan of government and law being the channels for intervention, but when we are talking about something so emotional, in which people are desparate for a child, whose judgment can be clouded by emotion and failure to understand such severe consequences, and have limited financial resources for expensive procedures, an outside party probably does need to be the regulatory body.

Anonymous said...

It is really simple. If you really LOVE babies - then you shouldn't want to risk harming them by trying to bring sextuplets to term. Anyone who messes with fertility treatments - should be required to have selective reduction if more than two fetuses become viable. Not following such a procedure is tantamount to child abuse - and should be prosecuted accordingly.

Say all you want about how the babies are a blessing from god - and god will provide - and that you wouldn't want to do anything un-natural to the pregnancy. This is - of course - absurd. Fertility treatment itself is un-natural. Those who use it have given up the claim to following "nature's course."

Finally - no positive media attention should be given to successful sextuplet delivery. Such attention is just begging for trouble from idiots who think they can somehow pull off the same achievement.

Judy said...

Anonymous,
So you believe in forced termination of pregnancy? Without regard to the risks? That's hardly simple at all.

With selective reduction, there is risk - from the risk of loss of the entire pregnancy to the risk of death of the mother. You wouldn't allow women to weigh the risks and decide for themselves?

You'd suppress media coverage? So you don't believe in the first amendment either? Media coverage should be balanced - not biased to favor your point of view.

I hope you aren't a physician or a nurse. I hope you don't hold any elective office. I hope you don't teach children. I hope you don't edit any major publications. You're entitled to your opinions - but I disagree with nearly all of what you've written.