How in the world does a woman with six children get a fertility doctor to help her have more — eight more?
An ethical debate erupted Friday after it was learned that the Southern California woman who gave birth to octuplets this week had six children already.
Large multiple births "are presented on TV shows as a 'Brady Bunch' moment. They're not," fumed Arthur Caplan, bioethics chairman at the University of Pennsylvania and an msnbc.com contributor. He noted the serious and sometimes lethal complications and crushing medical costs that often come with high-multiple births.
But Dr. Jeffrey Steinberg, who has fertility clinics in Los Angeles, Las Vegas and New York, countered: "Who am I to say that six is the limit? There are people who like to have big families."
Kaiser Permanente announced the mega-delivery Monday, with delighted doctors saying they had initially expected seven babies and were surprised when the cesarean section yielded an eighth.
Multiple births this big are considered impossible without fertility treatment, but the doctors who delivered the babies would not say whether the 33-year-old woman had used fertility drugs or had embryos implanted in her womb.
However, the children's grandmother, Angela Suleman, was quoted as telling the Los Angeles Times that her daughter had embryos implanted last year, and never intended to give birth to eight, but "they all happened to take." Suleman said her daughter rejected an offer from doctors to abort some of the embryos.
More common among younger women is the use of fertility drugs that stimulate egg production; doctors are supposed to monitor budding eggs and stop the drugs if too many develop.
Some medical experts were disturbed to hear that the woman was offered fertility treatment, and troubled by the possibility that she was implanted with so many embryos.
Bracing for backlash
Dr. David Adamson, former president of the American Society of Reproductive Medicine, said he was bracing for some backlash against his specialty.
In 30 years of practice, "I have never provided fertility treatment to a woman with six children," or ever heard of a similar case, said Adamson, director of Fertility Physicians of Northern California.
Women seeking fertility treatment are routinely asked to give a detailed history of prior pregnancies and births, and "it's a very realistic question to ask about someone who has six children: How does this fit into the concept of requiring fertility treatment?" Adamson said.
The woman's fertility doctor has not been identified. The hospital has not released the mother's name, citing her desire for privacy. There was no immediate information on whether she is married or who the father of the babies is. Her six other children range in age from 2 to 7.
Records show that she held a psychiatric technician's license from 1997 to 2002. It was unclear whether she is now employed.
It was only the second time in U.S. history that eight babies survived more than a few hours after birth. The six boys and two girls were said to be in remarkably good condition but were expected to remain in the hospital for several more weeks.
The mother of the octuplets lives with her parents in a modest, single-story home on a quiet cul-de-sac in Whittier, a Los Angeles suburb of about 85,000. Children's bicycles, a pink car and a wagon were scattered in the yard and driveway.
On Thursday night, the children's grandfather came to the door and angrily told reporters to leave the property.
Court records show Angela Suleman filed for bankruptcy last March, but after she failed to make required payments and appear at a creditors' meeting, the case was dismissed. She reported liabilities of $981,371, mostly money owed on two houses she owns in Whittier.
'She is an awesome mom'
The births were a hot topic of conversation on the Internet, with many people incredulous that a woman with six children would try to have more — and that a doctor would help her do so. Some criticized the doctor and suggested that the mother would be overwhelmed trying to raise her brood and would end up relying on public support.
Jessica Zepeda, who identified herself as a friend of the mother, said the woman and family would have enough money to raise 14 children. "She is not on welfare," Zepeda said. "She is an awesome mom, and will be able to take care of her babies."
Several doctors said it is not their role to dictate family size.
"I am not a policeman for reproduction in the United States. My role is to educate patients," said Dr. James Grifo, professor of obstetrics and gynecology at the New York University School of Medicine.
But Caplan said not enough attention is paid to the well-being of the children in high-multiple births. Such babies are often premature and underdeveloped, and are almost always found to have some health problem.
Caplan said everyone has a stake in mega-multiple births because they cause insurance premiums to rise when hospitals cannot get reimbursed for the huge costs such babies incur, and because those with disabilities typically require social services.
"To say all you need is cash and the will to have more kids should not be a sufficient standard to access services," he said. "It is insufficient for adoption. It isn't sufficient to be a foster parent. Why would it be sufficient to run down to the fertility clinic to get embryos transplanted or super-ovulated?"
Well beyond our guidelines
A few years ago, Caplan and others did a survey of U.S. fertility clinics. They found few had policies for deciding whether to help a woman get pregnant. Most clinics said they had patients meet with financial coordinators, but only 18 percent had them see a social worker or psychologist.
With in vitro fertilization, doctors frequently implant more than one embryo to improve the odds that one will take. Mothers-to-be who are found to be pregnant with several babies are given the option of aborting some of them to increase the chances the others will survive.
The U.S. fertility industry has guidelines on how many embryos doctors can implant, with the number varying by age and other factors. The guidelines call for no more than one or two for a generally healthy woman under 35, and no more than three to five, depending on the embryos' maturity, for women over 40.
If eight embryos were implanted at once, that is "well beyond our guidelines," Dr. R. Dale McClure, president of the reproductive medicine society, said in a statement.
Clinics that clearly violate guidelines can be kicked out of another group, the Society for Assisted Reproductive Technology, which in turn affects whether insurance covers their services. But the guidelines do not have the force of law.