Friday, June 22, 2007

Cooing coverage of sextuplets a disservice By Arthur Caplan
Why quintuplets, sextuplets and septuplets happen and what the real price is in the long run for megamultiple births are subjects that, while crucial for understanding the reproductive revolution and its benefits and costs, remain almost unexamined in newspaper, television and magazine accounts. And that is unfortunate, because these costs aren’t limited to just health and financial challenges faced by the family welcoming the new additions, but to society as well. ...

But the downside of megamultiples, in terms of risk to the fetuses or the moms, got little media play in the initial stories about the two sets of sextuplets.

When megamultiple pregnancies occur due to fertility treatments, it spells potential trouble for both the mother and the fetuses. Gestational diabetes, strokes and preeclampsia — a potentially lethal form of hard-to-control high blood pressure — are huge risks for moms having more than twins. And moms expecting triplets or more are almost guaranteed to have Caesarean sections.

The babies themselves are put at grave risk when there are more than two. Having megamultiples means the babies face less room to grow in the womb, prematurity and low birth weights. All of these translate into high risk for mental retardation, learning disabilities, cerebral palsy and vision and hearing loss for the babies. They are also 20 times more likely to die in the first month of their lives than singletons.

Infants born in big numbers also need to spend a lot of time in neonatal intensive care units to allow vital organs to develop, which means they require expensive, high quality medical care. Those costs are almost always borne by either insurance plans or state Medicaid funds, meaning you and I pay their bills. And obviously, if there are complications that affect the children as they grow, helping the kids — and the parents — with their health problems through special education, multiple surgeries and rehabilitative care can run into the millions of dollars. ...

Fertility clinics sometimes transplant more than three embryos at a time into women, knowing that megamultiples could result. But a clinic can look good in comparison to its competitors by saying it can succeed in delivering babies to infertile couples. So some, incredibly, continue the practice, understanding it may be at the cost of the mom and babies’ health.

Megamultiple births are not the miracles the media makes them out to be. In fact it could be argued that we should be doing more as a matter of public policy to discourage megamultiple births by getting infertility programs to do more to minimize the risk of creating them. But, given the kind of “check your critical senses at the door” media coverage that always seem to accompany these births, these are not ideas you are likely to be asked to consider in thinking about the realities about megamultiple births.

Art Caplan has been commenting on issues associated with the largely unregulated sphere of assisted reproduction for years, particularly criticizing the play of "market forces" as fertility clinics woo desperate potential customers with their manipulated statistics. While I have not pursued independent research in this subfield for some years, my impression is that Art is substantially correct. And no one knows the media bioethics story better than Art. :-)

1 comment:

Stacie said...

We have been discussing this at Since many of us have undergone ART of one sort or another to get our children we have a pretty decent grasp on the bioethics issues, and how the doctors in these sextuplet cases appear to have transgressed.