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Octuplets: how many is too many children at one time?

By TERRI LANGFORD

Associated Press

HOUSTON -- While doctors try to ensure the health of the world's first surviving set of octuplets, some in the medical community fear the remarkable births could threaten infertility programs.

"We look at this as a disaster as an infertility standpoint," said Dr. Randle Corfman, director of the Midwest Center for Reproductive Health in Robbinsdale, Minn.

Corfman worries that insurance companies may reconsider providing health coverage for women like Nkem Chukwu who undergo fertility treatment. And others question if the treatment justifies the health risks of underdeveloped multiple births.

By the time Chukwu's eight tiny children are well enough to be taken home, an estimated $2 million will have been spent on their care, about $250,000 a child, predicts Texas Children's Hospital's chief neonatologist Dr. Leonard Weisman.

Doctors said the infants could be in the hospital for up to two months, while their mother may be released within a week.

The six girls and two boys remained in critical but stable condition today at Texas Children's. The hospital's web site described the mother as "alert, happy and excited" and said the babies had an uneventful night.

Seven of the eight weighed between 1 pound and 1 pound 11 ounces at birth. Doctors say that in general, such babies have an 85 percent chance of survival with today's improved techniques for caring for small babies. The other baby weighed 11 ounces at birth, and her chances would be somewhat less. She is so small the hospital described her as "approximately the size of a Beanie Baby toy."

Chief among the worries with the Chukwu children was lung development. Baby A, the girl born Dec. 8, was delivered 15 weeks premature. Her two brothers and five sisters who followed Sunday morning were born 13 weeks early and all were placed on ventilators.

"It's alarming in the sense premature babies have problems," Weisman said Monday.

Dr. Brian Kirshon, who delivered the octuplets, said the woman and her husband, Iyke Chukwu, a respiratory therapist at a Houston hospital, rejected the idea of "selective reduction," a technique in which doctors abort some fetuses so the others have a better chance of survival.

"It was totally out of the question," to the deeply religious, Nigerian-born couple, Kirshon said.

The octuplets are covered by the family's insurance. But it's a matter of time, according to Corfman, before insurance companies re-examine how to cover infertility treatments when multiple births produce such sickly children.

"Our fear is that is exactly what will happen," he said. "They'll say we cannot cover this.

"When we use these medicines we have to be conscious of the fact that we cannot predict with certainty which eggs will take. When we start cranking up having the woman produce more than one egg, we run the risk of producing more than one baby."

And more babies in a womb designed to hold just one increases the likelihood the infants will have undersized lungs, brains and hearts.

Weisman said the advent of fertility treatments has forced the medical community to confront the ethical issues surrounding multiple births.

Should doctors, for example, be more aggressive about promoting selective reduction? And should multiple births, which are increasing annually, be viewed as successful notwithstanding the health risks?

"For certain families who are having trouble conceiving I think they are a success," Weisman said. "The problem, the side effect is you wind up with all these multiple pregnancies, multiple births which result in a lot of increase in health problems."

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