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19 August 2009

One mom, 12 babies

The rise in multiple births - especially triplets, quadruplets, quintuplets and more - is largely the unintended result of fertility treatments.

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If you thought Nadya Suleman, also known as Octomom, rewrote the history books on multiple births, you're in for a surprise: a Tunisian woman is reputed to be close to full term with twelve babies, if the local Tunisian newspapers can be believed.

An outcry followed Suleman's January 2009 delivery of her eight babies. As a single, unemployed mother of six, it was deemed highly irresponsible of doctors to allow her further fertility treatments.

Already there are doubts about the Tunisian story. Questions are being asked about the physical possibility of carrying twelve babies to full term. But even if this turns out to be a hoax, multiple births as a result of fertility treatments are definitely on the rise.

Fertility treatments
These days, more and more couples are seeking support from multiple baby support groups. The rise in multiple births - especially triplets, quadruplets, quintuplets and more - is largely the unintended result of fertility treatments.M

They include drugs such as Clomid and Pergonal; in vitro fertilisation, when the sperm and egg are joined outside a woman's body and the resulting embryo (or embryos) are placed in the uterus; and gamete intrafallopian transfer (GIFT), in which the embryo is inserted into the fallopian tube.

More foetuses, more risks
Multiple births are riskier than single births. Babies, if they survive, often develop serious health problems because the births are almost always premature, says Dr James Lemons, chairman of the American Academy of Paediatrics' Committee on Foetus and Newborn.

According to the American National Centre for Health Statistics study, rates of low birth weight, very low birth weight and infant mortality were four to 33 times higher for twins, triplets and other multiples, compared with single births.

Among the problems: underdeveloped lungs that can lead to respiratory distress syndrome or chronic lung disease, and intercranial bleeding, which can lead to developmental disabilities like mental retardation. Premature babies are also more prone to neurological disorders and hearing and vision problems.

Even worse, twins are four times more likely to die in the first month of life, triplets 10 times more likely and quintuplets 30 times more likely, according to the National Centre for Health Statistics study.

Painful choices
Mothers-to-be, when they find out they are pregnant with "multiples," are also faced with what can be the wrenching decision of "selective reduction" - in effect, aborting one or more foetuses to make room for the others and reduce the risk of pregnancy complications.

"Many of these families have wanted nothing more than to become parents and have gone through painful experiences to become pregnant," says L. Bleyl, author of Exceptional Pregnancies. "Then all of a sudden, they have (a doctor) telling them if you go through with this you're going to have babies that are terribly damaged and it will ruin your life."

Even the apparent success stories can lead to heartache. Bobbi McCaughey, the Iowa woman who gave birth to septuplets in 1997, told Ladies Home Journal that three of her children suffer serious health problems.

While there have been major strides in the world of pre- and post-natal care since the study was done, experts doubt that even that could assist any woman to carry to full term and deliver twelve babies successfully.

Concerns about the rising rate of multiple births prompted the American Society of Reproductive Medicine to issue new clinical guidelines that recommend no more than two eggs produced by in-vitro fertilisation be implanted in healthy women under 35. But these remain mere guidelines.

The guidelines, which accompanied a huge study in the November 1999 issue of the Journal of the American Medical Association, suggest that limiting the number of implanted embryos will reduce the risk of multiple births without affecting the success rate of in-vitro fertilisation.

But older women, especially, might not agree to it, says Dr Jay Nemiro, a reproductive endocrinologist at the Arizona Centre for Fertility Studies. Less likely to become pregnant than younger women, women in their 30s and 40s often want more than two eggs implanted to better their chances.

In fact, women in their 30s and 40s using their own eggs, as opposed to eggs donated from a younger, more fertile woman, have very little to worry about - at least when it comes to multiple births, Nemiro says.

"They shouldn't be scared because they are at very, very low risk of multiples," Nemiro says. "At their age, I'm just happy when we achieve one pregnancy. Occasionally, they get twins, but almost never triplets or more."

(The Health24 team, updated August 2009)

Read more: Women pregnant with 12 babies

 
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