Multiple births add to risks for parents, babies

MINNEAPOLIS -- Three or four times a month, Dr. Judy Ney has to break some bad news to a couple desperate to have a child.

Not because they can't have a baby. Because they're having too many.

As a specialist in high-risk pregnancies at Abbott Northwestern Hospital in Minneapolis, Ney explains the hurdles they face -- and the grim choices they may have to make.

For infertile couples, the idea of having three or more babies at once may seem like winning the lottery. But to medical specialists, the surge in multiple pregnancies is one of the most alarming side effects of the boom in infertility medicine.

"The problem is that you're walking this line between getting pregnant and getting too pregnant," said Dr. Theodore Nagel, an infertility specialist at the University of Minnesota.

The risks were driven home last week when sextuplets were born in Minneapolis 18 weeks premature and in Arizona 10 weeks premature.

Since then, three of the babies born to the Minnesota couple have died and the others remain in critical condition. In Phoenix, 32-year-old Jenny Masche suffered heart failure after delivering three boys and three girls on June 11. She was recovering late last week.

It is one of the cruel ironies of modern medicine, experts say: With infertility treatment, even success can come at a heavy price. The treatments boost the chances of having "multiples," twins or more. And the more fetuses a woman carries, the greater the hazards -- including miscarriage, premature birth, disability and death.

It's not unusual for couples who have struggled to have a baby to suddenly face the gut-wrenching decision of whether to abort some of their fetuses to give others a better chance.

The number of "multiples" has mushroomed from about 1 percent to 3.3 percent of all births in the past two decades, largely as a result of fertility drugs and treatments. Most are twins, but triplets or more occur in two of every 1,000 births. Since 1981, that has contributed to a 30 percent increase in preterm births, costing a total of about $26 billion a year in medical care.

On average, twins are born at 35 weeks -- five weeks premature -- and quadruplets at 29 weeks, according to the March of Dimes. The sextuplets born last week in Minneapolis were at just 22 weeks, which experts say is the cusp of survival.

"We can do a lot of good things in the ICU [intensive care unit], but we are not the placenta," said Dr. Ted Thompson, a University of Minnesota specialist in preterm babies.

"Anything above three is going to be a disaster and should not be allowed to happen anymore," said Dr. Jacques Stassart, an infertility specialist. "And we have the tools to prevent that from happening."

Public-health agencies and national medical groups say doctors shouldn't even start treating infertile women without discussing "selective reduction" and the risks of multiple pregnancies.

"We start essentially with what type of risk the patient is willing to take," Stassart said. "Her willingness to consider selective reduction will determine the level of aggressiveness in treatment." His patients who say they won't abort an embryo won't get more than two implanted, he said.

But doctors can't control everything.

Molly Magnani, 45, struggled through six years of infertility and three miscarriages. So when her doctors told her she was about to ovulate six eggs, she thought the most she'd get would be twins -- if she was lucky.

After she found out she was pregnant she, her husband and their 8-year-old son went for her first ultrasound. There were four little heartbeats. "My 8-year-old started cheering. My husband turned white as a sheet. I lay there and thought, 'Oh, what are we embarking on here?' " she said.

Her doctor asked about reducing the number of embryos to three. Magnani said she couldn't do it. While eliminating one would lessen the health risks for her and the remaining embryos, it would increase the chance of miscarrying the rest.

"It wasn't so much the loss of the one," she said. "It was the loss, potentially, of all of them." She went into labor at 24 weeks and lost one baby at birth. Haley, Madison and Carver are now 5 ½ and ready for kindergarten.

Magnani knows she's lucky that her kids have had no long-term health repercussions. But she thinks parents need to know more about the risks and potential problems with multiple births.

"When they come out, you're thinking survival," she said. "Then it's 'Are they going to have cognitive function, are they going to walk?' "

Then there's the cost. By the time her three babies left the hospital two months after birth, their medical care had cost $1 million each, she said, which her insurance paid.

Ryan and Brianna Morrison, the parents of the sextuplets born in Minneapolis last week, said doctors encouraged them to reduce the number of fetuses months ago but that it was "not an option" for them.