8 babies, and a lot more questions over such a risky pregnancy

Even as the birth of octuplets at Kaiser Permanente Bellflower Medical Center in Bellflower, Calif., drew attention around the country, questions arose Tuesday about whether the mother's doctors did enough to prevent such a risky pregnancy.

The chances that the eight babies born Monday were conceived naturally are infinitesimal, say infertility specialists and doctors in maternal-fetal medicine. Today's reproductive experts have the tools and the know-how to avoid such high-risk pregnancies — and often try desperately to do so.

"When we see something like this in the general fertility world, it gives us the heebie-jeebies," said Michael Tucker, a clinical embryologist in Atlanta and a leading researcher in infertility treatment. Tucker added that, "if a medical practitioner had anything to do with it, there's some degree of inappropriate medical therapy."

The parents of the octuplets have not been identified, and Kaiser officials say they have not been authorized to release information on how the babies were conceived.

Doctors reported Tuesday that the eight babies — six boys and two girls — are doing fine. The babies, delivered by cesarean section, ranged from 1 pound, 8 ounces, to 3 pounds, 4 ounces.

"The babies had a very good night," said Dr. Mandhir Gupta, a neonatologist at Kaiser Permanente Bellflower Medical Center. The babies are stable, and on Tuesday morning breathing tubes were removed from the two who had been receiving help breathing. They began feeding as well.

However, higher-order multiple births (defined as three or more babies born together) are dangerous for the babies and the mother. Infants born prematurely face the risk of breathing problems and brain injuries that may cause permanent disability. Problems in premature babies, including learning disabilities or cognitive delays, often are not apparent for years.

The American Society for Reproductive Medicine and American College of Obstetricians and Gynecologists says "doctors should be making efforts to curb these higher-order multiple gestations," said Dr. Geeta Swamy, an assistant professor of obstetrics and gynecology at Duke University. "But it really is still up to the individual physician. There aren't any laws or legal ramifications to it."

The babies could have been conceived through in-vitro fertilization (IVF), in which eggs and sperm are combined in the lab and a specified number of the healthiest-looking embryos are transferred to the uterus. That scenario seems unlikely because fertility doctors are asked to adhere to guidelines that limit the number of embryos transferred. As a result, higher-order multiple births resulting from IVF are uncommon.

A more likely scenario is that the mother received infertility drugs in controlled ovarian hyperstimulation. That treatment, typically used to achieve pregnancy in women who do not ovulate, stimulates the ovaries to produce a number of eggs. As the eggs near maturity, the patient usually has artificial insemination.

An oral drug, clomiphene, can be used to stimulate the release of one or two mature eggs. But more powerful, injectable medications may produce eight to 10 mature eggs, said Dr. David Diaz, medical director of West Coast Fertility Centers in Southern California.

Some patients with infertility problems try controlled ovarian hyperstimulation instead of IVF because it is far less expensive — about $2,000 to $3,000 instead of the $10,000 or more charged for IVF. Kaiser Permanente does not cover IVF for its members. Although the octuplets were born in a Kaiser hospital, it's not known whether the mother of the octuplets is a Kaiser member.

Infertility experts generally try to prevent multiple births not only because of the myriad potential health problems for mother and babies but because such births consume enormous financial resources for hospitals, health insurers and families.

Higher-order multiples are always born prematurely, often before 30 weeks gestation. Such babies are at risk of respiratory distress, infection and damage to their organs. Premature infants have a higher rate of death in the first month of life than babies born full-term. Later, these babies are at higher risk for developmental problems and cerebral palsy.