Financial compulsions lead to patients asking for more Embryos

Birth rate of twins and triplets is set to increase as more Australian women undergoing in-vitro fertilization (IVF) insist doctors to implant multiple embryos to reduce the cost of fertility treatment.

Despite multiple births carrying a five-fold greater risk of death, premature delivery or other complications, clinic chiefs say more couples are taking the chance.

According to experts, cuts to health care rebate have pushed up patient costs by about $1500 for each IVF cycle, forcing many to delay or abandon attempts to conceive. There is more pressure from cash-strapped patients to implant multiple embryos to boost chances of pregnancy in one cycle, Sydney Morning Herald reported.

'They're saying, we understand that it's more dangerous but we can't afford to do another cycle so we'll have two embryos put back and we'll deal with the consequences. If our (premature) baby... has to have eight weeks in intensive care, well medicare pays for that,' said Gab Kovacs, international medical director at Monash IVF in Melbourne.

Medical director of Fertility First in Hurstville, Anne Clark, said while some patients asked for more than a single-embryo transfer, more opted out of having a second child through IVF.

IVF Australia medical director and Fertility Society president Peter Illingworth said the trend would affect the health system.

'There can be long-term health complications for twins born as a result of IVF,' he said.

'Ideally, we would like to put one embryo in at a time because of those risks but we are getting more pressure from patients to do two.'

In January, federal Health Minister Nicola Roxon capped Medicare safety net payments - which paid 80 percent of the gap between doctors' fees and the Medicare rebate - after a review found specialists were charging patients excessive fees.

According to government, patients would be no worse off if specialists charged $6000, the cost of a typical cycle. But doctors said the average cycle cost up to $7500, or higher if patients required extra treatment.

Sandra Dill, from infertility support group Access Australia, said it had been receiving 30 to 40 calls and e-mails a week since the changes, from patients complaining to be under increased financial stress.

Sextuplets

Selby quadruplets turn 5

Everyone in the seven-member Selby family gets to claim a day of the week. Having a "special day" means each girl -- quadruplets turning 5 today and 7-year-old big sister Brooke -- can pick breakfast, choose a movie and generally have a say in daily decisions. It's one way Brian and Bonnie Selby balance the competing needs in a family where "everything we do is five times over."

The river of laundry, diapers and formula unleashed by the quads after they were born six weeks premature on Aug. 25 in 2003 is a distant memory. Car seats and strollers also are gone, making it much simpler to get out.The biggest challenges now are tracking all the activities, from part-time preschool to ballet to swimming lessons, and tailoring parenting to the girls' evolving personalities.

"They're individuals," said Bonnie, 41. "They don't like to do the same things."

Sydney -- a tall brunette in contrast to her shorter, blond sisters -- is introverted and passionate. Amanda is a "sweet teddy bear" who loves to cuddle.

McKenna and Ryleigh looked enough alike that their parents finally decided on a DNA test to determine whether they're fraternal or identical. Turns out, they're identical.

Along with looks, the two share some personality traits. They're outgoing, strong-willed and free-spirited. But while Ryleigh is the princess, McKenna is more sporty.

The "quad squad" still shares a room, recently switching from toddler bed to bunk beds. To keep things fair, they switch every couple of months so each girl gets time in a coveted top spot.

The four girls also share a middle name -- Faith -- after Baby Faith, a fifth sister who died during the second trimester of Bonnie's pregnancy, the result of an exceptionally fruitful in-vitro fertilization.

Though multiple births are on the rise, quadruplets remain rare.

According to the federal Centers for Disease Control and Prevention there were 434 quadruplet births recorded in the United States in 2002, compared to 69 quintuplet births. There were 4 million U.S. births that year.

Mornings at the Selby house are a mad rush to get everyone fed and dressed and Brooke to nearby Superior Elementary, where she's in second grade. At night, even with "assembly line" showers, it takes an hour to get all the girls washed, dried, dressed in pajamas and hair detangled.

And, five years after their birth, the quads' baby books aren't done.

"I still haven't really started," Bonnie said. "The intentions are good, but the time isn't there."

Big sister Brooke is generally "gracious" about sharing her world with four younger sisters. To give her personal attention, she gets to go on "date nights" with dad, a 46-year-old corporate controller for a biotech firm.

Bonnie keeps their Rock Creek home ruthlessly organized.

A new mud room -- previously the laundry room -- keeps a multitude of shoes and coats out of the way. Plastic bins keep art supplies and toys contained. A drawer in the kitchen holds hair brushes and ties.

The basement was transformed into a fantasy playroom with the help of friends.

Walls are washed in pastel hues. A friend painted a tree on one wall, while Bonnie added hand-painted letters that spell out words like "dream" and "laugh." There's a "schoolroom," a homemade wood "stage" and a playhouse donated by a neighbor.

The Selbys said they've been blessed with both material donations and donated time.

A friend with older twin girls regularly leaves clothes on the doorstep. A stalwart volunteer from Rock Creek Church has continued her weekly visits since the girls were born, coming each Wednesday to make peanut butter sandwiches. Bonnie's mother, Minnie Byrd of Denver, remains their No. 1 helper.

The girls celebrated turning 5 with a weekend party at Chuck E. Cheese. They donned princess outfits, played games and indulged in the rare treat of soda.

Turning 5, McKenna said, is "to be older and do more fun stuff."

The family took their first real vacation, a weeklong trip to a ranch near Gunnison in June, since the quads were born. But their favorite activity of summer, hands-down, was a trip to Denver's Elitch Gardens amusement park. Coming in a close second was learning to ride two-wheel bikes and learning to swim.

Noted Ryleigh, "I'm learning to blow bubbles out my nose."

Asked what it's like to be a set of four, the girls are stumped. After all, they've never known another way.

Five years into living as a family of seven, their parents can't imagine a different reality, either.

"This is my life," Bonnie said. "You either fight it or learn to love it. I love it."

Septuplet joy for Egyptian couple

An Egyptian woman has given birth to seven babies in the northern city of Alexandria, doctors said. The mother, named as 27-year-old Ghazala Khamis, is said to be well and the septuplets - four boys and three girls - are reported to be stable. The babies are said to weigh between 1.45 and 2.8kg (3-6lb); the couple already have three girls.
They sought fertility treatment hoping to have a boy, and were said to be astonished at the multiple pregnancy. Since the introduction of in-vitro fertilisation (IVF) treatment 30 years ago, the number of multiple births has increased dramatically.
Health experts say septuplets are very rare, and it is even less common for all to survive. The seven were delivered by Caesarean section a month early, and all have been placed in incubators designed for premature babies. The woman's brother said that the Egyptian health minister had promised free milk and nappies for the babies for two years, to help the family cope.