Octuplet birth raises questions

Initial reports about a California woman who delivered octuplets last month evoked wonderment over the fact that all seemed to be doing well. But as more details about the woman dribbled out, wonderment turned into disbelief for many. The Associated Press has reported that the mother is a single 33-year-old named Nadya Suleman who already had six children at home, and that all 14 of her children were conceived via in vitro fertilization, or IVF. The octuplets are now the longest-surviving bunch in U.S. history.

The six boys and two girls — whose names have not yet been released — were born weighing between 1 pound, 8 ounces and 3 pounds, 4 ounces.

Kaiser Permanente spokeswoman Socorro Serrano says the babies are all doing well.

The country's first set of octuplets was born to Nkem Chukwu of Texas on Dec. 20, 1998. A week later, the tiniest of the infants died of heart and lung failure. The baby, named Odera, weighed only 10.3 ounces at birth. The surviving seven siblings celebrated their 10th birthday in December.

How Nadya could afford expensive IVF, and why a doctor would transfer enough embryos to result in octuplets, a rare, extremely risky "high-order multiples" pregnancy, is unknown.

"We're certainly trying to find out who the treating physician was so that we can find out the circumstances of the conception," says Sean Tipton, a spokesman for the American Society of Reproductive Medicine.

The octuplets, believed to be only the second set ever born in the USA, have raised a number of questions for fertility specialists:

Q: Are there any laws against transferring more than a few embryos to a woman's uterus?

A: There is in the United Kingdom, which has a national health program, but not in the USA.

To reduce the number of multiple births resulting from IVF, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART), one of its member organizations, have drawn up guidelines suggesting limits based on a patient's age and other factors related to her chances of conceiving.

In general, the older women are, the less likely they are to conceive with embryos created with their own eggs. Under ASRM guidelines, only one or two embryos should be transferred to women under 35. The upper limit in women over age 40 is five.

SART could revoke a clinic's membership for blatantly ignoring its guidelines, Tipton says. "Being a member of SART is an important credential, because many insurance companies who pay for IVF will only pay for it at SART clinics," he says.

Q: What are the odds that every embryo will "take" and result in a baby?

A: Remote, says Terrence Lee, a reproductive endocrinologist in Brea, Calif., who writes a blog called Fertility File. "If you hear that a baseball player got eight hits last week, you usually don't think that he had only eight at-bats." Eight babies suggests many more embryos were transferred.

Q: Can't doctors just say no when patients ask that more than the recommended number of embryos be transferred, especially if they question a woman's ability to care for multiples?

A: Not really. The ASRM ethics committee addressed the question in 2004, when it said fertility programs can withhold services only if they have "well-substantiated judgments" that the patient won't be able to provide adequate child-rearing.

That bar is high, says Robert Stillman, a reproductive endocrinologist in Rockville, Md. Drug abuse, child abuse or psychotic behavior could be grounds to withhold treatment. "We're not in a position, nor should we be in a position, of deciding who's going to be good parents or how many children we want them to have," Stillman says.

Q: News reports have said Suleman didn't want to discard any of her frozen embryos. Did she have other options besides transferring them all at once?

A: "This is an avoidable consequence of fertility care," says Anne Lyerly, a Duke University obstetrician/gynecologist and bioethics researcher.

"If she couldn't bear to discard those embryos or to have them be in somebody else's family, they could have been transferred one at a time or two at a time." If that had been done, Lyerly says, Suleman might have decided to stop trying to have more children before using all of her embryos.

The Macho Men

Last photograph of my dog Lucky

Garfield Forever

The Ostrich Story

A man walks into a restaurant with a full-grown ostrich behind him..

The waitress asks them for their orders.

The man says, 'A hamburger, fries and a coke,' and turns to the ostrich, 'What's yours?'

'I'll have the same,' says the ostrich.

A short time later the waitress returns with the order 'That will be $9.40 please,' and the man reaches into his pocket and pulls out the exact change for payment.

The next day, the man and the ostrich come again and the man says, 'A
hamburger, fries and a coke.' The ostrich says, 'I'll have the same.'

Again the man reaches into his pocket and pays with exact change..

This becomes routine until the two enter again. 'The usual?' asks the waitress.

'No, this is Friday night, so I will have a steak, baked potato and a
salad,' says the man.

'Same,' says the ostrich.

Shortly the waitress brings the order and says, 'That will be $32.62.'

Once again the man pulls the exact change out of his pocket and places it on the table.

The waitress cannot hold back her curiosity any longer. 'Excuse me, sir. How do you manage to always come up with the exact change in your pocket every time?'

'Well,' says the man, 'several years ago I was cleaning the attic and found an old lamp. When I rubbed it, a Genie appeared and offered me two wishes.


My first wish was that if I ever had to pay for anything, I would just put my hand in my pocket and the right amount of money would always be there.'

'That's brilliant!' says the waitress. 'Most people would ask for a million dollars or something, but you'll always be as rich as you want for as long as you live!'
'That's right. Whether it's a gallon of milk or a Rolls Royce, the exact money is always there,' says the man.

The waitress asks, 'What's with the ostrich?'

The man sighs, pauses and answers, 'My second wish was for a tall chick with a big ass and long legs who agrees with everything I say.'

World's first pregnancy using IVF egg-screening technique

A British woman has become the first in the world to conceive using a new IVF technique that could more than double the success rate of pregnancies. The 41-year-old woman was treated after suffering two miscarriages and having 13 courses of IVF, none of which led to a baby.
The technique allows doctors to screen fresh eggs for abnormal chromosomes, which are a major cause of miscarriage. Many embryos that have damaged or missing chromosomes miscarry, but others go on to produce conditions such as Down's syndrome.
The woman, who was treated by doctors at the Care Fertility Group in Nottingham, is expected to give birth in the next two months. Fertility clinics have long sought a way to check eggs or embryos for major chromosome abnormalities. A healthy egg carries 46 chromosomes – 23 pairs – but before it can be fertilised it needs to ditch 23 of these, which it packages into a structure called a polar body. The new technique checks the chromosomes in the polar body.
Doctors at the clinic collected nine eggs from the woman after stimulating her ovaries with standard hormone-based drugs. Using the new screening technique, they found that only two had intact chromosomes and so were likely to implant and lead to a successful pregnancy. Both embryos were implanted into the woman and one went on to a pregnancy.
Simon Fishel, director of the Care Fertility Group, said the milestone demonstrated the "wonderful ingenuity of humankind". The screening process costs £1,950 on top of standard IVF treatment, which can £3,500.
"One of the main reasons why IVF doesn't work is chromosomal abnormality," said Fishel. "Full chromosome analysis offers huge hope to many couples who have a poor chance of conceiving, those who have had many failures, and for those who want to maximise their chance at each attempt. We now have the best tool for achieving this."
Up to half the eggs of younger women, and up to 75% in women over 39, have abnormal chromosomes.
The technique, called polar body array comparative genomic hybridisation, is the first that can check all of an egg's chromosomes to see if any are missing or duplicated.
The process uses a laser to make a small incision in the outer membrane of the egg, from which doctors can extract the polar body containing the 23 chromosomes that were expelled before fertilisation. The doctors then use a computer-driven screening process to check if all of the chromosomes are present.
"This screening method has the potential to improve birth rates, minimise the incidence of miscarriage and birth defects caused by chromosomal irregularity," Fishel said.
Fishel's clinic has agreement from the government's fertility watchdog, the Human Fertilisation and Embryology Authority, to offer the technology to any of their patients. Because the procedure is experimental, however, it will not yet be offered on the NHS.
The HFEA has ordered UK fertility clinics to take steps to reduce the number of twins and triplets born to IVF couples. In most cases, this will involve transferring only one embryo to the womb at a time. Doctors believe the new technique will allow them to select the most promising embryos, increasing the chances of a succesful pregnancy.
A previous trial conducted last year by the Care Fertility Group and an American team suggests the technology could double the number of embryos that implant in the womb, from 25% to 50%.
Fertility doctors at other clinics cautiously welcomed the development today. Stuart Lavery, a senior consultant gynaecologist at Hammersmith Hospital in London, said: "Although it is still at a very early stage, this technique may offer a new diagnostic and therapeutic hope to couples who suffer from repeated implantation failure in IVF."
"Previous methods of screening embryos to detect abnormality have not proven to be sufficiently effective in increasing live birth rates. We need further research in this area so questions of reliability, efficacy and safety can be fully answered."
Tony Rutherford, chair of the British Fertility Society, said: "It is absolutely essential that these new techniques are subject to further rigorous research, and should only be offered to patients within the context of a robustly designed clinical trial, carried out in suitably experienced centres."
Around 6,000 babies a year are born in the UK to otherwise infertile couples as a result of IVF. The technique was developed in the 1970s and the first test tube baby, Louise Brown, was born in 1978.

Have Another ‘Fertilitini’

Once upon a time, a woman's ovaries were her own private affair. Aspiring mothers struggling with fertility issues whispered to their doctors about their travails, took drugs to stimulate their follicles and crossed their fingers. Today, aging eggs and donor sperm are the topic of open conversation on blogs, on Oprah and in movies like "Baby Mama" (storyline: a 37-year-old businesswoman hires a surrogate after being told her chance of getting pregnant is just about nil). Even politicians are in the fertility limelight. Sarah Palin's baby, Trig, was born when she was 44. And the newly appointed New York senator, Kirsten Gillibrand, cast a vote in Congress the day before giving birth to son Henry at age 41 last May.

And yet, despite the outing of the female reproductive system, many young women still don't fully understand the facts about age as a risk factor for infertility. Their Ob-Gyns don't always tell them. And 40-plus Hollywood mothers (some of whom are presumably using donor eggs to get pregnant) and cases like Palin and Gillibrand reassure them. So this week, the American Fertility Association (AFA) is launching "Manicures & Martinis" at the Dashing Diva Nail Salon in Manhattan, the first in a series of one-hour conversations about reproductive health. The event, targeted at women in their 20s and 30s who want to have children someday but aren't ready now, features a leading fertility expert, who'll talk about the reality of the biological clock and other risk factors for infertility. Yes, there'll be martinis—an offering criticized by some health advocates as irresponsible— but there will also be an organic alcohol-free "fertilitini."

Corey Whelan, AFA's director of development, says this is the kind of program she wishes existed when she was trying to get pregnant in her 20s and 30s while suffering from polycystic ovary syndrome. "I wanted to create a program that was soft, that was light and that was non-threatening," says Whelan, now 53 and the mother of 13-year-old twins conceived through in-vitro fertilization (IVF). The goal is to inform women so they can explore their options at an earlier age, she says, and the message is "one of hope, not one of doom and gloom."

To get the word out, AFA is joining the world of social marketing, advertising the event on Web sites like Facebook.com and Meetup.com. Whelan's hope is that women who attend will spread the word to their friends in person and electronically—a girlfriend-to-girlfriend experience, as opposed to some dreaded medical information session that few young women would be inclined to sign up for. "We would not be able to bring this particular demographic into a lecture hall or symposium," she says. "They wouldn't be interested and it wouldn't work."

But will women show up? AFA's Manhattan event is fully booked, with 25 women signed up and more than 30 on a waiting list. The confirmed participants are all single and between the ages of 21 and 34. One woman registered her daughter, her niece and her daughter's best friend, says Whelan, who plans to offer similar events in other venues (cheese shops, billiard halls) across the country in 2009.

Talking to women about age and motherhood is always controversial. No matter how public the topic of reproduction has become, an individual woman's fertility and the choices she makes about when and how to have children remain highly personal. While many women and health-care providers believe that informing women about age as a risk factor is empowering, others say that harping on the topic smacks of paternalism and is unfair to women who are still in search of a partner.