Thursday, February 5, 2009

Baby Love x 8

Eight? Really? Eight babies. In one uterus.

What's happening?!

We pride ourselves here at Knifestyles on being the "Science Thursday" of the celebrity world, exploring the medical misconceptions showcased in People magazine and the like.

But now a young, six-time mother presents the taxpayers of California and Kaiser Permanente with eight premies.

Twins are the up-to-the-minute fashion accessory in celebrity circles (Angelina Jolie, Julia Roberts, Jennifer Lopez, Ricky Martin, Lisa Marie Presley, Geena Davis, Marcia Cross, Nancy Grace, Dennis Quaid, P. Diddy, Melissa Etheridge, Diana Krall, Patrick Dempsey – oops, I've run out of room). Has this engendered a public right to likewise 'put in an order' for a multiple pregnancy?

Assisted reproductive technology (ART) has come a long way since Baby Louise who just turned 30 (our first test tube baby works at the post office now).

The case of Nadya Suleman aka Doud (33) does not just raise questions, it shouts them. The only thing we know for sure is that someone's not telling the whole truth.

Q: How did she procreate so many, so often?
High tech fertility à la mode requires a lot of expertise and equipment. This was not a do-it-yourself job. It's possible that a one-time pharmaceutical hyperstimulation of the ovaries (eg, 10 day course of injected pergonal, hMG, or FSH) may have provided enough to stock the freezer. Donor-dad has only one brief performance to make, usually in the clinic restroom with the magazine of his choice. Once stockpiled, these frozen embryos can be thawed sequentially and stored indefinitely.

Q: Doesn't the biological father get a say?
Well, no, if it's done through a reputable sperm bank. But several of the previous birth certificates list the Y chromosome as belonging to "David Soloman." It's a bit queasy knowing this name translates to "Doud Suleman" in Arabic.

Q: How did a single parent of six, attending school and living with her divorced mother, afford repeated IVF pregnancies?
In California it costs about $12,500 per cycle to attempt IVF, slightly lower in areas where insurance plans cover it. Five successful transfers in six years is staying pretty busy; each pregnancy is 40 weeks in gestation plus another few weeks in pharmaceutical preparation. I'm going to hazard a guess that her egg retrieval and first five transfers were covered under her insurance and were done by-the-book. She was probably on a first-name basis in the fertility clinic. She may even have sold eggs to help defray the copays.

Only this last time was different.

Q: Why eight?
Perhaps her parents' financial underwriting was at an end: "this is your last baby and I mean it!" If she hadn't met her goal, she may have reasoned (okay, too strong a word) she could get her way by using up all her remaining frozen embryos in one fell swoop. But– eight out of eight embryos all take in one transfer? It is statistically improbable.

Q: Why would a doctor go along this?
He or she wouldn't. It's unbelievably risky for mother, babies, and physicians. The serious and sometimes lethal complications of high-order multiples are enough of a medico-legal liability to dissuade any physician from transferring so many embryos, but there are also professional guidelines.

The American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) both call for no more than one or two embryos for a generally healthy woman under 35. Reproductive endocrinology is a small club and its members are aghast. "Anyone who transfers eight embryos should be arrested for malpractice" says bioethicist Dr. Arthur Caplan.

All of which leads me to suspect we'll find out that this last IVF was without physician involvement. Perhaps Suleman and a highly-trained technician pal made use of an employer's facility to thaw and transfer the remaining baker's dozen on their own time. I'm taking bets on it.

Q: But what about the Chukwu octuplets in Texas?
The only other live-birth octuplets in the US were delivered in 1998, the result poorly monitored fertility drug use, not IVF. The smallest died within a week and the other seven needed about $250,000 of NICU apiece just to get them healthy enough to go home.

Q: Who's going to pay for this?
Kaiser Permanente, the largest not-for-profit managed healthcare plan in the US, will likely pass along their costs to their 8.6 million members. The average price tag for just one cesearean birth is about $25,000 in California; this one took 46 doctors and nurses to deliver. NICU care is in the range of about $2,000/day/baby. The bill will be well over $2M.

Dr. Charles Sophy
, medical director of Los Angeles County Department of Children and Family Services, says studies estimate the providing the bare necessities to raise a child to adulthood is $2.5 million. Or roughly $35 million for 14. The cost of services for the babies with on-going health problems and disabilities, the ones short-changed in that crowded uterus, increases that amount exponentially.

A family living on $61,742 and owing creditors $984,426 as of a year ago, is unlikely to be able to meet even a fraction of these crushing expenses. The cost will most likely fall to the state of California.

Q: Can any of this possibly be in the best interests of the children?
A single parent with fourteen children under the age of eight, eight of whom are going to mature simultaneously, is quite outside the laws of human nature. I wish we could rewrite the ending of this fairytale.

Join us Thursday @ 10am to hear Anne flesh it all out with Kevyn Burger on-air. Can't make it? Use this link to find the FM107.1 audio archive of Knifestyles broadcasts by date (second hour). Step one: select the date shown on the blog posting; step two: click on Kevyn Burger; step three: click on second hour. Add your comments below.

1 comment:

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