The septuplets born in November brought joy to Iowa, but doctors in Britain are not pleased by the news. Why? Because of fertility drugs, report Chris Mihill and Sarah Boseley
The seven little McCaugheys would not have known, but they were making good-news headlines across the world last month: the second-known set of septuplets ever born alive, and, if they live, the first to survive. Doctors at the Iowa Methodist Medical Centre in Des Moines, United States, talked of a miracle, and their father Kenny described “one of the most blessed events that I have ever encountered”.
The news was not, however, received with such unqualified enthusiasm on the other side of the Atlantic. In Britain, fertility specialists and even charities for the infertile were raising serious questions about whether such a multiple pregnancy should have been allowed to happen. Far from being a triumph of medicine, many professionals were seeing the treatment of Bobbi McCaughey, the mother, as almost a medical disaster.
The 29-year-old seamstress from the small town of Carlisle, Iowa, may have had her seven babies, but many experts fear for their long-term survival. But even if the babies do live, they may still be mentally and physically handicapped. Some small- weight premature babies, as were these, who survive to adulthood have their lives dogged by ill-health. And, in the shorter term, there is a strong risk of lung damage, infections, cerebral palsy, blindness, mental retardation and development problems with speech and co- ordination.
“It is a miracle this US couple have got healthy children out of it at 32 weeks, although there is still a high chance of something going wrong,” Peter Brinsden, the medical director at the British clinic where the first test-tube baby was born in 1978, said last week. “I hope the outcome is happy, but I have to say it is not good medicine.”
There are more multiple births now than there have ever been, for a simple reason: fertility drugs. Bobbi McCaughey had been taking Metrodin, one of the most widely used fertility drugs, although others such as clomiphene and Pergonal are also common. The drugs work by stimulating the follicles in the ovary to produce extra eggs. A woman can produce 10 or more eggs in a month, rather than just one.
The drugs are based on naturally occurring hormones produced by the pituitary gland to stimulate the ovaries. For many years these have been derived from the urine of menopausal women, who produce large amounts of the chemicals during this time because the ovaries are starting to fail and the body tries harder to stimulate them.
In many cases the urine is collected from nunneries; in recent years demand for the drugs has become so great that urine collection is a big industry in countries such as Spain, where tankers tour villages picking up specimen bottles and transporting them to processing factories. The newer drugs, however, are man-made versions, derived from DNA technology.
The drugs are used in three types of fertility treatment. They are given in low doses to women who naturally lack the hormones, and in higher doses to those attempting artificial insemination, to increase the chances of pregnancy.
The highest doses are used in women undergoing in vitro fertilisation (IVF). From up to 10 eggs in a monthly cycle, two or three embryos are implanted, and the rest frozen so that future attempts at pregnancy can use the embryos created at the same time. At the levels used for IVF, the drugs cost around 1 000 per treatment in Britain.
It would not be permitted to implant seven embryos in Britain. Legal controls set out by the Human Fertilisation and Embryology Authority say that no more than three – and preferably no more than two – embryos should be implanted, in order to reduce the chances of multiple pregnancies.
Despite this, the authority’s latest annual report, published earlier this month, warned of the growing number of multiple births arising from IVF, with a third of IVF treatments now resulting in multiple pregnancies.
Yet even in Britain there are no legal controls governing the use of fertility drugs, and babies born as a result are not recorded centrally, as they are for IVF. There have been 20 000 IVF births in Britain since 1978, when Patrick Steptoe and Robert Edwards pioneering work at Bourn Hall in Cambridge resulted in the birth of Louise Brown.
The current medical director at Bourn Hall, Peter Brinsden, said that although the septuplets had been delivered alive, the case raised worrying questions as most large multiple pregnancies end in tragedy.
“This is not so much a failure of medicine, because it achieved a pregnancy, but it is an unhappy outcome. The aim of fertility treatment should be to give couples one or two children at most. Treatment with fertility drugs needs to be monitored so carefully. The aim should be for a maximum of two babies.”
Once a multiple pregnancy had occurred some couples would refuse to contemplate selective reduction because of religious views, but the chances of a miscarriage before 30 weeks were extremely high, Brinsden said.
Tim Hedgley, chairman of Issue, the charity for people seeking fertility treatment, said it was important that patients listened to the advice of doctors, although doctors had no right to insist women underwent abortions if they experienced a multiple pregnancy.
“It is not good to carry seven babies. [Bobbi McCaughey] is very lucky to have got through it so far. We see a successful fertility treatment as a single live birth. Multiple births are fraught with difficulty.”
Yet with an estimated one-in-six couples facing fertility problems, more than two million people in Britain need medical help in achieving the family they long for. “Infertility is as common as cancer and it is as real a problem,” he said. “It can absolutely destroy people.”
Then there is the stress multiple births cause for the parents. A mother alone can cope with twins, but with more, assistance is essential. Some fathers end up giving up their job to help with caring for the children, which means the family has another adult on hand but must cope on state support.
For some, sponsorship has been one way out of the financial nightmare. Already Procter & Gamble has offered the McCaugheys free nappies for life. But with quads and even quins, the sponsorship possibilities are limited because there have been so many of them.
We have moved beyond the 1930s, when the Dionne quintuplets in Canada became a freak show. The five identical girls were taken away from their parents by the Ontario government and placed in a hospital. There was nothing wrong with them, but they were used as a happy story to relieve the misery of the Depression.
The best-known such family in Britain is probably the Walton sextuplets born in November 1983. The parents welcomed sponsorship deals and did well. Unfortunately for other sextuplets – the Colemans and the Vinces – the novelty has worn off.
Perhaps the McCaugheys of Iowa, starting life with their septuplets, are not facing the good news the world’s media would like.
— Research by Matt Keating