But triplet, quadruplet, quintuplet, sextuplet, septuplet, and even octuplet births are possible, too. This hormonal disorder often causes infertility.
Kate began fertility treatments almost immediately after she and Jon got married. The pair conceived their twins, Cara and Madelyn, thanks to the help of an IUI procedure also called artifical insemination. Their daughters were born in October The fertility drugs Kate was taking caused multiple eggs to mature during her fertile time and that coupled with the sperm injection caused multiple eggs to ferti lize.
And evidently, couples do. According to the CDC, multiple births have increased greatly in the last 20 years, thanks to fertility drugs. In , 68 sets of quintuplets or more were born, compared with 13 in Arthur Caplan, director of the Center of Bioethics at the University of Pennsylvania, believes that ethically, doctors must do whatever they can to prevent multiple births.
But unlike in many European countries, where the number of embryos that can be implanted in women is kept to a maximum of three, the U. That makes it harder for doctors to resist parents who want as many embryos as possible implanted. Occasionally parents have moral objections against freezing embryos and not using all of them, leading them to argue that all of them should be implanted.
Once high numbers of embyos are implanted and become viable, patients often also have moral reasons not to cull or selectively reduce them.
In addition to more specific guidelines by professional medical organizations to inform parents of the risks of high-multiple births, Caplan says he'd like to see insurance cover more IVF treatments with a limit on the number of embryos that can be transferred. Paula Mahone, medical director of the Perinatal Services at Iowa Methodist Medical Center, who treated the McCaughey septuplets in , said that she doesn't think regulating the number of implanted embryos is the best way to prevent multiple births.
They told him they did not want multiples but would not selectively reduce, a procedure in which some fetuses are eliminated through injection of potassium chloride. The doctor proceeded with treatment, which consisted of injections of fertility drugs, or gonadotropins, combined with intrauterine insemination IUI , a form of artificial insemination in which the sperm is injected into the uterus.
Kate likely had IUI with her first treatment as well; her book does not make it clear. The bad thing is that it's notoriously hard to control how many eggs will be fertilized. When the Gosselins went for an ultrasound during the treatment, they saw three, possibly four mature follicles, the cyst-like structures that cradle a developing egg. The doctor, Kate writes, told them that they would be unlikely to end up with three or four babies -- an odd claim, if he made it -- but said that they could forgo the insemination and try again later.
They decided to go ahead. When the sonogram showed seven developing embryos one would later disappear , Kate writes, Jon dropped to his knees. The thing is, if they had gone straight to IVF, all of this would have been much less likely to happen.
They might well have gotten twins, but they would have been highly unlikely to get six. It's true that in the early days of IVF -- the s and '90s -- doctors often stuffed lots of IVF embryos into a woman's uterus, because little was known about how many might take. The result was plenty of multiple births. Largely because of IVF and fertility drug treatments, such births in this country have increased dramatically. In , only 1, triplets or higher-order multiples were born in the United States; in , that number rose to 7,, according to the National Center for Health Statistics.
Babies born as multiples are far more likely to be premature, the health risks to infants and mother are much greater, and the toll on parents of triplets or more -- "severe physical and psychological exhaustion" as one study put it -- is immense.
And sextuplets-plus-twins put strains of a whole new level of magnitude on parents. In recent years, the rate of triplets and higher births has fallen slightly in the United States, thanks to the efforts of IVF doctors to reduce the number of embryos transferred.
There are still outliers, such as the doctor who apparently transferred six embryos into "octomom" Nadya Suleman two of those must have twinned, or split but they really are, now, the exception. The American Society for Reproductive Medicine has developed voluntary guidelines saying that no more than two embryos should be transferred in the case of women under 35, and doctors should consider transferring only one. This is known as Single Embryo Transfer, and it's becoming increasingly common in European countries where IVF is often covered by national health insurance.
In this country, only a small number of states mandate insurance coverage of IVF, and at least one, Connecticut, sensibly limits the number of embryos that may be transferred.
IVF is better for the mother and better for the resulting child, and it is increasingly cost-effective.
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