Making Multiple Births Fun and Profitable

[Hat tip to Art Caplan for bringing this story to our attention] With all the recent attention given to Nadya Suleman and her brood of 14, comparisons have been made to the popular show on TLC, Jon & Kate Plus 8, which chronicles the life of the Gosselins raising a set of twins and sextuplets. Philly magazine examines the way that the Gosselins have found a way to make the family business quite a profitable one -- and the article asks the uncomfortable question "when do your kids stop being your kids and start becoming your meal ticket?":

"TODAY THE TWINS are eight and the sextuplets four, but Jon and Kate actually look younger than when the show began, more camera-friendly and polished. They’ve had their teeth whitened; Jon’s been working out and got a (free) hair transplant. The Gosselins have turned up on Oprah and Good Morning America, and inside the pages of In Touch Weekly and People. The show is TLC’s most popular series.

As a result, the family now goes on more free trips, and is treated to swag and catered to at every outing. Phils skipper Charlie Manuel let Jon and some of the kids run the bases after a game last season (they had box seats, and got an autographed bat from Shane Victorino); a zoo tour included getting to privately feed the giraffes. “They get the publicity of the trip, we get the trip,” Kate explains in one of the “Viewer FAQ” episodes. The kids model the latest tyke couture from Gymboree. They frolic with Wii Music, Play Doh’s Fuzzy Pumper Barber and Beauty Shop and Little Tikes Jump ’n Slide Bouncer as Jon gushes about why these are such great playthings and the camera zooms in on the logos. Nielsen ranks the series eighth out of 149 cable shows for product placement."

For the rest of the article, click here.

We’ll take only one baby please…

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?

Too many twins? Says who?

Today's NYT ran a piece that describes calls to reduce the number of multiple births resulting from in vitro fertilization efforts. Since the introduction of IVF in 1980, multiple births in the United States have increased by a whopping 70 percent--in no small part due to the fact that many prospective parents choose to implant multiple embryos in the hopes of increasing the odds of a successful pregnancy and birth. Several of us have blogged on other issues re multiples before, too... here, here, here, and here.

The article quotes a few experts who basically say that as the technology has improved, the need to implant "extra" embryos has diminished; but this raises the question of just what a successful IVF result looks like. Is one baby? More than one baby? All the babies the woman wants? And what about the health status of the infant(s)? If carrying multiple fetuses increases the health risk to mom and babies, but the woman wants to "maximize her investment" in the painful and expensive IVF cycle by shooting for triplets, can/should physicians try to dissuade her? On what basis?

It will be interesting to see how this plays out, particularly since fertility medicine is largely a consumer-driven affair. Infertility treatment generally isn't considered medically necessary by insurers and therefore isn't a covered benefit. People who pursue it are paying thousands of dollars--per cycle--out of pocket. Given all that, I wonder whether "the customer is always right" will be the governing rule.

Multiple births, multiple headaches?

About a quarter of women who undergo IVF give birth to more than one baby. How's this for unintended consequences?

According to a study published in this month's edition of the journal Fertility and Sterility, women face increased psychosocial risks with each increase in birth multiplicity (singleton, twin, triplet) resulting from assisted reproduction. Based on survey responses from 249 women, researchers concluded that, for each additional multiple-birth child, the odds of having difficulty meeting basic material needs more than tripled. The odds of lower quality of life--as well as the odds of increased social stigma--more than doubled. Each increase in multiplicity was also associated with increased risks of maternal depression.

Anybody want to make a bet about whether physicians will share this information with women who seek infertility treatment? And if not, have women really had the opportunity to make an informed decision?

The study was performed by researchers at Massachusetts General Hospital, Harvard Medical School, and the RAND Corporation. (Ellison MA et al. Psychosocial risks associated with multiple births resulting from assisted reproduction. Fertil Steril 2005;83(5):1422-1428.)