We have had many questions from our patients about the recently publicized case of a California woman who gave birth to octuplets. While the details of how this higher order multiple pregnancy occurred are still unclear, it is known that she conceived using in vitro fertilization.
One of the biggest challenges in fertility care is balancing the desire for pregnancy with the risk of multiple gestation–twins, triplets, and beyond. Pregnancy rates are higher the more embryos we transfer, and some infertile couples feel that any number of babies is better than remaining childless. It’s our job to make sure they know that the risks of very aggressive treatment, and possible higher order multiples, are unacceptably high. The California woman managed to stay pregnant long enough to give birth to eight live babies, but more often these pregnancies result in premature babies too small to survive, or who survive with life-long, devastating health problems. The media tends to focus on happier cases; the tragic ones never make the papers.
The American Society for Reproductive Medicine (ASRM) publishes guidelines for the optimal number of embryos to transfer, based on patient age, embryo quality, and other criteria. Following these guidelines should result in acceptable rates of success (live birth) while keeping high risk multiple gestations to a minimum.
The California woman states that six embryos were placed in her uterus. Two of them divided, bringing the total number of babies to eight. Under ASRM guidelines, transfer of this many embryos in a young woman with proven fertility would be considered ill-advised. While we wish the best for those eight babies, and their six older siblings, this case will unfortunately create significant criticism toward reproductive medicine. Thankfully, the vast majority of infertility doctors do their utmost to avoid just this type of outcome.