Pittsburgh Post-Gazette - Baby Boom Baby Bust - Conception technologies give rise to ethical concerns

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Conception technologies give rise to ethical concerns (Pt. 3)


	Timothy and Sonja Myers of Armstrong County use teen-age son Michael, center, and a daughter, who is not pictured, to help them care for the quadruplets they produced in January through in vitro fertilization. The babies are connected to monitors that check their breathing and heartbeats.

Nearly four months of holding, feeding, bathing and diapering Richard, Christopher, Alandra and Abraham Myers has convinced their parents their conception was cause for celebration, not consternation. It was different when Sonja and Timothy Myers first learned they were to have quadruplets.

"I thought our lives were over -- I didn't want to talk to anyone about it," said Sonja, 30, who had a tubal ligation after bearing two children in her first marriage.

She underwent surgery to undo the previous procedure after marrying Timothy, and wanting children with him. The surgery failed. The couple resorted to in vitro, performed by Dr. Miguel Marrero at St. Clair Memorial Hospital.

Marrero transferred four embryos, which wasn't unusual. Twins had resulted occasionally when he inserted four embryos through in vitro. More rarely, the patient would have triplets, but never quadruplets.

He'd always considered the chances of all four embryos surviving and implanting in the uterus to be too remote to even discuss with patients. That's no longer the case.

Still, "I haven't seen anyone with multiples seem sad about it," Marrero said, guessing most patients would prefer four children at once to none at all.

The McCaughey septuplets were born before the Myers quadruplets, and the children were all healthy in both cases. Doctors say such stories shouldn't disguise the fact that multiple births make the following more likely: medical complications and Caesarean sections for mothers; premature birth, low birth weight and developmental disabilities for infants.


Dr. Miguel Marrero, checking a monitor during retrieval of a patient's eggs for in vitro fertilization, created the infertility program at St. Clair Memorial Hospital in 1996 after leaving The Western Pennsylvania Hospital.

The septuplets "were a vibrant example of the fact that multiple pregnancy rates are too high and need to be lowered," said Dr. Robert Stillman, medical director of Shady Grove Fertility Centers in Washington, D.C.

"People were frightened out of their wits," Wakim said of his infertility patients' reaction to the septuplets' birth.

The McCaugheys did not use in vitro, only a fertility drug, Metrodin. Some women are so over-stimulated by such drugs, with an ultrasound confirming an unusually high number of follicles containing eggs ready to be released, that their doctors discourage them from trying to conceive that month so they won't have three or four or more children.

"For most people, twins or triplets are OK, but anything higher than that is unacceptable," Hall said.

Infertility specialists say the best chance of reducing multiple births is through new research intended to prolong monitoring of embryos in the laboratory.

Embryos are typically transferred into a woman on the third day after fertilization, with lab specialists making an educated guess about their ability to thrive in the womb. Researchers are trying to make it possible to study the embryos' cell growth in the lab for at least five days, which would provide a better assessment of the likelihood of pregnancy.

"Day five or six transfer will be much more common in the future," Stillman predicted. "It will lower the risk of multiple pregnancies, because we'll put back fewer embryos" with greater confidence that at least one of them will be successful.