As she awaited the arrival of her eight children, Nkem Chukwu was determined.
Fed intravenously and placed in a near upside down position for three weeks to relieve pressure on her uterus and so avoid early birth as long as possible, she knew that each day she persevered the octuplets chances for survival increased.
Seven of the babies were delivered by Caesarean section on Dec. 20, about 10 weeks premature. The other baby had been born naturally on Dec. 8. When the last baby arrived on Dec. 20, the 27-year-old Houston woman captured the international spotlight as the mother of the first known set of living octuplets.
Weighing as much as 25.7 ounces to as little as 10.3 ounces, the babies fought for survival at Texas Children's Hospital. Within the first week, the tiniest baby, nicknamed Odera, had died from heart and lung failure. Her brothers and sisters are expected to remain in the hospital for at least two months. Chukwu was discharged on Dec. 20.
While many hailed the courage and faith of Chukwu, some medical ethicists have used the octuplets' birth to highlight the complexity of fertility drugs. After miscarrying triplets earlier in the year, Chukwu began using fertility drugs to stimulate her ovaries. Use of fertility drugs, such as Pergonal, can lead to “multiple pregnancies,” meaning more than one baby may develop in the uterus.
Immediately after the birth, Dr. Randle Corfman, director of the Midwest Center for Reproductive Health in Minneapolis, called the octuplet’ birth a “disaster” from an infertility standpoint. Others questioned whether the amount of money spent on caring for Chukwu during the pregnancy and the premature babies was justifiable. Although the Chukwus have health insurance, it is estimated that caring for the babies in the hospital for the next two months will cost at least $250,000 per child.
Secular medical ethicists aren't the only ones questioning the use of fertility drugs. Catholic bioethicists are also expressing concern regarding their misuse. While pointing out that there is nothing immoral or unethical about fertility drugs per se, they underscore the fact that hyperstimulation of a woman's ovaries can lead to increased risks for the woman and her babies.
“Human beings are meant to reproduce one at a time,” Msgr. William Smith of St. Joseph's Seminary in Dunwoodie, N.Y., told the Register. “One cannot be indifferent to the risks involved in administering fertility drugs.”
Msgr. Smith said the key to safe and effective use of the fertility drugs in aiding infertile couples rests in the monitoring of women once the drugs are administered.
Sister Renee Mirkes PhD, director of the Pope Paul VI Institute Center for NaProEthics (Natural Procreative Ethics), agrees that close monitoring of women using fertility drugs is the critical element. She said while there is no objection per se to the use of fertility drugs, the risks involved can be substantial.
“Fertility drugs in and of themselves are not immoral—it's the dosage at which they are given and how the woman is monitored after she's given these drugs,” said Sister Mirkes.
Sister Mirkes said responsible physicians should closely monitor women to determine how many eggs are produced and counsel couples about the option of delaying intercourse during that cycle to avoid the creation of multiple unborn children. While she acknowledges that it is impossible to predict exactly what will happen with the use of the drugs, the risk that women will conceive multiple children is always present—potentially putting the lives of the mother and her children at risk.
One particular concern of both Msgr. Smith and Sister Mirkes is the link between the use of fertility drugs and abortion. Referred to as “selective reduction” or “selective termination,” this procedure is sometimes recommended to mothers who conceive more than one child through the use of fertility drugs or in vitro fertilization.
Both Chukwu and Bobbie McCaughey, the Iowa mother who gave birth to septuplets in 1997, were offered the option of aborting some of the children, to increase the chances of survival for the remaining children. Both immediately refused, citing their religious convictions about the sanctity of human life.
In the wake of the octuplet’ births, some ethicists suggested doctors should become more aggressive in promoting “selective reduction” to parents who conceive multiple children. This suggestion was immediately criticized by Msgr. Smith.
“Physicians should be more aggressive in telling their patients the truth,” he said. “And the truth is that selective reduction is just a euphemism for abortion.”
Sister Mirkes said her uneasiness with the manner in which some physicians are administering fertility drugs stems partly from the acceptance of abortion as an option if more than one child is conceived. She fears that as more couples use fertility drugs more physicians may see selective reduction as a solution.
“Women will still be desperate enough to have children that they will go to physicians to hyperstimulate pregnancy, and the backup for many of these physicians will be selective termination,” she said.
This anti-life mentality in treating infertile couples stems from society's acceptance of abortion in general, she said.
“If going from one child to none, as in abortion, is acceptable, some will say, ‘What's wrong with going from three children to two?” said Sister Mirkes.
The acceptance of selective reduction is evidenced in the literature produced by fertility centers. For example, Pacific Fertility Medical Centers recommend abortion as an option on the center’ web site where it advertises its services to infertile couples.
The web site defines “selective pregnancy reduction” as a “procedure where a needle is passed under the ultrasound guidance directly into the sac of one or more of the pregnancies. A chemical solution is injected, and this results in the absorption of the particular gestation(s), reducing the total number proportionately.”
While Pacific Fertility Medical Centers claim they do not advocate abortion, they clearly support it as a viable option:
“We do, however, remain advocates of free choice in such issueas and when it comes to the circumstances where either the mother's life or the bab(ies) within the uterus are threatened through the continuation of a multiple gestation, we feel Selective Pregnancy Reduction to be a choice which can be vindicated on the basis that it will save the life or lives of the remaining fetus(es), enabling them to survive and grow to full viability.”
This support for the use of fertility drugs with the backup of abortion is cause for grave concern, according to Sister Mirkes: “This is a manifestation and a facet of the utilitarian way we look at life, reducing the person to an object or thing.”
In Donum Vitae, the document released by the Congregation for the Doctrine of the Faith in 1987, specific guidelines were issued concerning biomedical techniques involved in “assisted reproduction.” These teachings, reiterated in the Catechism of the Catholic Church, state: “Research aimed at reducing human sterility is to be encouraged, on condition that it is placed ‘at the service of the human person, of his inalienable rights, and his true and integral good according to the design and will of God’” (DV,introduction).
The difference between the use of fertility drugs and procedures such as in vitro fertilization (IVF) is the separation of the conjugal act of a husband and wife from procreation. In Donum Vitae, techniques which “dissociate the sexual act from the procreative act” are deemed “morally unacceptable” (DV II, 4). While actions such as IVF separate the sexual act from the procreative act, fertility drugs do not.
While the use of fertility drugs is not deemed immoral, Catholic bioethicists caution improper use of the drugs can lead to not only serious health risks for women and children, but also abortion.
“The use of fertility drugs can put mothers and babies at risk,” said Sister Mirkes. “Hopefully this [the octuplets case] will call the medical community back to the canons of good medicine.”
Greg Chesmore writes from Bloomington, Indiana.