Is Eight Enough? How About 14? Octuplets

This week's news regarding the lady (Suleman) with octuplets has started a lot of discussion, unfortunately I think it together with the economic stresses has stirred up a hornet's nest of prejudice passion. Suleman gave birth to octuplets after "successful" IVF treatment. She is a single mother with 6 other children, also conceived through IVF. Three of her older children (ages 2-7) have disabilities. It seems that the octuplets were conceived via frozen embryos from a previous IVF cycle. (Probably the ones where she had her first 6 children.)

First, at issue is not how many children a single mother should have. For some, one is too many; while others would like 10 or 12. There are two big issues here (but I will not discuss the second issue which is how much will all of this cost the public who will be paying for most of this and the associated problems?):

How could a physician who takes the Hippocratic Oath ("I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.") risk the mother's life and the potential children's lives and well-being by transfering 6 embryos into a woman that previously had little problem getting pregnant via IVF??

Steven Orry, president of the American Society for Reproductive Medicine has said, "Infants born as multiples are almost always premature and have higher rates of low birth weight, cerebral palsy, developmental delays, birth defects and death. Even twins, who usually survive, are hospitalized twice as long as singletons and have much higher medical costs over the first five years. Cost of multiple births can easily top $100,000."

Complications
The most important complications to the mother are pre-eclampsia, preterm labor
and delivery, and gestational diabetes. As the number of fetuses go up, thes risks of these complications soars. Other complications include cholestasis, dermatoses, excess weight gain,
anemia, hyperemesis gravidarum, exacerbation of pregnancy-associated gastrointestinal symptoms including reflux and constipation, chronic back pain, intermittent dyspnea, postpartum laxity of the abdominal wall, and umbilical hernias. (Source: ASRM Practice Committee Guidelines on Multiple Pregnancies).

Complications for the babies (according to the ASRM Practice Committee) include complications from pre-mature birth: "cerebral palsy, retinopathy of prematurity, and bronchopulmonary dysplasia as well as those of fetal growth restriction (polycythemia, hypoglycemia, necrotizing enterocolitis). It is unclear to what extent multiple gestations themselves affect neuro-behavioral development in the absence of these complications. Rearing of twins and high-order multiples may generate physical, emotional, and financial stresses, and the incidence of maternal depression and anxiety is increased in women raising multiples. At mid-childhood, prematurely born offspring from multiple gestations have lower IQ scores, and multiple birth children have an increase in behavioral problems compared with singletons."

Alternatives?
The potential outcome (a healthy child) was not worth the risks (including death of the mother and the babies). Was there an alternative? Sure! Thaw fewer embryos and transfer only 2 and then if the woman did not get pregnant, thaw another 2 and transfer.

The physician is lucky Suleman survived her pregnancy. Now she must wait to see what this will cost her children. How many will survive? How many will have life-altering consequences for the rest of their lives?

Hunter's "Friend"

Hunter has been hanging out with a friend that happens to be a girl named Janie (and no, she doesn't have a gun - yet). We like Janie. She is very kind, bubbly and active. We also like her family. Last night she came over to eat dinner, play with Legos and watch WallE. Here is a photo of her as she was dodging the camera.

Gina! Gina! Gina! Galaxy Traveler

Gina has expressed concern that I have very few photos of her on this blog, so this blog is dedicated to the beautiful image of my fantastic wife.
Here she is right before eating this tasty rock. This was a cold afternoon of camping up on the Mogollon (mogeyon) Rim. It was a windy night but we had a nice afternoon kayak.

Gina and I both enjoy kayaking. BUt Gina is by far the more skilled kayaker. Sure there are some that surf the wakes of oil tankers in the ocean. Gina is the real exploer though. She has invented a sport called shark wake kayaking. You just toss in a baby seal in front of your kayak in hopes that a large great white will explode from the ocean and make a wake big enough to play in. Here is Gina with the move that won her the World Shark Wake Play Boating Championship.

Yes Gina is an explorer. She has been to many places in her earlier career as a fight attendant. She keeps track of all of the states she has visited as well as each planet or satellite. Gina is more than a world traveler - she is a galaxy traveler.

Here is a photo from one of Gina's favorites trips to the moon where she stopped to relax for a while just as another flight of tourists arrived.

Of course she has photos when she visited Mercury and Jupiter. And who can forget that wonderful trip to the Planet X!

Gina has truly done it all! We love you Mrs. rock eating, shark flipping, moon romping woman!

And Thanks For All the Fish!

We had a great Thanksgiving with Colton and Hunter home, and Rachon, Jared and Max coming to visit for several days. We went to the zoo at night and watched all of the people marvel at how cute and happy Max was stumbling around the zoo. Gina and I took Rachon and Jared to a Coyotes hockey game, which was fun - especially since we won. Afterwards we ate Japanese food.

Thanksgiving day was huge. I made a mince meat and an apple pie, but the best menu item was Wayne's sausage stuffing. I could hae eaten all of it - in fact, I almost did. All of the young cousins had a blast playing together. Summer remembered that I used to jump with her on the trampoline so she got me jumping with her and about wore me out.

The next day, we went to the arboretum (plant zoo) outside of Superior, AZ. It was the most crowded I have ever seen it. Max had a blast running around and it was just a perfect day for a little hike. As a grandpa now, I think I figured out why grandparents like their grandkids so much. I think it's because it wasn't too long ago we remember their parents as teenagers and so the contrast to such a loving, humble, always happy, undemanding child is such a contrast to the typical teen.

Max Loves His GiGi

BUNDLE OF JOY?


Max just loves his GMa Gigi - except when he wants his Mom.

Munching Max

Summer 2008 - Lots of Traveling

This summer has been full of traveling. Between my extra job at the University of Kansas, obligations to professional groups and vacation, I feel like I have been doing nothing but traveling - and fixing our medical practice.

WORK
We have grown so large at work that we have been in need of a major overhaul. I have learned one important thing - I do not like being an owner and having to manage a small business that has grown into a large business. So as of a few weeks ago we have partnered with IntegraMed, a company that manages IVF practices nationwide. This should take a lot of the load off of me eventually, but the 6 months of negotiations have about wiped me out. Now I just have to get through all of the transitions. All in all, it will be good for us.

This is my last year on the SART Executive Board. It has been a big responsibility as SART is the member organization of 90% of IVF practices. I have had to work with helping to design new database entries for embryo quality, a controversial ethical guideline for PGD and a modification of our advertising policy for member clinics. I have also served on the web site committee and the quality control committee. I will be glad when November comes and I can step down. I intended to then relax with no more voluntary positions, but I was talked into being next year's President of the College of Reproductive Biology. I was promised it would be fairly easy with mainly putting together an embryology program for next year.

VACATIONS
Now to the family! We had a couple of great vacations. Most of us went to a time share in Sedona and spent time hiking and playing. Shane, Gina, Colton and Hunter were there for a few days. And Rachon, Max, Hayley and I were there for the whole time. Then one of Gina's friends, Carrie, came up from Barstow to spend a few days in Sedona with us. We had a blast with the highlights being a hike to Devil's Bridge, swimming at Slide Rock, and a hike into West Fork.

Later, we all went to Dad's time share at Snowbird. Shane, Hayley and I went first to a photography class at the Grand Canyon. Then we went fly fishing on the Colorado at Lee's Ferry. (Not to be confused with Lee's Fairy.) We had an awesome time with Dad and Ann. We spent time on the zip line there, the alpine slide and we saw lots of deer and even a moose and her baby. One of the highlights was going to the 24th of July Parade in SLC and seeing the Prophet. Colton, Shane and I also went to Temple Square one day.

We just returned yesterday from a quick 3 day trip (Gina and Kim) to Aaron Gardner's home to attend his daughter's wedding reception. It was great seeing all of the Gardner Family, the Smith Family (Aaron's wife), several old friends from BYU and Max, Jared, Rachon, Shane, Brett and Hayley. Why did I say Shane? Well, he has moved to Torrance and is living with Kelly while going to school. We have missed him so much, but we know that he wanted to just experience a different place and spend some more time with his mother.

HAYLEY TO PA
Another piece of news is that Hayley will be moving to Pennsylvania in a few weeks. She got a job as a nanny with a family in PA and she is very excited about the year or more she will spend there until she gets accepted into graduate school.

OTHER
Colton and Hunter have started school already with Hunter at Jr High and Colton at Mt View High. They are enjoying their new classes - so far. Gina begins her classes next week. She hopes to apply to the deaf interpreter's program next year. Oh yes, I almost forgot, Gina really did a lot of traveling while the boys were at their dad's in Idaho. She went to visit her sister in Montana, visit her best friend in Spokane and spent 1 week at a deaf immersion camp where she sould not speak!! (She made up for the week in the first day back.)

Gina and I also went to see White Star. It is a musical with the first part being Saturday's Warrior and the last part being what happened to the main character Jimmy Flinders. We loved it.

Scott and I went to Mom's grave site on the anniversary of her passing. We had a great time there with our wives - reminiscing about mother and then we went to one of her favorite places to eat, the old Rosa's.