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Dr Manny's Notes

Who's Responsible for Octuplets' Birth?

Do no harm.That's one of the oaths doctors have to take and should always practice under - but as more facts come out about this woman in California who just gave birth to octuplets, I'm beginning to wonder whether that oath was forgotten.

I'm still not clear as to how this mother ended up with eight children, but what we doknow, is that she had some sort of fertility treatments. This story leaves me with many questions.

First: Did she have a need for fertility treatments? Here's someone that already had six children under the age of eight. When you advise a woman to undergo fertility treatments, you have to take her previous obstetrical history into consideration, and whether any treatments are going to put her life or the life of the potential newborn(s) in danger.

Second: What kinds of fertility treatments are available? Well, for the most part, you either have in vitro fertilization (IVF) or ovarian stimulation. If it was indeed IVF, I don't know any physician in his or her right mind that would place eight embryos inside a woman's womb in 2009 - especially knowing all the potential risk that an octuplet pregnancy can bring on. In many countries around the world, IVF implantation is limited to one or two embryos.

With hyperstimulation on the other hand, physicians are able to recognize a situation where significant stimulation of follicles has occurred, and most likely, they will decide not proceed with the completion of the cycle due to the potential dangers associated with large multiple births.

In either case, ending up with eight fetuses is not something that is medically indicated, but rather an accident -or better yet - lack of proper medical care.

Now I know the challenges that physicians and their staffs face when dealing with infertility issues in patients that deeply desire to have a child. But choosing the right technique, and psychologically evaluating the person that you're about to treat, is part of that oath of doing no harm.

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