The Baby Keeper

A Phoenix obstetrician uses controversial methods to help infertility patients and their babies survive high-risk multiple-birth pregnancies. But is he promising more than he can deliver?

By Mary Carmichael | Newsweek Web Exclusive

Jan 30, 2009 | Updated: 11:44 a.m. ET Jan 30, 2009

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There aren't many women who can understand what the mother of the octuplets, born in California this week, might be thinking right now. Cintya Diaz is one. In early 2008, after a series of fertility treatments, she went in for a 10-week ultrasound, thinking—based on four previous scans—that she was carrying a single fetus. The ultrasound technician said "the baby looked small," Diaz recalls. Then, the tech turned from the screen, surprised. "Cintya," she said, "I didn't know you were expecting four!" (Article continued below...)

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Six Babies? The Masche Sextuplets

Diaz, 29, hadn't known either—and suddenly, she was "scared to death." She had good reason to be. Her first pregnancy had been successful; she had a healthy 12-year-old daughter, Daisy. But her second ended in tragedy; she lost twins at 26 weeks. I wasn't able to carry two babies, she thought. What would make me think I should try to carry four? Diaz's obstetrician agreed. He said she would need to "selectively reduce" the fetuses, aborting some of them to give the others a better chance.

The risks were clear, yet the idea of abortion made Diaz uneasy. She had the name and number of a reduction specialist in hand when a friend, the mother of triplets, told her there was an alternative: Dr. John Elliott, the director of maternal-fetal medicine at Banner Good Samaritan Medical Center in nearby Phoenix, who specialized in large multiple pregnancies. She went in for a consultation and, four hours later, came out determined to carry all four fetuses to birth. "I don't trust a lot of doctors," she says. "But Dr. Elliott empowered me. I came out of that appointment like"—she raises her fist —"yes! I can do this."

Carrying multiples—or, as they're called when there are more than two babies, "supertwins"—is a risky proposition, healthwise, for both mother and children. It's also an increasingly common one. Fertility therapies such as IVF and treatment with Follistim, a drug that prods eggs to mature, have become more advanced, successful and widespread in the past two decades. As viewers of TLC's "Jon and Kate Plus 8" know, occasionally—particularly if infertility docs are not careful—the treatments cause many embryos to take hold in the womb instead of one. And that's where the wrenching decisions come in. (Follow the history of multiple births in our photo gallery.)

Although there are no comprehensive statistics that show how many women are accidentally impregnated with multiple viable embryos—no one collects data on women who abort in those circumstances—it's clear the number of women carrying multiples has been on the rise. The California octuplets are only the most extreme example (no set of eight has ever been conceived naturally).

Twenty years ago, there were 90,118 sets of twins born in the United States, 2,529 triplets, 229 quadruplets, and 40 sets of five or more babies. By 2005, according to CDC data, those figures had risen to 133,122 twins; 6,208 triplets; 418 quadruplets; and 68 sets of five or more. The numbers peaked in the late 1990s and early 2000s, but did not subside to anywhere near previous levels.

The increase in multiple births doesn't just reflect a jump in babies being conceived with the help of medical technology; it is also the result of efforts by some obstetricians to help women bring those high-risk multiple pregnancies to term despite the odds. Elliott is one of the most radical practitioners of what might be called "extreme obstetrics." Medically, Elliott's strategies seem to work: his patients carry their triplets, quads and quintuplets for longer than the national average. But some doctors criticize his methods as unproven or even dangerous, and they worry that docs like Elliott are inadvertently encouraging more women to try to carry supertwins—and to risk serious medical complications—simply by offering hope. On the other hand, pro-life advocates, among others, would certainly say that controversial doctors like John Elliott are saving lives.

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Posted By: tj48 @ 07/25/2009 11:42:48 PM

I don't agree with the entire process. Women are not biologically engineered to carry litters of fetuses to term. If implanted women are so averse to selective removal of fetuses, are they willing to accept the responsibility of the death of a child after birth, or the cost to the child and the family of the very real risk of having a profoundly impaired child? I smell hypocrisy.
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Posted By: cpritchet @ 03/17/2009 7:56:12 PM

I can only hope that in the future, the number of couples who decide on IVF will decrease. I think its popularity is primarily based on the fact that it's a relatively new procedure, and that we never hear about the heartbreaking ordeals that can come from it - you only read about the 'miracle births'. To me, it's shocking how many women (and their husbands) are willing to spend thousands of dollars and put their health, and the health of the children they are trying to conceive, at risk. We need to step back and take a good look at our lives, and appreciate the children we do have, the husbands who love us, and the friends and family that are by our side. Shouldn't we at least try to be happy with the hand God dealt us? I am not implying that that IVF should never be considered. I realize it's not a black and white issue, few things are in life. What's right for one person, may not be right for another. But, we owe it to ourselves, to make the best decisions we can, and I think IVF needs to be taken more seriously. Before you risk your life for something you think you want, take into consideration all the things that are good in your life that you could be gambling away. As for selective reduction, how can so many women be against it? They have already tampered with nature to get pregnant, and yet refuse to tamper with nature in order to ensure the health and safety of themselves and the child (or children) they wish to bring into the world. These mothers need to step up and take responsibility for their actions, and do what's in the best interest of their family. If you can't bear the thought of reduction, you probably shouldn't even consider IVF. It's time we stop glamorizing IVF, and see it for what it really is.
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Posted By: RMcD @ 03/04/2009 3:03:16 PM

I believe it is completely natural for a woman to want a child, and it must be heartbreaking to be infertile. That being said, there is no excuse for going forward with an IVF pregnancy of so many children, or for doing it again after already having more than one child. Considering the realities of our planet and the already massive overpopulation that exists, I believe that people should voluntarily choose to have only 2 children- the number that would replace the parents. Certainly if someone naturally gave birth to triplets, or had one child and then twins, that would be different, but we have all forgotten to think about the old saying, "just because you CAN do something, doesn't mean you SHOULD." There are millions of orphaned and unwanted children in the world, children who desperately need families, just as there are families that need children. It seems to me the epitome of narcissism to insist on children with your DNA when so many need your love. On the other hand, someone who cannot manage to love a child that does NOT have their DNA would be a pretty lousy adoptive parent. Nonetheless, given the expense and dangers of the multiples, adopting the British regulations where government medical insurance covers a certain number of IVF attempts but forbids transfer of more than one embryo at a time, seems like a good idea.