Minn. sextuplets spotlight tough decisions for hopeful parents

(AP) - After years of infertility treatments and three heartbreaking miscarriages, Molly Magnani stared nervously at the black and white monitor as an ultrasound wand moved over her belly. She saw one fetus. Then another. Then - wait - were there more?

You have four, her doctor said. Her 8-year-old son cheered. Her husband, David, turned white and was told to sit down.

"And I just was laying there thinking, 'What have I gotten myself into?'" Magnani recalled. "You're overjoyed and excited, but I remember being scared to death."

For infertile couples who have longed to fill their homes with children, the sudden prospect of twins, triplets or more can be thrilling at first.

But the risks of a multiple pregnancy means they may quickly face the agonizing decision of whether to abort some of the fetuses to give the others a better chance to live.

It's an issue highlighted this month by the births of separate sets of sextuplets in Minnesota and Arizona. Four of the six babies born to a St. Louis Park couple on June 10 have died, and the others are in critical condition.

In Arizona, the mother was treated for acute heart failure after giving birth.

"No sensible person takes this decision lightly. ... They were potential babies, and we had been trying so hard to have babies."

"I think that these instances give the whole question of fertility treatment a black eye because the results are so tragic, and the costs are so enormous," said Dr. Theodore Nagel, a reproductive endocrinologist at the University of Minnesota.

A high number of fetuses can be prevented if the treatments are done carefully, he said.

But in cases where there are too many fetuses, doctors will talk with families about aborting some to give others a better chance of survival. That procedure itself has some risk.

"The best thing in the world would be to avoid the situation of having to make that decision altogether," said Dr. Tracy Prosen, an assistant professor at the University of Minnesota who specializes in maternal fetal medicine and clinical genetics.

When fetuses are randomly removed, it's called multifetal reduction. More frequent is selective reduction, where couples pinpoint fetuses to be removed -- perhaps those with abnormalities.

In Minnesota, parents Ryan and Brianna Morrison tried for more than a year to conceive and turned to fertility drugs. Once they realized they had six fetuses, doctors encouraged them to consider removing some, according to the family's Web site.

"However, we knew right away that this is not an option for us," the couple wrote in an entry posted before the births. "We understand that the risk is high, but we also understand that these little ones are much more than six fetuses. Each one of them is a miracle given to us by God."

The Morrisons have declined interview requests, and a spokeswoman at Minneapolis Children's Hospital said they would not comment for this story.

Prematurity is the prime complication in multiple births. While just 7 percent of twins are born early, 92 percent of triplets are born prematurely, said Dr. Diane Ashton, deputy medical director of the March of Dimes. Quadruplets or higher-count births are always premature, she said.

Premature babies have less developed organs than full-term babies, and are more likely to face serious health problems, including cerebral palsy, mental retardation, chronic lung disease and vision and hearing loss.

The Morrison sextuplets were born after 22 weeks of gestation, just a little more than half the length of an ordinary pregnancy. The smallest was just 11 ounces, the largest only a little more than a pound.

That gestation period is right on the edge of viability. Babies born at 21 weeks usually do not live, Ashton said; at 23 weeks, viability jumps to about 70 percent.

Nagel, who is not involved in the Morrison case, said managing infertility treatments is important.

In vitro fertilization allows control of the number of eggs implanted in a woman's uterus. When patients use drugs to increase ovulation, the number of eggs a woman produces can't be controlled as precisely.

Skilled fertility doctors monitor egg production and advise couples against intercourse when it appears too many eggs have been produced. But sometimes, he said, fertility drugs are administered by obstetricians, gynecologists and internists without special training.

"Sometimes it is well done, and other times it is inappropriately done," he said.

But even when properly managed, multiple-fetus pregnancies do happen.

Dan Neil and his wife, Tina Larsen, of Los Angeles, had been trying to conceive for about three years and eventually turned to in vitro fertilization.

On the first try, two implanted embryos didn't take. The second time, they used three embryos and none worked. In the third cycle, they ended up with five embryos - none of which seemed particularly strong.

Still, their doctor said all five embryos wouldn't be implanted unless the couple agreed to a reduction if too many developed. They agreed -- and ended up with four fetuses.

"We are pro-choice people," said Neil, a columnist and automotive critic for the Los Angeles Times. "Yet no sensible person takes this decision lightly. ... They were potential babies, and we had been trying so hard to have babies."

Neil, who wrote a piece in May about his decision, said considering the risks and the difficulty Larsen was having with the pregnancy, eliminating two fetuses was a smart choice to give the other two a chance to survive.

"(Reduction) wasn't something that we would want ... but when you start to emotionally and politically marginalize obstetrical procedures, you create vast unintended consequences for fertility medicine," Neil said.

Larsen is in her 23rd week and the couple is looking forward to two baby girls, already named. Rosalind and Vivian are due in October, and Neil has their Halloween costumes picked out -- two little cherries on a stem.

For Magnani, of Eden Prairie, the decision was different. She was undergoing intrauterine insemination and her doctors told her during one cycle that she had a potential for six fetuses. She was asked if she wanted to proceed, considering the risk.

After so many miscarriages and years of trying, she thought the more eggs the better. When she found out she was having four, she and her husband decided they would choose selective reduction only if there was a genetic problem that would affect survival of the others.

Plus, she worried that the procedure could force her to miscarry all the fetuses - something Prosen said happens in about 5 percent of reductions.

"We had tried too hard, and come too far," Magnani said. "And I thought, you know, I couldn't do that. I couldn't deal with losing all of them," she said.

Magnani remembers her pregnancy as a fearful time - afraid she would do something wrong to miscarry, but also afraid that if she became emotionally attached she would lose them all.

In the 25th week, one of the fetuses began moving down the birth canal - a process that took about a week. Martin lived only 2½ hours, but Magnani believes he saved his brother and sisters, who were born a day later, at 25 weeks and two days.

Now, they're happy, healthy 5-year-olds.

"Everything's normal," Magnani said. "Whatever they encounter now, they probably would've anyway. So a little of the guilt starts to dissipate. You feel that you did your best for them."

(Copyright 2007 by The Associated Press. All Rights Reserved.)

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