Q: So then the best situation for women getting fertility treatments is to have one successful pregnancy?

 Dr. Chung: It’s never the goal of a physician to put a patient in the position of considering selective reduction. Singleton pregnancy [having one baby] is the best outcome.

Q: What are the risks associated with multiple-birth pregnancies?

Dr. Paulson: We work hard to avoid octuplets because it can be very dangerous. It’s dangerous for the mom and baby. The risks are relatively small for the mother if she’s in her 30s. Young and healthy people can usually adapt.

The bigger danger by far is to the babies: prematurity. The uterus is designed to carry one baby to term. Even with twins, there’s a much higher risk of premature delivery. It’s even more dangerous to try and carry more babies to viability. They are almost always born prematurely. Severe prematurity can lead to neonatal death or neurologic problems. Eight babies at one time is a bad idea.

Q: Why would someone with children seek out fertility treatment?

Dr. Paulson: We don’t know…I’m reluctant to pass judgment. There may be all kinds of extenuating circumstances. These are private, profoundly felt decisions.

Dr. Chung: Secondary infertility is where something changes, when you’re not able to be pregnant again. There are often very complex social issues involved. For example, a new male partner who has no children of his own might want to have children. We don’t know the social circumstances in this case.

Q: How much control do doctors have over preventing higher-order multiple births?

Dr. Chung: In IVF, you have complete control over the number of embryos that you put back into a woman’s uterus— the American Society for Reproductive Medicine has guidelines about this. If you do replace two embryos at a time instead of one embryo it will increase the odds of pregnancy. If it was IVF, and the doctor replaced eight embryos, then whatever doctor was treating in this case was practicing out of the bounds of care—professional, not legal, boundaries.

Q: Why do women opt for fertility treatments that increase their risk of multiple births?

Dr. Chung: Most women who are undergoing fertility treatment have been trying to get pregnant for over a year without success. The treatment is designed to increase their chances. Some patients welcome the idea of twins, but anything beyond twins the medical profession will advise against.