I am astounded that our health care system seems to condone the circumstances that resulted in the birth of seven babies for that woman in Iowa. Although everything turned out O.K., it seems like her own health and the health of her children were at great risk. Aren't physicians like you concerned about the dangers of large multiple births? If so, what's being done about it?

Avoiding multiple births is one of the greatest challenges facing physicians providing infertility care. I am certainly concerned. The first step I take with my patients is to outline all choices for therapy. For patients with polycystic ovary syndrome (PCOS) we will discuss the use of insulin lowering drugs, a newer experimental protocol for ovulation induction that limits the risk of multiple births and reduces cost. As is the case with all fertility therapy, informed consent is mandatory. Couples need to fully understand the risks of multiple births with each therapy before proceeding.

Many new treatment protocals call for the use of lower doses of fertility drugsùan important step toward reducing the risk for multiples. There are also ways, during therapy, to reduce risk. If monitoring with transvaginal ultrasound shows an increased risk for a multiple birth, a couple may choose to simply cancel the treatment cycle. Others choose follicular reduction where I will remove some of the eggs with a simple office procedure similar to an egg retrieval. Others, including the now famous McCaugheys of Iowa, simply understand and accept the risks associated with multiple births.