Is This Right? Who Has the Right to Say?

One

baby? Fine. Twins? Surprise. Triplets? How nice...I think. Quadruplets? Gulp. Quintuplets? In the range of five babies and beyond, we enter a realm of fascinated horror, sublimated into sentimentality. We call the Guinness Book of World Records and the local TV news. If P.T. Barnum were here, we'd alert him; the circus loves biological anomalies, in the way that it cherishes those stunts in which eight clowns emerge from a Volkswagen.

But the intimate reality--what could be more intimate?--poses a sequence of haunting questions that ascend to the metaphysical. The womb is a very small apartment, and overcrowding creates the sort of triage dilemmas that doctors face on battlefields. Which one of the babies is one too many? The third? The fifth? The eighth? And since nature does not number the fetuses, how does one assign them priority in the event that "selective reduction" becomes the choice?

Months ago, doctors told Nkem Chukwu they couldn't be sure, but they thought she was probably carrying seven fetuses. She and her husband--devout Christians, Nigerian-born U.S. citizens--refused to abort any of them. "I wasn't even going to give it a second thought," she said last week as she was dismissed from St. Luke's Episcopal Hospital in Houston. God had blessed her, she explained, and she declared her babies "unique."

Unique they are. They required that their heroically stoical mother give up solid food and lie at an angle with her pelvis higher than her head for weeks in order to minimize pressure on the cervix.

When at last the babies, eight of them, were born, five days before Christmas and three months premature, they ranged in weight from 10.3 oz. to 1 lb. 10 oz., the world's first octuplets to be delivered alive. Within a week, the smallest baby, Odera, weighing hardly more than a small bird, died. As of the New Year, doctors, with disconcerting precision, gave the others a 92% chance of surviving.

Did Chukwu and her husband Iyke Louis Udobi make the right decision? And who has the authority to judge that decision? Baby boomers who have postponed parenthood 20 years or more increasingly turn to fertility drugs, knowing this will lead to twins 20% of the time and to triplets or more an additional 5% of the time. The sidewalks of Manhattan's Upper West Side are clogged these days by strollers for twins and triplets, pushed by gray-haired parents. And it's no longer unusual in any part of the country to meet women in their mid-40s who are pregnant for the first time.

But before you arrive at the metaphysical questions, you face the medical ones. Chukwu, who miscarried triplets earlier in 1998, was treated this time with injectable fertility drugs called gonadotropins at a Houston clinic. Such drugs stimulate the follicles to mature in preparation to release eggs. The woman is monitored, and if a large number of follicles mature, most doctors advise her to cancel the cycle in order to avoid multiple births. Canceling the cycle is simple; either by withholding a second drug that stimulates the follicles to release eggs or, if the eggs are released anyway, by avoiding sexual relations for a while.

It isn't clear why Chukwu did not take such steps early on. Doctors say many patients have invested so much time, effort and money--$10,000 or more for in vitro fertilization, lesser amounts for fertility drugs--that it's difficult to persuade them to end a cycle.

Multiple births have multiple costs. They take a "terrible toll" on a woman's body, says Dr. Thomas Vaughn, a fertility expert in Austin. "A human uterus is made to carry 6 to 8 lbs. Beyond that, women have trouble walking, breathing; it's hard on the heart." The babies are punished as well; many multiple-birth preemies suffer brain damage and other problems. Finally, there is another cost: the hospital bill for each of Chukwu's surviving babies will be $250,000, and that's just the start.

We thrash out the ethics of these matters in a sort of MSNBC of the mind, a noisy internal theater, entertaining first one dogmatic view and then its opposite. Is "selective reduction" moral? Are fertility drugs a blessing or a contravention of nature's or God's decision?

I knew a brilliant man, of my father's generation, who, when drunk, would recount the horrors of his days as a Marine on Guadalcanal. There he glimpsed "the madness of God" in nature's orgies of simultaneous life and death, generation and decay. Surely a similar dissonance hums now in all of our medical ingenuities. Fertilizations run amuck, while the dying plead to be disconnected from life support.

Thus, hyperfertility becomes another part of surreal life as the millennium ends here on Planet Kevorkian. All life is sacred. But as these manipulations (to generate life, to cancel it) go on, I think I hear the distant, rushing sound of divinity escaping.