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(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.

      "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."
     

Gallery

Health

Amy Forliti, Associated Press

Author

Another one of the sextuplets born to a St.
Louis Park couple has died, hospital officials said Monday. The little girl is the fourth of the babies to die since they were born on June 10. The situation highlights the difficult decisions faced by parents with a multiple pregnancy.

Minn. sextuplets spotlight tough decisions for hopeful parents

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