Fertility Drugs: A Mixed Blessing

"They just kept coming. We weren 't expecting anything like this."

Mark Levy, 27, of Fairfield, Ohio, had good reason to be surprised and excited last month. His wife Pamela, 28 and previously childless, had just given birth to quintuplets--a phenomenon that until recently happened only once in every 41 million births. But quintuple deliveries and other multiple births have become more commonplace lately; Pamela, like thousands of other women, had been taking a fertility drug called Pergonal. Doctors estimate that women who become pregnant after treatment with Pergonal are many times more likely, and women who take another fertility drug called Clomid slightly more likely, than other women to have more than one baby.

The Levy quints are doing well, and their parents seem to be adjusting to the startling increase in the size of their family. But many of the multiple births that result from the use of fertility drugs turn out to be mixed blessings at best. The infants are usually born prematurely, and because of overcrowding within the womb are likely to suffer even more problems than most "preemies." The prospect of multiple births also puts a strain on pregnant women. They are usually dismayed when they first hear the news. In fact, many families feel that they are simply unprepared--physically, financially and emotionally--to cope with more than one new baby at a time. Most women nonetheless profess to be delighted after they find themselves the mothers of twins, triplets or even quints.

Multiple births are not the only problems that go with fertility drugs. Though many, perhaps even the majority of women who take fertility drugs experience no ill effects, a number develop potentially serious illnesses. Researchers found that women who took Clomid occasionally developed ovarian cysts. which, without skillful treatment, can rupture and cause internal hemorrhaging and death. The incidence of cysts is higher with Pergonal.

Casual Use. Most fertility experts insist that the drugs are indeed safe --if they are used with care and discretion. Unfortunately, says Manhattan Gynecologist Edward Stim, who rarely prescribes the drugs, they are sometimes given on a casual, "Why not give it a try?" basis. Clomid, a synthetic hormone-like drug, seems to work by stimulating the pituitary gland to release hormones that help to ripen the ovum. Pergonal, a hormonal extract from the urine of postmenopausal women, primes the ovaries so that another hormone --human chorionic gonadotropin or HCG--can ensure the release of the ovum. Neither treatment should be used unless doctors have first determined that a woman's inability to have a baby is caused by a failure to ovulate, which accounts for only 5% to 10% of all cases of infertility.* The experts urge that patients be monitored carefully to prevent the development of cysts.

Some doctors feel that women faced with giving birth to litters should consider having abortions. "If there are more than three fetuses, it's a disaster," says one fertility expert. But Dr. Robert Kistner of Harvard Medical School, a pioneer in Clomid treatment, feels that multiple pregnancies can and should be prevented before they start. Kistner treats women who do not respond to Clomid alone by priming them first with small doses of Clomid and Pergonal, then checking their estrogen (female hormone) levels to estimate how many eggs they are about to release.

If his test indicates that the patient will yield only one or two, he administers HCG to trigger release. If the test suggests the ripening of more than two eggs, he withholds the drug; the small doses of Clomid and Pergonal alone are insufficient to produce ovulation. Kistner's system appears to be effective. Of 80 patients treated with Clomid and Pergonal in sequence, most of those with simple ovulation problems became pregnant and had babies. Only one woman had more than one baby, and she had only twins.

Whether produced with the help of fertility drugs or naturally, premature babies always suffer from being expelled from the womb before they are ready. Figuring that preemies miss the security of the womb, Dr. Louis Gluck of San Diego's University Hospital has designed a tiny, heated water bed to simulate the warmth and buoyant pulsations of the baby's uterine environment. He also attached a tiny motor that provides motion similar to what the fetus experienced when the mother's heart beat and as she walked about. The preemie's sense of security is further heightened by the recorded sound of a pregnant mother's heartbeat piped into the artificial womb. Gluck hopes that his invention, which has been tested on only half a dozen babies so far, will help lower the high mortality rate of premature infants.

Normal newborn infants need reassurance too. Reasoning that newborn babies cry, at least in part, because they miss the sound of their mother's heartbeat, Dr. Hajime Murooka of Tokyo's Nippon Medical College inserted a minuscule microphone into the wombs of three expectant mothers and taped their heartbeats. When the taped heartbeat was played back to 300 crying babies (20 of them preemies), 85% either went to sleep at once or stopped crying in a minute. The word spread quickly throughout Japan, and heartbeat cassettes and records are selling at a brisk rate. But Murooka warns that the recordings should be played for only the first two weeks of the infant's life; otherwise, the baby will sleep most of the time and lack the stimulation necessary for normal development.

* More common causes: male sterility and infections that scar the lining of the uterus and fallopian tubes.

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