It Gets Messier

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On Friday, February 06, 2009, NBC's "Today Show" aired an exclusive interview with Nadya Suleman, the mother of the octuplets born 11 days ago.

She finally provided an explanation for why she would have eight more children when she already had six children to care for, "That was always a dream of mine, to have a large family, a huge family."

While I've met many people who have said they want a large family, I have never met a person who yearned for a "huge" family, much less one not involving another parent. It begs the question, "Why?"

Fortunately, Ms. Suleman gave us an answer, and by giving us an answer this previously inexplicable story begins to make some sense. It seems her desperate desire for a huge family has its roots in what she perceives to be a difficult, dysfunctional childhood. "I just longed for certain connections and attachments with another person that I really lacked, I believe, growing up," she explained. She added that she lacked a "feeling of self and identity. I didn't feel as though, when I was a child, I had much control of my environment. I felt powerless."

What's so astonishing is that all of these regrets and misgivings about her childhood are coming from an only child! Just how much of a "connection" will she be able to have with each of her 14 kids, ranging in age from 7 years to just 11 days? And just how much of a "connection" will each child have with her?

How much of a sense of "self or identity" will each of her children have being only one of fourteen?

How much "control" over his or her "environment" will each of these children feel they have when they are competing with 13 others for attention from a single parent?

It's a sad irony that by having so many children she has all but guaranteed that precisely the same issues she had with childhood, which she was apparently hoping to correct by having many children, will also be suffered by her children.

A person should never bring a child into the world so they can work through their own childhood issues. They should work through their childhood issues first. Parenting is about providing a child with a loving and nurturing environment that allows them to complete the many daunting tasks involved in "growing up." It's not about giving yourself a second chance at growing up. Dr. Nancy Snyderman, NBC's chief medical correspondent said it very well, "I think when you don't have a connection in childhood, you go see a therapist. You don't have 14 babies."

In my earlier blog on this topic, I highlighted the importance of psychological screening when faced with a patient with ambiguous or questionable motives for having a child or additional children. When there's a doubt, any doubt, a psychological evaluation is mandatory. None of this is meant to disparage Ms. Suleman in any way. Coping with unresolved psychological issues is very difficult and can lead to dysfunctional, even self-destructive behavior in virtually anyone. Few, if any, people can honestly say they have never engaged in such behavior when faced with significant psychological stressors. Sitting home alone and drinking a couple bottles of wine or eating a gallon of ice cream is one thing. Placing 14 innocent third parties on the couch beside you during a destructive session of "self-therapy" is quite another.

Which brings me back to the mystery fertility specialist who "cared for" Ms. Suleman; he or she represents the classic "enabler." In her interview on "Today," she said she had six embryos transferred. Based on national guidelines, that's at least three times too many embryos for a patient her age, and perhaps six times too many for a patient like her, a young woman with a proven track record of becoming pregnant following advanced fertility procedures.

In her interview, Ms. Suleman indicates that her physician warned her of the risks of a multiple pregnancy and recommended that she transfer fewer than six. Ms. Suleman apparently insisted that they all be transferred, saying they were all her "children, and that's what was available and I used them. So, I took a risk." As I mentioned in my previous blog, her insistence is utterly irrelevant. Transferring six embryos is clearly outside the standard of care and thus should not have been an option for her.

These situations are easy to avoid. It is not uncommon for an infertile woman or couple to form an attachment to their embryos and view them as children-to-be, and thus be reluctant not to transfer all that appear viable. In cases like that, the number of embryos thawed becomes a critically important decision. You simply don't thaw more embryos than it is prudent to transfer. And, if the patient has a last second change of heart about the disposition of any excess viable embryos following the thaw, they can be refrozen. These are two simple solutions to avoid a situation like the one that occurred that fateful day.

Even if the fertility specialist transferred these embryos based on the erroneous belief that a patient has an absolute right to make medical decisions for herself regardless of the standard of care or the risk involved, he or she forgot one very simple fact when agreeing to transfer those six embryos. There were seven patients in his clinic that day, not one. Only one gave consent. The other seven, who lay silently in a petrie dish while their health and lives were put at enormous risk, could not.