ALEXANDRIA, Egypt - The 27-year-old woman and her husband already had three children — all girls. They badly wanted a boy, and she had not conceived in five years, so doctors gave her hormones.
The startling result was healthy septuplets — four boys and three girls — heralded by Egyptian doctors as a miracle. But debate persists about the ethics of fertility treatment in a nation where medical oversight is lax, incubators and neonatal respirators are rare, and many families face pressure to have a son.
In addition, Egypt faces concerns about overpopulation and cheap fertility drugs could lead to a wave of multiple births. President Hosni Mubarak warned in June that growth is hindering Egypt's economy, saying Egypt's population of 79 million — mostly crammed into the 3 percent of the country's area around the Nile River — will double by 2050.
For the mother, Ghazala Khamis, the most pressing question now is how her impoverished family is going to get by.
'I'm really scared'
"I'm really scared," she said, lying in her hospital bed in this Mediterranean coastal city. "We live in a mud hut with only two rooms. I don't know how we're going to afford 10 children now."
Khamis' husband Farag Mohammed Ali, a 31-year-old farm laborer, can find work only a few days a week, she said. "I'm really worried about what the future looks like."
Much about the Aug. 16 birth, by Caesarean section, was stunning. The babies are large for a multiple birth, weighing between 3 pounds 3 ounces and 4 pounds 10 ounces each. The duration of the pregnancy was also the longest ever for septuplets — 34 weeks.
By contrast, the world's first surviving septuplets, born to the McCaughey family in Iowa in 1997, came at 31 weeks and the biggest baby weighed about the same as Khamis' smallest. There are two other sets of surviving septuplets, both born to Saudi women.
Khamis' doctors waited so long to deliver the babies because Egypt has only a few respirators for newborns, and none were available. So for weeks, doctors kept Khamis in Alexandria's Shatby Maternity University Hospital, letting the fetuses develop enough that their lungs could function on their own after birth. But the wait also increased the risk to the mother.
"We were simply blessed by God that no complication happened ... If there had been a complication, Ghazala would have died," Dr. Mahmoud Meleis, who performed the Caesarean section, told The Associated Press.
After their birth, images on television showed the boys — Mohammad, Kareem, Bilal and Yassin — and girls — Israa, Habiba and Do'a — lying side-by-side in two makeshift incubators, oxygen hoods covering their heads. Four were then whisked by ambulance to two other hospitals because there were not enough incubators at Shatby.
Except for the television images, Khamis has not yet seen all her babies; she has been able to hold and breast-feed only the three at Shatby. Though she was ready to leave days after the birth, she remains hospitalized because she has nowhere to stay in Alexandria, a four-hour drive from her farming village of Ezbat Emara.
Last week, baby girl Habiba and boys Yassin and Mohammed were resting in incubators at Shatby, tiny caps on their heads — red for the boys and lime green for the girl. All were breathing on their own, though Habiba and Yassin wore protective eye patches.
Some Western medical ethicists have questioned the use of fertility drugs by a young woman who already has three children, considering the risk of multiple births.
"This is a medical failure," said Guido Pennings, a professor of fertility ethics at the University of Ghent in Belgium. "You cannot take this risk because of the complications to the mother and the babies."
Pennings, who was not involved in the case, said Khamis' doctors should have been more careful in prescribing fertility drugs to a woman who had already demonstrated she was capable of conceiving.
"Twenty-seven with three children: That woman is fertile," he said. "Even if she had a period of infertility, that's an indication that you should be careful when you stimulate" ovulation.
Some Egyptian doctors are worried that the mix of cheap fertility treatments and Egyptians' eagerness to have many children could lead to more risky multiple pregnancies — which the country's health system cannot handle. Locally made versions of the drugs are government-subsidized and only cost about $7.50 a shot.
Pressure to produce a son
There is also pressure on women to produce a son as a point of pride and for financial reasons. Boys help families by working and earning incomes — often at a young age — and they ensure inheritance, since daughters and wives can only inherit a portion of their father's money, and if there are no male children, the bulk goes to the fathers' brothers.
"The important question to ask is why did she want to become pregnant after already having three children," said Hassan Sallam, head of Obstetrics and Gynecology at the University of Alexandria.
"It's because she had three daughters and didn't have a boy. In many parts of Egypt, if she doesn't have a boy, it's as if she didn't have children at all."
Khamis sought fertility treatment five years after her youngest daughter, 5-year-old Rahma, was born because she was having trouble conceiving and wanted a boy, said her doctor, Abdel-Rahim Moussa.
He said he prescribed fertility drugs to stimulate egg production. After five injections, he recommended Khamis and her husband have intercourse.
The doctor said he was stunned when he later found nine heartbeats; he said he couldn't remember whether he did a sonogram to see how many eggs had developed before recommending the couple try to conceive.
"It's just so rare that all the eggs would get fertilized with regular intercourse," he said.
The doctor said he strongly advised Khamis to undergo fetal reduction, in which some fetuses are terminated to ensure the safety of the others and the mother. But he also told her there was the possibility of losing all the fetuses, and Khamis refused. Later, two of the fetuses were lost during the course of the pregnancy.
Emad Darwish, the hospital director, said Khamis should have received more counseling about fetal reduction. "I have performed several reductions and have never had a case where I lost all the fetuses. She needed to know that," he said.
Religious decree on fetal reduction
Although Islam forbids abortion, Darwish said a recent religious decree by Islamic authorities at the country's main Sunni religious institution, Al Azhar mosque, allows fetal reductions due to the high risk to the mother and babies in a multiple pregnancy.
The real problem, doctors say, is a lack of guidelines in Egypt for fertility treatment and not enough facilities to deal with high-risk pregnancies. There are no restrictions on what fertility treatments or drugs can be given, and Egypt does little enforcement of pharmaceutical purity or standards.
Facilities for the septuplets' birth were poor. The Health Ministry sent incubators that were not sterile, there were not enough for all seven babies and there was no air conditioning in the operating room.
"There are just no rules or protocols for doctors to follow in this country," said Meleis. "Laws will be passed and they are not followed or implemented. No one had any idea what to do when it came to Ghazala's births — it sort of all just happened."
Sallam said he hoped the case would make doctors realize that "women can actually get pregnant with seven, eight or nine babies" and would open the way to discussion of fetal reduction.
"We need to tell people that it is safe and that it is OK religiously," he said.
Khamis, meanwhile, is pleading for help for her family. The Health Ministry has pledged milk and diapers for two years, but Khamis says what she really needs is an apartment in Alexandria to be closer to doctors.
In line with some Egyptian traditions, each of the septuplets was given a name on their birth certificates, then a second "nickname." The children were nicknamed after Mubarak and his family — in hopes of winning government help for the children, the mother's brother, Khamis Khamis said.
Surrounded by family in her sweltering room, a cockroach crawling on the ceiling above her head, Khamis raised her head from a pillow when news came that her husband had named the babies.
"They should have asked me first," she said after hearing the names. "I wanted one to be called Abdel-Rahim," after her doctor.
didn't a Jesus-freak couple somewhere in the midwestern US boondocks do the same thing and end up with septuplets a little over a decade ago?!
It's a Christian couple in Iowa. Please be respectful of others. You'd want others to be respectful of you.
Lisa,
I'm sorry that you were offended, but I really dont worry about whether or not others are respectful of me. I'd rather be hated for who I am than loved for who I'm not.
I am not offended. I just think your comment was rude. It's possible to make a point without belittling others, which is what you did. When you diminish another, you also diminish yourself.
I'll concede all but your last point - how do I diminish myself when I diminish someone else. This would only be possible if there were absolutely no difference between me and some religious knuckleheads who use fertility drugs to defy nature's laws and end up with 7 children, two of whom are going to be deformed for life!
Now, I would have to find *that* offensive! :)
That's just rude and not very thoughtful.
If I was rude, I was deliberately so. Peopple that have more than a couple of kids are social parasites in my book and I make no apologies for venting my opinions of them in the strongest terms possible.
Sharat C,
First of all, Iowa, isn't "the midwestern boondocks". Have you ever been there? It's actually a very nice place full of very good, hardworking people.
Secondly, the Christian influenced couple from Iowa that had the septuplets did have fertility issues. Their previous kids were also had with "help".
I'm not going to say that reduction wasn't a probable possiblity, but that's what I would have done....we can't speak for her. Now, this poor woman in Egypt didn't seem to even have the information or education from physicans about her options in reduction (not abortion...different, by the way). It doesn't seem like the physicans even knew what to do or where to go. That's upsetting. If they are going to go around shooting up fertility drugs, then they better have a good handle on what COULD happen, not what SHOULD happen.
I am also sad about "more than a couple kids" being social parasites. Wow. You obviously don't have kids, or had terrible siblings yourself. Our family is large, and fabulous, and loving and handled. We are engaged, we work together and we all have responsibilities that make things work. Granted, we don't have septuplets, but I didn't need fertility drugs for help.
I agree with Lee, that you are rude. Doesn't matter if you care. That's the problem. You think you can just post things and say things without consequence. Even if you don't bear the consequence, some one does. There's always the effect after cause. Be wary of how you treat others.
I don't see how you can call it a "medical failure" if all babies are alive and okay. The reason she would have had so many babies is because they usually implant a woman with several fertilized eggs, in order to increase the odds that one will attach. So what happens is that more than one attach, and then the same doctors will want to do a "selective reduction," to again increase the odds of a successful birth. Maybe they should worry less about "odds" and more about doing what's right to begin with.
And to answer Sharat's question, there have been several, please be more specific than "midwestern US boondocks."
That's too many babies to have all at once. He is a part time farm worker I fear these children will no t be well cared for. And why would doctors in an over-populated country ever EVER give fertility drugs?!
They were not conceived via in-vitro fertilization. The doctor gave her hormone shots to increase her egg production, which resulted in nine eggs being fertilized, and seven survived.
I think it's unconscionable that a doctor would give fertility drugs to a 27-year-old woman who already has three children, and is too poor to care for those three, let alone seven more.
In response to T Bourlon:
It was the McCaughey Septuplets in the Iowa branch of the MidW US Boondocks in 1997.
Also in the case of all the women implanted with eggs, the right thing would have been to NOT implant them with anything. Its mother nature's way of saying there are way too many people in the word already and on top of that there's a reason that certain women cant conceive and we ought to respect nature's way of telling us that.
George Carlin put it best in his last book (When will Jesus bring the Pork Chops): "if these diaper-sniffing Christian babymongers would stop popping out so many of those cross-eyed kids, there'd be a lot more room for the rest of us" I honestly don't mean to pick on fundamentalist Christians. Fundamentalists of Hindu and Muslim stripes have proved that they can be just as atrotious when it comes to birth control.
I think it is both...a miracle that all seven lived and were as large as they were and a failure for even administering the drugs in the first place. It was a reckless action that endangered the mother and impact the family for years and stretch them to their limits. While this is a single incident that gets us talking, there has to be a shift in the culture where females are not valued. It starts way before doctors administer fertility drugs.
Sharon:
Nice use of the "Stretch them to their limits" metaphor. That poor woman in Egypt could definitely relate to it! *grin*
Congrats to them. When do they get a TLC show showing them being potty trained, taking showers, and every other pedoriffic dream like Jon & Kate Plus Eight?
Regardless of whether it is ethical or not, or whether it is a miracle or a mistake, the family is badly in need of help. Is anyone else interested in making small contributions? I don't know how to get in touch with them but I'm sure it can be done with a little diligence.
I agree with you. The babies are already here. Let us do the good deed and help if possible. If I donate money how do I know that the family will actually get the money???Big Question? I feel that she needs to be in a larger home and have support like we in America do for women who have larger families. Her husband needs a steady job to provide and feel of self worth also. I would not mind sending them baby clothes but how is it done?
I really don't know yet. I have sent some emails trying to get information. It would be nice if we could have their address so things could be sent directly to them but it may not be possible. It would be a huge risk for them, considering how many people disagree with their choice. I would definitely NOT have made that choice myself but the deed is done and we can't penalize the children. Hate mail and unwanted attention would be as devastating as poverty.
I don't know how the Egyptian government would handle something like donations. We do know that some of the places we sent food failed to distribute the food and it ended up either rotting or being sold on the black market with great profits for the usurpers. No, we don't want that to happen -- nor do we want to be suckered in by some upstart "charity" that will take our money and send nothing to the family. I advise caution unless it is a well established organization with a good reputation. And DEFINITELY don't send anything to me. If I can get an address we will all send to it. How's that?
Mary:
If you can find out how to make a contribution, I'll pitch in if the couple signs some sort of consent decree to the effect that
(a) He gets a vasectomy
or
(b) She gets her tubes tied
I'll double my contribution if they do both (a) and (b) just to be sure that between them they dont produce another litter! Heck, I'll even throw in a month's supply of Trojans!!
It seems to me that what they did was incredibly selfish. I can understand that it's important to have a son, for the reasons stated in the article; however now they have become a burden to themselves and their community just to have a son.
When do they get a TLC show where they get all kinds of freebies, show their kids in the bathroom, and show the shrew of a mom screaming at the kids/smacking the husband a la Jon and Kate Plus Eight?
The freebies are the biggest hindrance in the effort to discourage such monstosities - its what basically keeps these clowns masquerading as parents in business.
There are countless children worldwide born in poverty, neglect and abuse that languish in those conditions because we cant produce a telegenic "man-bites-dog" story about them. On the other hand if they're born in a batch of 6 or more, all of a sudden, they're a sensation and we pamper them to no end, even if their parents are a couple of some means that lives in a comfortable, bland and sterile (yes, I'm aware of the irony!) suburb.
Sharat, I completely agree - there are so many abandoned, neglected, and abused children out there without a home, food, etc, yet people who are "blessed" with 5+ multiples get to live off of tax dollars and on television. Brilliant.
How do we get this family some supplies to keep those babies alive? I would like to give them some baby clothes and blankets at least.
Sharat C: Well said. It's nice to see some common sense when it comes to this topic.
That's too many! To too poor people! Was their doctor INSANE?!? And I don't have a bias because they are foreign or Moslem, I feel the same way about any Americans as well. And I feel the same way whether we are talking about kids or pets. If you can't afford them, don't have them. The solution: sell a few of the excess on E-Bay. They could get some money to live on for a short while, anyway. Wonder what babies go for these days........
Ask the couple in canada who put their baby up for sale as a joke.
It is too bad that people still think that boys are "better" than girls. Secondly, someone might suggest adoption. There are a lot of couples that can't have children that would cherish a girl.
Third world countries should not be allowed to have fertility drugs. Especialy the one's who want to blow America Away!
It's sad for the parents to have children you can't provide for. No matter if there was no boy. What in the world are people thinking!
Sharat, I understand your point but I'm not really willing to put conditions on charity. We do way too much of that with our foreign aid, and even within our own country. Life is a gift from God and, so far as I know, there are no conditions that we, personally, have to meet to have it. The parents may have been irresponsible, as were the doctors, but the babies are completely innocent.
Here in the United States, all people have access to food, shelter, medical care and a basic living -- but again, with conditions. Most obvious is the need to apply and prove that it is necessary. Then it is necessary to comply with regulations the person may not even be aware of until finding themselves cut off for infringing. In most non-industrialized countries there are no resources other than begging and, even then, most of the other people nearby are equally poor.
Mary Beth, I'm not a computer genius but I will scout around and see if I can get some information about getting some supplies to the family. I appreciate your compassion.
Not ALL people have access to Healthcare, shelter, and food in America. When millions of Americans do not have health insurance - options are blocked. Hospitals turn patients away. Clinics ask for 'insurance information' before asking your name or what it is you wish to see the Dr. about. I agree that administering fertility injections to a family who are already struggling is insane.
A similar incident happened near Seattle. The family was/are living with her parents, have two girls, and she took fertility drugs. Now they are begging for donations to have a house built, cloth, provide the basic needs for their children. I don't understand the logic of purposly getting pregnant when the parents already struggling. C'mon - we want our kids to have a BETTER life - not struggle from day one!
Mary,
I understand, and even completely empathise with, your sympathy for the children involved. But my point is that we would be performing an act of selective charity in helping these particular individuals. What about the hundreds of thousands of children in Darfur that live in agonising and unrelenting misery? And thats just a single example of the sort of atrocities that children (not a miniscule fraction of whom are septuplets) have to endure, worldwide.
Moreover, I happen to be an atheist, so the argument that life is a "gift from god" does not even register, leave alone resonate in the realm of my thought process. Life is a biological mechanism that's governed by, as well as constrained by, the laws of nature. We can obviously tamper with it as evidenced by the numerous "septuplet" scenarios, but we do so at an expense, tangible or not.
There are many parts of the world where raising a single child can be an onerous burden, leave alone 7! So the parents should have had these considerations drilled into them by their doctors and mullahs, the latter of whom I am willing to wager, were actually facilitators in this whole ghastly exercise.
While some sort of help may certainly be called for on humanitarian grounds, the perpetrators of this abomination (parents, doctors, mullahs etc) should all be held accountable and at the very least, incur the strongest and harshest condemnation possible. They should be made to feel ashamed of themselves for being such social parasites.
The are not a gift from God, they are a product of greed and medical science...They made them, along with their dr. let him support them...And before I am attacked for being uncharitable...I give $, clothes, time, school supplies and food to those who need it in my community....
It's truly nice and admirable of those who want to provide assistance. However I'm doubtful that any goods sent to them would actually turn up on their doorstep. A pakage of American clothing, formula, baby supplies, would surely be confiscated enroute and end up for sale at a market somewhere. If you want to help them out, be sure to do it through an international aid organization based here in the US.
Wait, I'm confused. I don't mean to be rude, but if they're so poor, how can they afford all these doctor visits and fertility treatments? I thought that over here they were expensive as well.
Ummm, we are the only country that makes you pay to go to the hospital.
The treatment costs are only the equivalent to $7.50. It is possible for people to afford them. The important thing in a country like this is to have sons no matter the cost, there has to be a paradigm shift in the culture. As it is now, females just cost a family money because one family raises them to just be married off and work in someone else's household. With a son, they remain in the family and become a breadwinner for his family and extended family.
Outraged1961 said "Ummm, we are the only country that makes you pay to go to the hospital."
Sorry - not true, Outraged. Many countries charge hospital fees. I've worked in several African countries where fees are charged. Some don't have the tax base to provide free care, and so user pays. Even those of us with public health care do pay - through taxes.
Good Lord! I'm sure she'll end up in the states somehow, and we'll all be paying for them!!!
I think that this is a very interesting story. Having septuplets is dangerous for mom and babies - no matter what the circumstances of the health care system or the parents' financial means. Why is the slant on how dangerous it is only in Egypt? I had twins and know from experience that more than one child in the womb is dangerous, no matter the country.
Because, as the article stated, the meager supplies at the hospital made the risk higher. At least in some parts of the world, your medical professionals are actually prepared when faced with a risky birth.
It is a miracle that we have the ability to help couples concieve. Whether it is always the best option for certain couples is not our decision. Now that these babies are here, it is better to offer help than to condemn the parents/medical community.
By not condemning this action, we are endorsing it. And it is not a "miracle".. it is cheap science.
It is no miracle that we help infertile families to conceive, it is plain science. Infertility is something that many religions abhor and Churches in the US even have special prayer services for couples who otherwise can't conceive. There are many religions that consider birth control of any kind to be irreligious. But did anyone ever consider that we are in a broken, fallen world and while infertility is a sign of that brokenness and therefore should be prayed about; excessive fertility is also a sign of that brokenness? Medicine (a product of science and religion that has become its own fledgling entity now) is committed to doing no harm and to in fact helping people. Is it helping to cause infertile couples to have 7 babies at once? I don't think so. But is it helping to cause fertile couples to stop conceiving? Probably. The killing of unborn babies through in vitro fertilization or abortion whether to stop overpopulation or to help infertile couples conceive is an abomination in medicine and religion. So this conception, I say again, was no miracle.
On the other hand, I am totally with Mary that we should do all we can to help these children...not just these 7 specifically but the children all over the world in poverty, want, and despair. One organization that helps: World Vision...and they work in Egypt too.
Why not just leave it at prayer then, if you're so convinced that the invisible-man-in-the-sky (to quote the late great George Carlin again) to whom you pray, can answer all problems due to infertility?! Why do you need fertility drugs?!
I think its because, goofy as these fundamentalist nutjobs are (Yes, I know its offensive and I don't care - that's the idea!), they have a subconscious awareness of the sheer futility of prayer alone.
The sheer irony of the most unscientifically tempered people on the planet being bailed out by monumental advances in medical science, is I'm sure completely lost on these wackos.
Yep, I think supplying New Born terrorists with food and blankets is a great idea!
Wow. bvharper apparently loves to make comments that aren't relevant to the discussion, and I feel compelled to reply:
Since when are all Muslims (which the article doesn't say, but I would assume from their names) or all people from predominately Muslim country terrorists? You're an ignorant person who obviously just wants to start arguments.
WOW - definitely "selective reduction" would have solved a lot of their problems. They wanted "a" boy, not three boys!! Too late now, I guess!! And, actually, isn't it their business, not ours?. Why do we insist on minding other people's business when it isn't hurting us in the least? So, MYOB folks!
"And, actually, isn't it their business, not ours?. Why do we insist on minding other people's business when it isn't hurting us in the least? So, MYOB folks!"
But I would argue that this is our business, and for two separate reasons. Firstly, unchecked population growth, especially in impoverished nations, leads to geometric increases in disease and famine, which result in a severely decreased standard of living for the entire population. Secondly, this family and many like them are clearly not in a financial position to be adequately providing for so many children, which similarly results in a decreased standard of living for the specific children in question. Both of the reasons, then, share a common theme: a decrease in the standard of living (read: an increase in physical suffering).
Although I think it's generally of the utmost importance to respect individual rights, I think we need to remember that there are cases where "respecting" individual rights inevitably leads to collective harm being done to a larger group of people. The crux of the matter, then, is in deciding which is more beneficial to society in certain cases -- preserving the rights of an individual or ensuring the collective health of the many? While this is exactly the same kind of argument that can be manipulated to push irresponsible laws, like the Patriot Act, during times of hysteria, I think that the decision to ensure the health of the many at the expense of individual rights can sometimes be the sensible thing to do. Of course, this is entirely contingent upon what your definition of "individual rights" is, and I'm not sure if the "right" to have a child passes the smell test in all cases.
While using the long arm of the law to limit the number of children a person has bothers me on a certain level, I also recognize that there need to be fundamental expectations of an individual's ability to raise and provide for a child. And unfortunately, in this country as in around the world, it seems that the least capable to raise children are usually the ones most likely to have them.
I'll adopt one of the girls. I make enough to support myself and a child and live comfortably. Plus I own a home with a nice playground in the back. I'm sure that would be a better option than trying to raise all ten children.
But really, human beings are not meant to have litters (as one of my professors once said). Our bodies can not handle that. So whenever a multiple birth case ends up on the news due to fertility drugs (no matter where), I just cringe at all the possible health complications that can arise from multiple births.
Also, anyone else catch the story about a woman and her husband who already had 4 children (one child on their own and three from fertility treatments), having another 5 babies with fertility treatment. To top it all off the family lived in a one bedroom apartment (mother is a stay at home mom dad is a carpenter)... that just made me sick to my stomach.
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