How Many Is Too Many?

Alternatively, as physician after physician noted in interviews, if insurance would pay for fertility treatments, prospective parents could afford to be cautious -- less likely to push to have more embryos transferred or to insist on going forward with artificial insemination even in a month when it seemed likely that six eggs were going to be released.

The Duncans kept their costs down by going to Canada for IVF treatments -- twice. The first time, Marie Duncan developed a life-threatening condition called ovarian hyperstimulation syndrome. She produced 30 eggs at once, but became so ill the doctors refused to go forward with the embryo transfer. Twenty-two of the eggs were strong enough to be fertilized and frozen -- but none survived to be transferred into Marie's uterus.

When the couple traveled to the Canadian clinic a second time, 10 strong embryos were produced, and the Duncans opted to have three transferred -- the maximum the clinic would allow. All three "took."

The clinic charged the Duncans $6,500 (plus drugs) for up to three IVF cycles using fresh embryos. (A similar three-cycle deal typically runs $20,000 in the United States.) With all drugs, travel, lodging and even sightseeing added in, the family's total costs came to just under $13,000.

Happy Endings

After dropping the first perinatologist who wanted them to reduce their pregnancy to twins, Lisa and Alex Owen found more encouragement with perinatologist Thomas Pinckert in Rockville.

"I do tell patients that statistics suggest that with triplet gestation, there's a 10 percent risk that the babies will be delivered" before they could survive outside the womb, Pinckert said. "There's another 10 to 15 percent risk of delivery at 24 to 28 weeks -- viable, but long-term survival is not as well spelled out. But optimistically, there an 80 percent chance that the babies will do well."

A prospective mother of triplets has an increased chance of pre-eclampsia or gestational diabetes, and any underlying health problems can be expected to worsen, according to Pinckert. "While most fertility doctors stress that you should reduce" triplets or more, he said, "we try to give an unbiased opinion. We evaluate for a mom's overall health -- does she have a reason she shouldn't carry [triplets]? Most don't."

The Owen triplets will turn 3 this week. Children and mother are all doing fine.

The Duncan triplets are also doing well at 10 weeks, reports Marie, except for one having colic.

Marie, on the other hand, is going to cardiac rehab three times a week, and is taking six drugs for her cardiomyopathy. She is taking a seventh for anxiety -- "because when I lie down at night," said Marie, "I start worrying about it. What if it happens again? What if I left four children behind?"•

Lisa Barrett Mann has written previously for the Health section about IVF issues.