>  <http://news.yahoo.com/s/ap/20080826/ap_on_re_mi_ea/egypt_septuplets>
http://news.yahoo.com/s/ap/20080826/ap_on_re_mi_ea/egypt_septuplets
> < <http://news.yahoo.com/s/ap/20080826/ap_on_re_mi_ea/egypt_septuplets>
http://news.yahoo.com/s/ap/20080826/ap_on_re_mi_ea/egypt_septuplets>
>
> Egypt septuplets stir debate on fertility drugs
>
> 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," 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.
>
> 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.
>
> 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.
>
>

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