Egypt septuplets stir debate on fertility drugs

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.

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