More than 900 men and women have signed up to attend a free fertility workshop today at the Hyatt Regency Trinidad hotel, in Port of Spain, to be hosted by the Barbados Fertility Centre.
This follows the historic births of the Caribbean's first set of sextuplets to Trinidadian parents Kieron Cummings, 29, and Petra Lee Foon, 28, at the Mt Hope Women's Hospital this week.
Director of the Barbados Fertility Centre Dr Juliet Skinner, in an interview with the Express yesterday at the Hyatt, said over 900 people were registered to attend the seminar, which will take place from 9 a.m. to 12.30 p.m.
The Express learnt the event was initially scheduled to cater for 300 people, but the number escalated to 500 and then to 956 in the past week.
Attendees will be informed of the various fertility treatments available.
However, both Dr Skinner and Dr Catherine Minto-Bain, medical director of the Trinidad and Tobago IVF Fertility Centre, have warned women against the unmanaged use of fertility drugs.
They stressed that having six babies is extremely dangerous and should not happen again, as both mother and babies are at high risk.
Both doctors also emphasised their institutions were regulated, accredited and on par with international best practices, and would not encourage multiple pregnancies because of the dangers to human life.
The doctors also stated Lee Foon was not a patient of theirs.
The Express understands Lee Foon took prescribed fertility drugs, which led to her multiple pregnancy.
Skinner said the birth of the sextuplets was not a success story, as it should not have happened in the first place.
She explained that when Clomid is used, it is a case of ovulation induction where the follicles are stimulated.
Skinner said ultrasounds must be done to check the response to the drug.
"...And that clearly wasn't done in this patient because she wouldn't be pregnant with six babies," said Skinner.
"We know that an awful lot of patients in this island get Clomid over the counter, so they aren't taking it from a doctor, they're actually taking it themselves—and that's dangerous. That (sextuplets) should not have happened if she was being cared for properly," she added.
She said in the event that a patient has six embryos, the current stance internationally would be that the patient be strongly advised to have a selective reduction of that pregnancy.
Skinner said the flip side of this story is the success of the local health care system in the management of the babies.
"Hats off to the Trinidad health care system and that team of doctors and nurses and the ICU carers right now... But is this a success story? No, this is a bloody disaster. Because remember, for this success story there are very many other pregnancies that ended very badly," said Skinner.
She explained that in the use of fertility treatment, a single baby was the best-case scenario, as even twins carried risks.
Skinner also reassured that the use of Clomid was safe, with proper management.
The sextuplets, she said, still have a long journey ahead of them.
She said in cases of extreme prematurity—which is less than 28 weeks old—the babies suffer long-term consequences: they are developmentally abnormal, in that they may not walk and talk properly.
She said a large percentage of premature babies also have lung and gut problems.
Skinner said even if premature babies survive the odds, they run the risk of being handicapped for life.
"These babies (sextuplets) are not out of the woods, they still have a long way to go. They still have challenges ahead of them," she said.
"We are going to be dealing with the aftermath of this ourselves at fertility clinics, because what's actually going to happen are patients are going to think it's okay to put in more embryos and it's okay to take risks. It's not," she said.
She said in a patient under the age of 35 years, no more than two embryos would be encouraged.
Skinner said if her advice had been sought in the case of the sextuplets, she would have advised fetal reduction.
Lee Foon, she said, was quite lucky her babies are alive and doing well.
She warned, however, that there are risks in multiple pregnancies. The mother puts herself and her babies at risk and they can all die or end up handicapped for the rest of their lives.
Minto-Bain pointed out that this was a problem in this country, as it is in other parts of the world—that there are prescriptive fertility drugs that are not well regulated.
She stressed the drug—clomiphene citrate—comes in different brands. Clomid is one of them which is widely used and considered safe, once managed properly. See sidebar above.
On Thursday, Health Minister Dr Fuad Khan told the Express he was unaware Lee Foon had taken fertility drugs; and multiple births were not only risky, but cause a strain on the health sector. Khan said he would work on bringing legislation through the Tissue Act to regulate fertility treatment.
Minto-Bain said she understood the minister's point. "We should be regulating the use of this drug, whether it is tablets, injections or IVF, because multiple pregnancies aren't healthy and he's (Khan) quite right in saying we shouldn't be creating these pregnancies unless it happens naturally and that's a one in a million chance. This shouldn't be happening over and over again. It's not healthy for mother or babies," she said, adding that it was also a huge drain on resources.
Minto-Bain praised the team of doctors and nurses at Mt Hope Women's Hospital who were caring for the sextuplets, but added that there was concern about the long-term health and well-being of the children.
Minto-Bain noted there were many women in this country who suffer from polycystic ovary syndrome and use clomiphene, and there should not be any fear in doing so.
The clinic, she said, has received hundreds of calls from women who are on the drug expressing fear that they were going to have multiple pregnancies. However, Minto-Bain said once the international best practice is followed and there are ultrasound checks, then there was nothing to worry about.
"We have hundreds of patients getting pregnant with clomiphene every year, but you use it safely and a certain dose. You don't go above 150 milligrammes and you do ultrasound to check—and if you're making more than the expected number of eggs, then your cycle is cancelled and you drop back on the dose," she said.
Minto-Bain said there is an absence of sufficient facilities to manage multiple pregnancies and also people cannot afford the type of care and long-term input that is required.
"Generally, premature babies will spend some time on the neonatal unit, requiring help to grow and eat and fight off infections. But longer term over the coming years sometimes they have problems with intellectual development, they need more help from an educational point of view, they can have long-term breathing and respiratory problems or sight problems," said Minto-Bain.
She said the fact that five of the six babies were breathing on their own and off ventilator support was an achievement for the Mt Hope neonatal unit and they should be congratulated.
"One of the things we see here in Trinidad and Tobago is women who have infertility problems truly desperate and they would go to anyone and do anything, and the problem is that overseas and in the Caribbean region where there is no regulation or legislation in place, clinics make an awful lot of money doing fertility work and multiple pregnancies don't matter to them. It goes down as a success in their clinic," she said.
Clinics and physicians, she said, need to be very ethical about what they do and that was why she welcomed Khan's recommendation for legislation.
Clomiphene citrate is indicated for the treatment of ovulation dysfunction in women desiring pregnancy. It initiates a series of endocrine events culminating in a rise of follicle stimulating hormone (FSH).
How it works
Clomiphene citrate comes in a pill, which a woman will begin taking on the third to the fifth day of her menstrual cycle.
The typical starting dose is one 50-milligramme tablet per day for five days. If a cycle is unsuccessful, the healthcare provider may increase the dose by 50-milligramme increments in subsequent cycles.
Clomiphene citrate "tricks" the body into believing the level of estrogen is low. As a result, the hypothalamus in the brain sends a signal to the pituitary gland to release more FSH and luteinising hormone (LH) into the bloodstream.
The high level of FSH, in turn, stimulates the development of a follicle and egg. If the treatment cycle is successful, a surge of LH may occur about a week after the last pill is taken.
This surge of LH causes the egg to be released, in a process called ovulation. In some cases, the treatment may result in more than one egg.
If ovulation does occur, fertilising the released egg, either through timed intercourse or intrauterine insemination, is the next step.