Medicine: Too Much of a Good Thing? <

Smiling wanly, Patti Frustaci stood proudly outside Childrens Hospital in Orange County, Calif., holding tiny Stephen Earl in her arms. After nearly 20 weeks in intensive care, the last of her three surviving septuplets was finally on his way home. But last week, only four days after that seemingly happy occasion, Patti and her husband Sam filed a $3.25 million malpractice suit in Los Angeles County Superior Court against both the clinic and the physician who administered the fertility drugs responsible for the conception of Stephen Earl and his six siblings. Said Patti: “Life will never be what it was before we began this treatment.”

The Frustacis’ suit charges Dr. Jaroslav Marik, 52, and the Tyler Medical Clinic in West Los Angeles with medical malpractice, four wrongful deaths and the loss of earnings as a result of prescribing “excessive and inappropriate dosages” of Pergonal and HCG (human chorionic gonadotropin). The Frustacis also claim that the doctor and clinic failed to monitor Patti’s progress on the drugs. Both Marik and the clinic have refused to comment on the allegations.

Part of the claim is intended to cover the continued medical expenses of the three survivors. Two of the infants still suffer from a lung ailment that requires the continuous administration of oxygen at home, and their mother says she cannot resume work as a high school English teacher because of the time required to care for her children.

The principal drug in question, Pergonal, is a mixture of hormones extracted from the urine of postmenopausal women. It is used to stimulate the maturation of egg-bearing follicles in the ovaries of women who are infertile because their natural hormonal secretions are either low or out of sequence. In most cases, the drug causes the maturation of a single follicle, which can then be induced by HCG to release its egg into the fallopian tube for fertilization. But the exact amount of Pergonal required to cause just one follicle to mature rather than three or four–or in this case seven–varies from patient to patient. As a result, repeated monitoring of Pergonal’s effect is essential. Says Dr. Roger Lobo, chief of the division of infertility at U.S.C.: “We do not give Pergonal unless we are able to monitor.” One monitoring procedure consists of measuring levels of the hormone estrogen in a patient’s blood or urine. As the follicles mature, hormone levels gradually increase. The higher the estrogen level, the likelier it becomes that more than one egg has matured. Another procedure is the sonar-scanning technique called ultrasound, which produces black-and-white images of a woman’s ovaries upon which the number of ripening eggs can be counted. Multiple pregnancies can usually be avoided by using one or both methods. In spite of their ordeal, the Frustacis have faith in drugs like Pergonal. Said Patti: “I want to emphasize that we still believe in treatment for fertility.”