Sondra Headrick is in the 27th week of a pregnancy perilous for herself and the six babies growing inside her. Her sextuplets resulted from the use of powerful drugs that stimulate the ovaries - the only fertility treatment Sondra and her husband, Eldon, could afford.

Doctors say the dangerous though rare outcome could have been avoided if the Headricks had had access to a more costly infertility treatment called in vitro fertilization, or IVF.

IVF allows doctors more control over how many babies a woman ends up carrying. But it costs about $8,000 a cycle, compared with $1,000 to $1,500 a cycle for fertility drugs.

And few health insurance plans cover IVF. Kansas is among 36 states that do not require insurers to offer some fertility coverage.

It’s an issue more couples will face as a growing number seek treatment for infertility.

“The decisions we have to make are not driven by ends-based medicine,” said David Grainger, a Wichita fertility specialist who treated the Headricks. “They’re driven by the economics of what the patient can afford.”

But insurance companies counter that they can’t cover everything.

“Insurance started out as a way to fund catastrophic illnesses,” said Jill Sumfest, chief medical officer of Preferred Health Systems, the Headricks’ insurer. “That’s evolved somewhat, but there are still questions: Is it the responsibility of a health plan that is normally treating an illness or an injury to also pay for fertility services? That’s still a debatable point.”

Multiples on the rise

The number of multiple births has risen as more people seek advanced fertility treatments. In 1980, before the treatments were widely available, 1,377 babies were born in pregnancies involving triplets or more nationwide. In 1999, 7,325 were born.

But triplets and larger sets of babies are 10 times more likely to die than single babies. They are usually born prematurely and face heightened risks for birth defects, including vision problems, digestive problems and cerebral palsy.

About one out of four women who conceive using high-strength fertility drugs will have twins or more. About 7 percent of those will be triplets or more, studies show.

Federal statistics show that pregnancies involving triplets or more have been as common among women who use IVF as those who use the kind of fertility drugs that Sondra Headrick used.

What those statistics don’t show is how many of the triplet-and-more pregnancies involved four, five, six, seven or eight fetuses - and the danger to the mother and children rises dramatically at each of those steps.

In IVF, eggs and sperm are mixed in a laboratory, creating embryos to be inserted directly into a woman’s uterus.

The patient and doctor choose the number of embryos and can eliminate the possibility of high-order pregnancy altogether.

In contrast, “You have no control with the drugs,” said Alan DeCherney, chairman of the department of obstetrics and gynecology at the school of medicine at the University of California at Los Angeles.

Vigilant monitoring can reduce but not eliminate the risk.

In Sondra Headrick’s case, doctors saw nothing to indicate that the drugs had caused her ovaries to release so many eggs, which were then fertilized.

With IVF, doctors can keep that from happening.

Some doctors performing IVF choose to insert as many as six or eight - because odds are that only about 1 in 4 will implant and grow.

But they can also choose to put in less. Grainger’s clinic averages fewer than three per patient.

If IVF were more widely covered by insurance, doctors point out, they might insert just one or two at a time - knowing if it didn’t result in a pregnancy, their patients could try again without fear of prohibitive costs.

That was the implication of a study by Massachusetts researchers presented in 1998 showed that multiple birth rates were substantially lower in states that mandate IVF insurance.

Grainger operates one of the state’s three major fertility clinics and the only one in southern Kansas.

Only about 5 percent of his patients are insured for IVF, he said. They usually work for large, out-of-state companies.

Political concerns

In seven years on the state House Insurance Committee, Bob Grant, D-Cherokee, has never seen infertility coverage even discussed.

He predicted any effort to bring it up would be entangled in abortion politics.

That’s because IVF treatments sometimes involve the creation of excess human embryos that are frozen or destroyed.

The only bill dealing with IVF now includes the procedure on a list of treatments that doctors, hospitals and insurers could refuse to provide as a matter of conscience. The legislation, which cleared a House committee on Friday, names IVF along with abortion, euthanasia, infanticide and physician-assisted suicide.

Pat Turner, the state vice president of Right to Life of Kansas, said she sees the destruction of lab-created embryos as murder and high-tech fertility treatment as interference with God’s plans.

“I feel for those people - they just want to have babies,” Turner said. “(But) maybe we are not all supposed to have children.

“Maybe with counseling they could find other means of satisfying that desire without having to be accomplices in the destruction of the very lives they’re trying to nurture.”

What they could afford

The Headricks picked drug treatments because they simply couldn’t afford to pay for the more costly in vitro procedure.

Eldon Headrick works as a storm drain cleaner for the city of Wichita. Sondra Headrick was a hospital billing clerk.

Their quest for a second child cost them considerably.

They said they spent somewhere between $3,000 and $4,000 out of their own pocket to achieve their current pregnancy.

Insurance did pay for part of the procedure, mainly the artificial insemination the doctor recommended in conjunction with the drug treatments.

Eldon said he sees a double standard in the insurance company decisions.

“They cover stuff like Viagra for men with impotence,” he said. “Why not cover fertility as a medical problem?”

Medical care for Sondra and their babies is projected in the millions of dollars.

“If you ask me, it would be cheaper to pay for IVF,” he said.

Playing the odds

But insurance companies don’t make coverage decisions based on exceptional cases like the Headricks. Even with fertility drugs, the risk of becoming pregnant with more than three is just 1 percent.

“The fact is, overall in our industry, I don’t think we’ve seen many multiple births,” said Sumfest of Preferred Health Systems.

Sumfest said it’s cheaper to cover their sextuplets than to provide all infertile couples with IVF treatments.

With employers pressuring insurance companies to keep down premiums, it’s hard to justify expanded coverage for infertility, she said.

But reproductive specialists say infertility is a disease like any other.

“I think the patients who are affected should have the benefits of medical care just like any other disease,” said physician Sandra Carson of Baylor University Medical Center in Texas, the president-elect of the American Society of Reproductive Medicine.

Sumfest emphasized that in cases like the Headricks’ sextuplets, the insurance company is there.

“I’m focused on making sure that Sondra gets the best care she can, and that we keep the babies as healthy as we can.”