The 2021 birth of the Hali nonuplets was an extraordinary medical event. This delivery of nine babies captured global attention, setting a new record for the most children to survive such an occurrence. The Malian family’s story highlighted the complexity of multiple pregnancies and the rare circumstances leading to such a large number of births.
The Hali Nonuplets: Their Conception Story
Halima Cissé, the Malian mother, conceived naturally, without fertility treatments. Early scans initially showed seven fetuses. A transfer to a specialized Moroccan clinic, arranged by the Malian government, revealed the full extent of her gestation. During a Cesarean section at 30 weeks, two additional babies were discovered, bringing the total to nine. The nonuplets (five girls, four boys) were born weighing 0.5 to 1 kilogram each.
Natural Multiple Pregnancies Explained
Natural multiple pregnancies occur when more than one fetus is conceived. One common mechanism is hyperovulation, where the ovaries release multiple eggs in a single menstrual cycle. If each egg is fertilized by separate sperm, it results in fraternal or dizygotic multiples, who are genetically distinct. Identical or monozygotic multiples, in contrast, form when a single fertilized egg splits into two or more embryos, sharing identical genetic material.
Factors increasing natural multiple births include a maternal family history of multiples and advanced maternal age. Women over 30 may experience increased follicle-stimulating hormone (FSH), prompting the release of more than one egg.
Fertility Treatments and Multiples
Assisted reproductive technologies (ART) increase multiple pregnancy probability. Procedures like In Vitro Fertilization (IVF) often stimulate ovaries to produce multiple eggs. Retrieved eggs are fertilized in a laboratory, and several embryos may be transferred into the uterus.
Ovulation induction, another common fertility treatment, uses medications to release multiple eggs. Though often aiming for a singleton, these treatments can fertilize multiple eggs, resulting in twins, triplets, or higher-order multiples. Medical professionals monitor cycles, sometimes canceling them if too many follicles develop, to reduce high-order multiple birth risks.
Why Nonuplets Are So Rare
Nonuplet pregnancies are extremely rare, whether conceived naturally or with assistance. The statistical probability of conceiving and carrying nine fetuses is extremely low. For instance, spontaneous triplets occur in about 1 in 10,000 pregnancies, with quadruplets even rarer at 1 in 700,000.
High-order multiple pregnancies carry substantial risks for mother and babies. Extreme prematurity is the most common complication; nearly all higher-order multiples are born before 37 weeks. Early birth contributes to low birth weight and underdeveloped organ systems, increasing the need for intensive neonatal care.
Mothers carrying nonuplets face heightened risks, including gestational hypertension, anemia, and increased Cesarean section likelihood. Physical demands are immense, with elevated risks of complications like placental issues and hemorrhage. Due to these challenges, medical guidelines aim to prevent such high-order multiples, even in fertility treatments, prioritizing health and safety.