ALEXANDRIA, Egypt - The 27-year-old woman and her husband already had three children — all girls. They badly wanted a boy, and she had not conceived in five years, so doctors gave her hormones.

The startling result was healthy septuplets — four boys and three girls — heralded by Egyptian doctors as a miracle. But debate persists about the ethics of fertility treatment in a nation where medical oversight is lax, incubators and neonatal respirators are rare, and many families face pressure to have a son.