Foetal Reduction in Multiple Births

While doctors treat foetal reduction as a deeply regrettable, but necessary and sensible course of action, it is acknowledged that it places a heavy burden on parents.

  • It is estimated that modern fertility techniques in the US are responsible for 75% of multiple gestations.
  • A bioethical institute argues against embryo reduction.
  • There is an increase in maternal-foetal complications, in direct proportion to the number of embryos present in the uterus.
  • A pregnancy with more than three embryos is considered an iatrogenic complication of ART.
  • Tina and Ron Otten rejected the idea of ending the lives of their babies before birth.
It is one of the most agonizing dilemmas in modern medicine. Desperate for children of their own, a couple seek fertility treatment and discover that mother is carrying four, five, or six babies.

The doctors advise that unless the number is reduced, the other babies will possibly die, or be born premature and deformed.

The parents are told that "selective reduction" involves the doctor selecting the most accessible foetus, then inserting a needle containing a potassium chloride solution into the heart.

The doctor may recommend this treatment for more than one foetus, so that the remaining twins may have the best chance of survival.

One woman who was determined to carry all four of her babies, had a series of doctors who kept trying to tell her to "reduce her pregnancy". One specialist in particular was "overbearing" and "made me feel foolish".

"...I don't think enough doctors give women the feeling that they have a choice."
She managed to find a perinatalogist who had experience with multiple births, consulted support groups and went ahead with the quad pregnancy. "If we had listened to what the majority of the doctors say, we wouldn't have them," she said of her quads. "...I don't think enough doctors give women the feeling that they have a choice."

A case study
Most websites covering this issue acknowledge the heavy burden placed on parents. The doctors treat fetal reduction as a deeply regrettable, but necessary and sensible course of action.

The situation is particularly acute for Christian parents with strong anti-abortion views. Linda Mintle, Ph.D., in the USA, provides a real-life example of how one couple faced the decision.

Bob and Jan tried IVF and four viable embryos were transferred to her uterus and all began to grow. Jan was going to have quadruplets. They were shocked when the doctor recommended they consider "selective reduction", in order to give one or two of the foetuses a better chance of survival.

The decision would be theirs, the best time to carry out the selective reduction would be at 12 weeks.
He explained that there were several factors to consider. Jan was small-boned and petite, thus her body would have difficulty making room for four babies. Other risks were premature birth, and cerebral palsy. He was legally required to tell Bob and Jan of their right to selective reduction. The decision would be theirs, the best time to carry out the selective reduction would be at 12 weeks.

It is estimated that modern fertility techniques in the United States are responsible for 75% of multiple gestations. About 40% are due to fertility drugs and 35% from IVF.

Bob and Jan were now faced with a moral dilemma, whether to abort one or more foetuses to save the lives of the others. They were told that possibly all the developing foetuses would die, if they did not choose the selective reduction option.

Because Bob and Jan believed that human life begins once an egg is fertilized, "reducing" meant abortion. Since they did not believe abortion was a right moral decision, they felt they had to refuse the offer of "reduction".

The doctor insisted that they see another specialist who would support his recommendation to abort two foetuses.
Another opinion
The doctor insisted that they see another specialist who would support his recommendation to abort two foetuses. He believed Bob and Jan were in denial about the potential dangers to the developing babies, if they did nothing.

They agreed to hear the second opinion, but still held firm that abortion was out of the question. They couldn't face their children some day and tell them they decided to end the lives of two potential brothers and sisters.

Fully aware of the risks, Bob and Jan decided to continue with the pregnancy. At 13 weeks, one baby died, the second at 14.

The two surviving babies were born at 32 weeks. Both had breathing difficulties and physical problems. Despite all the loss and heartache, Bob and Jan were at peace, knowing they did not choose who would live or die.

Not all cases of multiple births end like this. Bob and Jan had friends who went through IVF and healthy triplet girls. One friend was advised to reduce one of her twins, chose not to, and gave birth to two boys who had a rough first year, but developmentally caught up. Another friend lost both babies at 17 weeks.

They wished someone had explained the risks of multiple gestations to them prior to conception
In retrospect
After the birth of their twins, Bob and Jan reflected on the experience. They wished someone had explained the risks of multiple gestations to them prior to conception. In their desire to achieve pregnancy, they never really considered the possibility of multiple births, even though it was mentioned several times.

A bioethical institute argues against embryo reduction
A member of the Bioethic Centre at the Catholic University in Rome, sets out the case against fetal reduction:

  • Research funds and researchers' energy would be better directed towards improving medical hormonal treatment, and the assisted fertilisation protocols, rather than refining embryo reduction techniques.
  • The incidence of multiple pregnancies with a large number of embryos (four or more) has increased over the last few years, because of an uncontrolled and unscrupulous use of assisted reproduction techniques (ART).
  • Many physicians consider that introducing more than one embryo in the woman's uterus, increases the possibility that at least one of them will implant itself, and that the pregnancy will continue. It often turns out that all the embryos introduced in the uterus implant themselves, so some pregnancies occur with seven or more embryos.
  • In tandem with the increase in the number of embryos (in particular more than three), there is an increase in maternal-foetal complications, in direct proportion to the number of embryos present in the uterus. In particular, the percentage of preterm deliveries increases, and a preterm infant risks serious metabolic and neurological problems.
  • This is why a pregnancy with more than three embryos is considered an iatrogenic (that is: problem resulting from medical treatment or diagnosis) complication of the assisted reproduction techniques.

It has been recommended that the number of embryos introduced into the uterus, should be strictly limited, to avoid reduction.
Ethical considerations summarised
The American Association of Obstetricians and Gynaecologists recommends that the number of embryos introduced into the uterus, should be strictly limited, so as to avoid any future need for selective reduction.

One of the greatest advances that could be made in the field of reproductive medicine would be to be able to reduce the transfer rate with In Vetro Fertilization (IVF), to no more than two embryos.

A Couple Who Rejected "Selective Reduction"
Tina and Ron Otten underwent fertility treatments to conceive their two older daughters, and used the identical method when they wanted to conceive for a third time.

They never dreamed the same injected fertility drug, would result in a pregnancy of six babies.

The Ottens rejected the idea of ending the lives of their babies before birth.

"We asked them not to even discuss it with us again," Ron Otten told a Belleville, Illinois newspaper. "We can't play God." Read the story here