Selective Reduction and its Effects

Embryo Reduction

An increase in the use of In Vitro Fertilization treatment techniques by childless parents has resulted in an increase in multiple births such as twins and triplets. Since the IVF is a high-cost procedure when compared to other fertility treatments, most couples want to be assured of a successful pregnancy and childbirth in the first few attempts. As a result embryologists will often introduce more than one embryo for better and faster IVF results. This has the side effect of increasing the chances of conceiving twins, triplets, or even quadruplets or quintuplets, which is unexpected for many couples.

Whether due to financial or emotional reasons many parents would prefer to avoid this outcome. There are ways to limit the chances of developing multiple children during the pregnancy, but these are not often discussed by doctors with the mothers-to-be as most of these procedures come with a certain amount of risk to both the mother and the child. In a case where a couple has developed multiple fetuses, most doctors recommend a selective reduction for medical reasons.

In selective reduction, one or more of the fetuses are aborted in the early stages of the pregnancy to allow the remaining fetus or fetuses to thrive. There are many health concerns relating to carrying multiple fetuses, so obstetricians will reduce them down to twins to ensure a safer outcome. This procedure prioritises fraternal twins, as they are identical and share the placenta which cannot be easily separated.

In some cases obstetricians have turned to selective reductions in the case of twins as well. This may not always be due to medical reasons but instead performed due to the parent’s requests. They may feel insecure in raising more than one child for financial or emotional reasons, so instead plan to have just one baby.

Situations like these require serious discussions with the parents as not only is the fetus’ life at stake, but by selective reduction we are also putting the surrogate’s health at risk – as per our service policy, we are committed to providing health security to our surrogates, and even minor risks to her health are ruled out. The moral dilemma must be discussed at length with the parents, surrogate, and health professionals before making a decision.

Our obstetricians and selective reduction experts emphasize that the procedure should not be performed unless there is a medical need. The desires of the intended parents do not come ahead of the surrogate or baby’s health. However, we are open to discussion and ready to proceed with the best possible solution for the parents, surrogate, and the babies together.

In Ukraine selective reduction is legal, but only on triplets or above. Performing this procedure on twins is not legal outside of extenuating circumstances as they share the same placenta.  Many other countries also have laws in place that only allow pregnancies to be reduced down to two, as medical ethics do not allow further reductions.

Psychological Effects of Selective Reduction

Some obstetricians may argue that there is a medical justification for reductions in the case of twins, but this highly contentious procedure is risky for both the carrier and the child.

Twins are born in perfect health in most cases of IVF. It might be logical to perform a reduction on 8 fetuses to bring them down to 2 or 3, but reducing twins is much harder to justify. The motivation behind reducing the numbers of fetuses may also be based on personal preferences. Many people argue that women should be able to abort pregnancies on the basis of personal preference, but others argue that they should not be able to discard the unwanted fetus at will or endanger the life of the remaining fetuses.

The moral questionability of twin reductions is raised in several psychological welfare affairs. Many are against the execution of reduction procedures by affluent parents, who go through the procedure only for the sake of having the desired number of children and no more. At the time of making these decisions, parents do not know what the future has in store for them. For example, they may end up with further difficulties with pregnancy in the future, and be unable to have any more children. It is important that the parents are absolutely sure of their decision to perform a reduction to avoid regret and grief in the future.

It is common for couples to reduce quadruplets to twins. However, it’s often the case that if the twins are born healthy, the parents start to feel guilty as they think that perhaps all four would have arrived healthy. This is a common period of grieving that many couples go through. Women who have faced difficulties in getting pregnant are at a higher risk for post-partum depression. By undergoing reduction they are even more likely to suffer psychologically. Our priority is to always provide information about all possible risks and outcomes when the couple is deciding on whether to have a reduction.

We do not oppose selective reduction, but rather commit ourselves to better educating the couples about the effects they may experience in reducing the fetus. Of course, selective reduction is at times absolutely necessary to save the lives of the remaining fetuses as it provides room for a healthy delivery. Couples should first consider the medical factors of selective reduction to avoid regrets in the future.