Self Magazine Examines Issues Related To Multifetal Reductions After Fertility Treatments

Main Category: Women's Health / Gynecology
Also Included In: Fertility;  Pregnancy / Obstetrics
Article Date: 31 Mar 2009 - 4:00 PDT

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Self magazine in its April 2009 issue examines issues surrounding multifetal reduction, a procedure used to reduce the number of fetuses in pregnancies with triplets or more, typically as a result of infertility treatments. According to Self, high-risk obstetricians typically recommend the procedure to avoid risks associated with multiples, including potentially fatal blood pressure swings in the woman; higher odds of developing gestational diabetes, anemia and kidney infections; premature birth; cerebral palsy in the infants; or death of the infants shortly after birth. Patients are usually told by high-risk obstetricians that the choice to reduce the number of fetuses is "not a matter of mere convenience but of life and death," Self reports. The procedure, which poses few risks to the woman, was developed in the mid-1980s in conjunction with the increase in women seeking infertility treatments like in vitro fertilization and intrauterine insemination. It involves injecting potassium chloride into the embryonic sac to stop the fetal heartbeat.

Self reports that pregnancies involving multiple fetuses, "even twins, can be a dangerous proposition," as the odds of spontaneous miscarriage increase from 1% with one fetus to 9% for triplets and continue to increase with each additional fetus. The risks of developing conditions like preeclampsia also increase in women pregnant with multiples, and nearly all multiple deliveries occur via caesarean section. The infants can "face a host of issues that often land them in the hospital's neonatal intensive care unit for months," most commonly as a result of preterm delivery, considered any time before 37 weeks' gestation, Self reports. As the number of fetuses increases, the average gestational age at delivery decreases, from 39 weeks for women pregnant with one fetus to 31 weeks for quadruplets. Harish Sehdev, a doctor at Pennsylvania Hospital in Philadelphia, said, "Part of our job is to help women deliver healthy babies. And sometimes that means offering a reduction." He added, "We can never tell in advance how far along a woman will go or what problems she'll have. All we know is that the hazards are pretty high when you're talking about multiples. For a lot of people, they're too high."

Self reports some people "equate multifetal reduction with abortion and insist it's wrong to sacrifice one fetus for the sake of another." Jeffrey Keenan, medical director of the National Embryo Donation Center and a member of the Christian Medical Association, said he is skeptical that everyone who chooses a reduction actually needs one, particularly women who are pregnant with triplets. Keenan said, "Like abortion, it's a matter of convenience because parents say they can't handle three or don't have room or won't get sleep." He added, "Do we want a utopian society, where every pregnancy is exactly what you want, with no complications? Life's not like that. If you want that, don't get pregnant." Some women considering multifetal reduction "hide it from loved ones, instead sharing their anxieties via Internet support groups," and physicians who perform the procedure can be "wary of discussing it" publicly, according to Self. Sean Tipton, a spokesperson for the American Society for Reproductive Medicine, said that for some physicians, discussing the procedure publicly is "a bit like inviting someone with a shotgun onto your front lawn."

According to Self, there are "no good statistics" on the number of reductions that occur annually because doctors are not required to report them. Anecdotally, doctors estimate that the number peaked in 2000 and has since declined with improved infertility techniques. In addition, ASRM has issued IVF guidelines that call for implanting one embryo in women younger than age 30 and two in women ages 30 to 35 (Patel Shepelavy, Self, April 2009).

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