For a woman who desperately wants a baby but has been unable to conceive, the thought of having the opportunity to have more than one child may seem like a miracle. This is why I was so thrilled to find out that a friend who had been suffering from infertility for several years had finally become pregnant with the help of in vitro fertilization. I remember listening to her talk as far back as high school about how much she wanted children and how she couldn’t wait to find the right guy, settle down and start a family. The first part of those dreams happened quickly for her. In fact, she married her high school sweetheart during college. Years passed though, and no baby arrived. She finally admitted she and her husband were coping with infertility and would be undergoing fertility treatments as a final attempt to have the child they so desired. Three cycles were unsuccessful, and she was nearly ready to give up. She decided to take one more chance, and when she found out that cycle had worked, she was elated. Two months later though, everything changed.

Because of her history with unsuccessful attempts, her fertility specialist made the decision to implant three embryos to give her the best chance.  She was only eight weeks pregnant when her doctor made the shocking announcement that she was pregnant with not one baby and not even twins. She was carrying five tiny fetuses. Her elation was quickly dampened with the doctor cautioned her about the risks of carrying high-order multiples. She was immediately presented with the most difficult decision she would ever be asked to make: whether to take the risk or “reduce” her pregnancy.

The concept of multiple pregnancy reduction is based on the lower risks of carrying twins or singletons as opposed to three or more babies. Those in opposition of the procedure consider it selective abortion, while supporters point to increased chance for both mother and babies to be carried safely. Research has indicated that such reductions place the surviving babies at risk of intrauterine growth restriction, severe prematurity, and even total loss.

The reality is, multiple pregnancy reduction is still considered by many to be a developing procedure. Though the devastating outcomes of total pregnancy loss, prematurity, and growth restriction are lessening with greater experience, parents are faced with a gut-wrenching decision based entirely on the unknown. Mothers who have been struggling for years to conceive are being asked, essentially, in which way they want to risk the lives of their babies. For those who are, themselves, at serious risk, it may be the only option. Research has indicated high order multiple pregnancy reductions in which pregnancies of triplets or more are reduced to twins, once beyond the actual reduction procedure, have approximately the same success rate and characteristics in terms of prematurity and growth restriction risk as non-reduced twin pregnancies.

It is always the parents’ choice whether to reduce a multiple pregnancy or attempt carrying all of them. Whichever way the choice goes, it has to be the most difficult one a parent could ever have to make.

Source: Evans, Mark et al. Improvement in outcomes of multifetal pregnancy reduction with increased experience. American Journal of Obstetrics and Gynecology,  2001. Vol. 184, Issue 2, pp 97-103.