Most pregnancies with three early gestation sacs (each sac usually contains one embryo) reduce spontaneously. In one study, there were 38 pregnancies with three gestation sacs between three and four weeks after IVF/embryo transfer. At delivery there were seven single babies, twelve twins and eighteen sets of triplets.
Selective termination is a procedure usually employed when one fetus is found to have a significant abnormality with the objective of allowing the pregnancy to continue with the expectation of delivery of the remaining healthy infant(s). Multifetal pregnancy reduction is the termination of one or more seemingly healthy fetuses with the objective of reducing the risks of higher order multiple pregnancies. Recent analysis of data from North East London showed that the neonatal death rate (babies dying in the first four weeks per 1000 live births) for a singleton pregnancy is 3.4, for twins 25.4 and for higher order it is 93.8. Multifetal pregnancy reduction has been shown to improve the perinatal outcome for pregnancy with four or more fetuses, although there is a 9% risk of losing the entire pregnancy.
The ethical issues associated with selective termination of a fetus with significant abnormality are identical to those pertaining when there is only one fetus. The ethical issues relating to multifetal pregnancy reduction are far more complex as it involves the sacrifice of one or more normal fetuses for the benefit of the remainder. Interestingly, a psychological assessment of surviving offspring and their parents in Holland found no adverse effects.
Related Medical Abstracts - Click on the paper title:-
- Information-sharing among couples considering multifetal pregnancy reduction. (2007-01)
- Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. (2006-01)
- Lived experiences of Taiwanese women with multifetal pregnancies who receive fetal reduction. (2006-02)
- Two hundred ninety consecutive cases of multifetal pregnancy reduction: comparison of the transabdominal versus the transvaginal approach. (2004-01)
- Embryo reduction versus expectant management in triplet pregnancies. (2004-02)
- Obstetric outcome and psychological follow-up of pregnancies after embryo reduction. (1999-01)
- Multifetal reduction increases the risk of preterm delivery and fetal growth restriction in twins: A case-control study (1997)
- Psychological reactions after multifetal pregnancy reduction: A 2-year follow-up study (1997)
- The current status of multifetal pregnancy reduction (1996)
- Pregnancy outcome after multifetal pregnancy reduction to twins compared with spontaneously conceived twins (1996)
- Follow-up of pregnancies, infants, and families after multifetal pregnancy reduction (1994)
- Improved results in multifetal pregnancy reduction: A report of 72 cases (1994)
Please click on the required question.
- 1 How successful is infertility treatment?
- 2 How can we compare infertility treatments?
- 3 How can we compare outcomes between different fertility units?
- 4 Are treatments for infertility improving?
- 5 Is there an increased chance of miscarriage following infertility treatment?
- 6 Is there an increased chance of ectopic pregnancy following infertility treatment?
- 7 What is a heterotopic pregnancy?
- 8 What problems can occur with multiple pregnancy?
- 9 What is selective termination of pregnancy?
- 10 How can the pregnancy risks following infertility treatment be reduced?
- 11 We have had infertility treatment which has been successful. How will our pregnancy be cared for?
- 12 If we have infertility treatment, will our baby be healthy?
- 13 What are the psychological effects of infertility? information?
- 14 Where can I obtain more information?
- 15 Infertility Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
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