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Multiple Births
Posted on January 11th, 2012
On 28 December 2011, The Daily Telegraph reported that there has been a dramatic rise in the number of so-called ‘selective reductions’ to women with multiple pregnancies, whereby one or more foetus(es) is terminated, but the pregnancy is continued with one or more other foetus(es).
The figures show an increase from 59 ‘reductions’ in 2006 to 85 during 2010, however there are no corresponding figures released regarding any increase in the numbers of IVF cycles and pregnancies over the same period, which means that although there is an increase in numbers, they do not indicate whether there has been a corresponding increase in multiple pregnancies in the same period. Separate figures show that although one third of the selective abortions involved pregnancies that were a result of fertility treatment, the remaining two-thirds did not involve such treatments.
Multiple pregnancies are more dangerous to both mothers and babies and most termination decisions are still made on the baby being seriously handicapped once born, as are similar decisions for singleton pregnancies. The risks of both prematurity and handicap are increased with a twin pregnancy and increase greatly with three babies or more. Older mothers are naturally more likely to have multiple pregnancies than younger women and in addition, many of the pregnancies achieved using IVF are often to older mothers who have and have had to go down the lengthy IVF process before achieving a pregnancy. Older mothers have an increased chance of having a child with Down’s Syndrome whether the pregnancy is a singleton or multiple; by natural conception or by fertility treatment.
An alternative reason that parents consider a selective reduction is to increase the chance of getting the pregnancy to a successful delivery, as multiple pregnancies usually lead to premature delivery of the babies, with prematurity increasing as the number of babies increases, to the point of non-viability.
Long waiting times and high costs of IVF treatment mean that although women are encouraged to have a single embryo implanted, despite the risks they often still wish to maximise their chances of a successful cycle and see the implantation of more than one embryo as a way of achieving this. This will continue to be an issue whilst the treatment costs are so high. If a more achievable fee structure for fertility treatment can be made, then couples may be more likely to have cycles of treatment with the aim of achieving a singleton pregnancy.
Several comments regarding this controversial procedure have been with well-rehearsed arguments regarding the moral use of fertility procedures and terminations in general, rather than the specific weighing up of risks to babies and mothers in a multiple pregnancy.
All decisions regarding abortion need careful weighing up of risks and circumstances, but to take a pragmatic decision regarding selective reduction will be particularly difficult given the possible loss of the entire pregnancy (either as an indirect result of the procedure or by doing nothing and all the babies being born too early to survive). The difficulty will be further increased by the relative rareness of the procedure meaning that couples will probably not know anyone who has been in the same situation as them and indeed many professionals may not have come directly across the situation before.
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