Selective Reduction: A Painful Choice

In this article:
The Most Difficult Choice
From Six to Three
No Options Discussed
Lingering Uncertainties
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As the use of infertility drugs rises, so does the number of multiple births. These pregnancies come with some risks and decisions required, the most extreme being the difficult issue of selective reduction.

It's one of life's tragic ironies. You've unsuccessfully tried for years to have a baby. But instead of having that child, you have empty arms and countless tears. So you throw yourself into an infertility treatment program in an attempt to have the baby of your dreams. Finally, it happens. You get pregnant thanks to the miracles of modern medicine.

But there's a hitch.

You learn that you have not one, not two, but three or more fetuses growing inside your uterus. Where once there was nothing, there's now an abundance. The doctors then forcefully lay an impossible quandary at your feet: Do you selectively reduce the pregnancy—abort one or more of the fetuses—in the hopes that the entire pregnancy will thrive and you'll have healthy babies? Or do you forge ahead and attempt to carry a risky triplet, quadruplet, or quintuplet pregnancy knowing they'll likely be premature and small?

While infertility treatments have enabled tens of thousands of families to have babies, a heart-wrenching and often unspoken side effect is what to do when confronted with a higher order pregnancy, one in which the mother is carrying three or more fetuses. Though some doctors are now using techniques to try to avoid that situation, there are no guarantees. Patients who have been desperately trying to get pregnant are still finding themselves in the unenviable situation of having to decide whether to abort one or more babies in the hopes of increasing the chances of healthy survival for the others.

The topic is an emotionally charged one, not often talked about among parents of multiples. It's still a subject discussed discreetly, in corners, not out in the open, some parents say. There are groups of people, namely medical professionals, who advocate reductions in order to protect a mother's life as well as to make sure the greatest number of babies is born healthy. Then there are others who can't bring themselves to consent to eliminating any baby and simply leave it in the hands of a higher authority. Whatever the choice made by the parents, it's called one of life's most difficult by those who have been there.

The Most Difficult Choice

Patrice Sullivan said she never felt as though she had an option. "It was a horrible choice," said the Boston area mother of six-year-old twin girls. After undergoing an intrauterine insemination—where the ovaries are stimulated to produce eggs, and semen is introduced directly into the uterus—Sullivan was shocked to learn she was pregnant with quadruplets. Soon after the ultrasound revealed four beating hearts, Sullivan's doctor told her, "This won't work." She was urged, for the sake of her own life and to attempt to have healthy babies with good birth weights, to reduce her pregnancy at least to triplets. "I trusted them," Sullivan said of the doctors.

Sullivan, who had been trying for years to get pregnant, was now faced with a procedure which she described as "like an abortion." After a great deal of agonizing—without emotional support from her doctor or the medical staff—she and her husband decided, at 11 weeks into the pregnancy, to reduce it to triplets. "It was very emotional," she recalled, saying that she was awake during the "horrible process." Five weeks later, Sullivan lost one of the remaining three fetuses in a miscarriage.