Selectively Reducing Multiple Births

Going through this morning’s news, I was struck by the New York Time’s coverage of the latest developments in the debate over in vitro fertilization and resulting multiple birth, which was sparked last month after Nadya Suelman, previously a mother of six, had octuplets.

In vitro’s a tricky subject—on one hand, it enables otherwise infertile women and couples to experience the joy of child rearing. On the other, it’s invasive and costly—leaving the treatment available only to those who are lucky enough to afford it.  The Times writes:

One cycle of in vitro fertilization costs about $12,000. Women who are not successful the first time often try again and again, which can push the cost of having a baby to more than $100,000. Because the technology is often not covered by insurance, doctors say they are constantly urged by patients to implant extra embryos.

Sure, it’s safer to implant the embryos one by one, but that quickly drives up the cost. However, implanting multiple embryos can lead to risky pregnancies—including "infant mortality, low birth rates, long-term disabilities and thousands of dollars’ worth of medical care," says the Times.

So what’s the solution? How can in vitro be less costly without putting the mother’s and the children’s health at risk?

Dr. Tien C. Chiu, a California doctor who specializes in fertility medicine, spoke to the Times about a case where the prospective mother could only afford one shot, so she asked for several embryos to be implanted at once. "I said under one condition. I made her sign an agreement that she would do selective reduction." That last term caught me off guard. I made a guess, then immediately hoped I was wrong.

According to the Gale Encyclopedia of Medicine (available with subscription), selective reduction is a form of selective abortion – a term that can refer to anything from ending a pregnancy to save the woman’s life, to sex-selective abortion in cultures that don’t value girl children.

However, what Dr. Chiu was suggesting is more specific. "Selective reduction is recommended often in cases of multi-fetal pregnancy, or the presence of more that one fetus, typically, at least three or more fetuses." It’s performed nine to 12 weeks into the pregnancy, and is carries the risk of premature labor or miscarriage of the remaining fetus(es). But this is comparatively better that sticking with quadruplets – "the risks associated with multi-fetal pregnancy are considered higher," says the Gale article.

Is this the solution to bridge the gap between in vitro and women who don’t have an extra hundred grand lying around? Implanting a bunch of embryos, hoping one will take and—if the woman ends up with anything more than twins, have the doctor remove them? A troubling decision, to be sure, but an option. The cost of one in vitro session and selective reduction: about $12,000. A troubling decision, to be sure, but an
option; The cost of one in vitro session and selective reduction: about
$12,000. The years of motherhood that make those tough few months worth it:

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