The subject of fetal reduction came up this weekend. An important and difficult conversation at any time when you are trying to achieve a pregnancy. After having to undergo infertility treatment and hoping that it will work in becoming pregnant, where does pregnancy reduction have a place in the conversation?
It’s almost like a ghost flitting through certain conversations, noticeable in the background, but not clear. Fetal reduction is a little talked about aspect of infertility treatment. Probably twins are a reason for many couples to feel celebratory; although even with twins there are higher risks to both mother and fetuses. Still, with twins, there is the expectation that everyone will make it through the pregnancy, healthy and sound.
When higher order multiple pregnancy occur, (triplets and higher) then there is much greater concern for the health and welfare of all involved. When elective single embryo transfer (ESET) is offered or encouraged, although not stated, the option of fetal reduction is one procedure that is trying to be avoided.
And we don’t really talk about it. There are reasons for that. It’s highly politically charged. A fetal reduction is an elective abortion. Yes, it really is, just that. There aren’t too many other medical procedures as politically, morally, ethically and emotionally charged as abortion. Not in this country, not in the world.
For some of us, it is simply not an option. When this is true, it is imperative that we understand the possibilities for complications for the babies and for ourselves. For those of us who would be able to use this option if considered necessary for health and safety, it is often a decision that is carried forward in our lives in ways that we can’t necessarily portend. (Read Jane Elisofon’s compassionate and thoughtful blog tomorrow about how we manage our feelings about an abortion that we had previous to undergoing infertility treatment.)
Multiple pregnancies are a risk of infertility treatment when we transfer more than one embryo in an In Vitro Fertilization (IVF)cycle. ESET is a way of avoiding multiples. As a patient, it is often hard for us to imagine any treatment working. We are hopeful, we are scared, we want to be pregnant and we want to do everything to ensure that fertility treatment will be successful. If putting more embryos back will increase our risks as well as increase our chances of success, than we need to know those risks. And we need to know about the procedure that we may be offered if the risk of multiples becomes a reality.
Intrauterine insemination (IUI) is the other fertility treatment that can cause high order multiples. Especially unmonitored cycles. If you are taking medications to produce more than one egg (ovum) and there are no ultrasounds being done to see how many follicles (potential eggs) are being created, than you are at risk of multiple gestations (pregnancies). If you are undergoing this type of treatment, you would do well to reconsider. Ask for an ultrasound or consider working with a physician or fertility program that monitors IUI’s as a standard of practice.
Fetal reduction is a difficult conversation at best to have while you’re trying to become pregnant and it is not coming easily. One question that needs to be considered with infertility treatment is, “what will we do if we become pregnant with more than we expected or is safe?” The longer that fertility treatment goes on, the longer that we don’t have a successful pregnancy, often the more risks that we patients are willing to take, as we feel that a viable pregnancy is slipping through our fingers. This is the time to listen more carefully to trusted health care providers, who are less emotionally involved, who feel less desperate and who understand the risks more completely.
If this conversation is not happening in your fertility program or in your fertility consultation, then it may be up to you to bring it up. Understand the risks of multiple pregnancies. Understand the choices that you will have, think about what you will and will not be willing to do, and make a truly informed decision before it becomes a necessity.