NYT article about reducing from twins to a singleton

[Anonymous]

The three very premature births that I have seen with friends were all singletons. There are about six sets of twins among my friends / families and none were extremely premature and all are healthy.

While the risk with twins is higher, people are making it sound on here as though it is always very risky to have twins and it isn't, and having a singleton doesn't guarantee a low risk pregnancy or birth.

[Anonymous]

I consider myself pro-choice but am bothered by the article. I think it's because I typically think of women (or girls) getting abortions because the pregnancy would be an extreme hardship or they feel like they have no other option. I don't typically think of people purposely creating the baby just to abort it.

[Anonymous]

PP above, you may know many healthy set of twins not born very prematuraly but many twin pregnancies are difficuly. I never for one second thought about aborting one of my twins. I had the pregancy from Hell. I had the worst pregnancy you can have and still have two healthy wonderful children. They were born at 31 weeks and I've met several other women whose twins were born at 31 weeks or earlier- I know one mom whose twins died because they were too preemie to live. I met another Mom when my guys were in the NICU who had one twin still born. It is incredibly risky.

I still have a problem with couples reducing from 2 to 1. If you put two embryos in, you know there is a good chance of twins. Your twins will both probably survive and be healthy. I do understand better going from 3 to 2. Having had my pregnancy I would not recommend couples transfer 3 embryos. I would also recommend people pregnant with multiples to work very very closely with a high risk OBGYN and take the upmost of caution during their pregnancies.

[Anonymous]

I am as pro-choice as they come and am also somewhat uncomfortable with this, though can't imagine faulting someone for making this decision; I have no idea what I'd do in this situation. I've been trying to figure out what's bothering me and how this is any different than any other abortion, and this is my theory:

Unlike a fetus aborted b/c of a severe abnormality, here parents are selectively reducing because of the *possibility* of problems, not the certainty of it.

While higher-order multiples have a very high risk of complications for mom and baby, it seems for twins the record is mixed. The pregnancy is often very very tough, but many twins are born at or close to term with no problems, even if many others are not. (My sister had twins, had an incredibly tough pregnancy, but babies were born healthy at almost 37 weeks.)

It's my understanding that abortions normally happen for one of two reasons--the baby is not wanted or cannot be properly cared for, or has severe abnormalities. Selective reduction for higher order multiples in a sense falls in both categories (just too many babies to care for, high high risk of problems). Twins fall into a very gray area with much uncertainty.

You're selectively reducing because of what you're afraid of, not because of what you know.

[Anonymous]

I;'m the OP who posted the article and I still can't stop thinking about it. Part of it is that I am pro-choice and would probably have reduced to twins if I'd had triplets (I transferred 2 embryos and had twins on my 4th IVF cycle, the other 3 cycles were SETs) -- and yet reducing twins to a singleton makes me really uncomfortable, esp when those twins were the results of fertility treatments.

Part of me feels like if the people in this article want so much control over their lives that they reject the idea of twins they did not plan for, maybe they aren't cut out to be parents -- after all you could have a high needs singleton who is as tough as twins. And I really thing there should be regulations that make it tough to transfer 2 embryos when doing donor egg.

DH and I waited until we got to the point where we were OK with the thought of twins before we transferred 2 embryos - I wish the couples in this article had done the same.

[Anonymous]

With the caveat that I'm pro-life, I'll say that this is one of the main reasons I was uncomfortable with doing IVF. Did NOT want twins (I'm a twin myself and love it, but was not ready to parent twins), but was afraid that transferring only one embryo would be unsuccessful, leaving you with no child at all. What do people do in that case?

[Anonymous]

Curious why people see a difference between reducing 3 to 2 vs. 2 to 1.

I want a singleton, but am doing super ovulation where I hopefully produce 3-4 mature follicles each month. This is done because of my age. Though statistically highly highly unlikely, what if all 3 or 4 eggs happen to be good that month and I get multiples of 3 or 4, even though the point of the super ovulation was that I was never getting good eggs. Reducing that down to 1 or even 2, how is that any different? Would it be different if I did it JUST for safety's sake and not because having 3 or 4 babies would turn me upside down financially and otherwise?

I know triplets is more risky than twins, but logically I just really don't see that much of a difference in reducing, at least to condemn the parents or mother, no matter how many you reduce and what you are reducing from.

[Anonymous]

You're selectively reducing because of what you're afraid of, not because of what you know.

Not necessarily, though. I haven't re-read the article and I know there were various circumstances described within it, but in some cases didn't the women have small children at home already? Maybe they just knew that they did not have the physical/emotional/mental resources to care for infant twins and a toddler.

...after all you could have a high needs singleton who is as tough as twins.

Or, you could end up with high-needs twins.

I've posted before that I'm as troubled by this as anyone else here....it just doesn't "feel" right to me, and I don't think it's a choice I would make. But having said that, who is willing to say "I want to make it illegal for women who have twins to reduce to a single fetus." Or that we want to punish doctors who perform abortions under those circumstances.

Unless we're willing to just come right out and push for that, then all we're really doing is saying "ew, that seems creepy" about people that we don't even know except for a few paragraphs on a page. We really, really can't know their lives and their circumstances and whether they SHOULD be prepared for twins or not. At the end of the day, they feel they weren't, so should we make people who clearly don't want to parent twins bear and raise them anyway? Part of the "choice" part of pro-choice is that people make choices that I disagree with.

(I do find it interesting, though, that reducing to a singleton seems worse to posters on this thread than just aborting the pregnancy altogether. Because that's another option -- terminating both fetuses and trying again for a singleton. That doesn't seem more palatable to me)

I recognize that the pro-life people on this thread have it easier in a way, because they would just say that all of tihs is wrong, full stop. But I don't share that same conviction for OTHER women. For myself, I can say, I don't think I abort a twin (or have an abortion, period.) For other women, I still feel like that's between them and their conscience.

[Anonymous]

OP here again - the "ew, that seems crrpy" response is exactly why I posted this. I find my (and other's) responses to this to be interesting because they really aren't rational and expose all the complexities in the medical technologies that have also brought us so much good (and brought me my wonderful kids).

That said - I still think it should be difficult for RE's to transfer two donor eggs embryos unless there are issues with a woman's uterus.

[Anonymous]

Hi, I'm the PP 14:54 -- see, the caveat that you offer is just the sticking point, isn't it? There's always an "unless." And I'm not trying to beat up on you or even disagree -- I can totally understand your point that it should be "difficult" for REs to transfer two donor egg embryos.

But then I have to ask myself, what do I mean by "difficult." Difficult as in, "illegal?" Or difficult as in, "the doctor must justify this step?" Because, I'm not a doctor. And I am sure that there are perfectly reasonable and legitimate medical rationales for placing two donor egg embryos in a woman who only wants a single birth. Not all donor eggs are perfect, either.

I'm in a support group with an older woman (40+) who was doing IVF with her own eggs and, with careful consideration from her RE, placed 5 embryos in her uterus. FIVE! It's astonishing...but then, none of them took. No success. Should that doctor have been required to write a report, consult a board, ask permission, to make that kind of medical judgment?

It's a thorny and complex issue. I do think that our medical technology may have outstripped our ethics at times. I believe that as much as we all want babies, we can't lose sight of our ethics. For some women, that may mean no IVF at all, and I respect that. For other women, that may mean single embryo transfers only, and I respect that as well. But for other women, that may mean that they don't want to potentially endanger their health or the health of one baby by going through with a twin pregnancy. I don't like that decision at all, but its not me.

[Anonymous]

I think that this is the hobson's choice that is fertility treatment. While occasionally the point of fertility treatment is to just spark ovulation and get one egg/follicle, for many many people effective fertility treatment means creating multiple eggs/follicles to have a chance at pregnancy. So the hobson's choice is: chance at pregnancy and have a risk for multiples or have no or small chance at pregnancy and ensure no multiples. There is absolutely no way to resolve this with Clomid or injectable IUIs, where in most instances the whole point is to create more than 1 egg/follicle. Yet, at the same time, the overwhelming number of patients do not want twins at all.

I do not want twins at all, but cannot see how I undertake any meaningful effective fertility treatment (short of IVF where you could put in one) without taking that risk. When I get to IVF (and of course I hope I do not), this is going to be an impossible decision for me. Because I bet the RE will say you are killing your chances (and your chances cost $15k) with just one embryo implanted. Do you want 2?

For me, I'd like the opportunity to reduce from 2 to 1. For me, reducing an embryo (this is all theoretical because who knows how I will feel in the real situation) is something entirely different than aborting a fetus that has developed for many weeks. And for me, reducing from 2 embryos to 1 and 3 to 2 or 3 to 1 is no different. I would be doing so for the same reasons and reducing is reducing.

[Anonymous]

As a staunchly pro-choice woman, this article did unsettle me as well. What I found most odd was the attitude that it was more understandable in cases of IVF, as an IVF pregnancy was already so controlled. To me, it would be more understandable in a completely unintentional twin pregnancy, than one where there were multiple embryos transferred and the risks of multiples were explained.

It's not like anyone has control over being infertile, but they do have the choice to undergo treatment..and accept the consequences. Reduction for medical reasons is another matter. It's the elective reductions that seem like a slippery ethical slope. But it is still a personal, private choice, just like an elective abortion of a singleton. It's legal, and it should stay that way, whether or not I would make that choice myself.

[Anonymous]

Interesting you mention the cost: I have a feeling that if IVF didn't cost $15K+ per try, there'd be FAR more women who would be willing to roll the dice and just implant one at a time. Now of course, not every woman would feel this way because there is all the injections and side effects and what have you, and some women wouldn't want to keep doing that month after month for one embryo.

But I do wonder sometimes if we end up with these multiples because of the complexities of our health care system. For so many women, one or two IVFs is all they can possibly afford to have a biological child. And then, insurance companies that wouldn't pay for IVF end up paying on the other end for a premature infant with potentially very expensive health needs. It might have been cheaper for them to just pay for the IVF.

A while ago when I was looking at Shady Grove's stats, I came across this document they wrote after the octuplets were born in California. It talks about their success rate with single embryo transfer. Even though this isn't directly about reducing twins to singletons, I feel like it touches on some of the issues we've been talking about, especially in terms of risk factors of carrying twins and higher-order multiples.

http://www.shadygrovefertility.com/sites/default/files/Octuplet%20Response.pdf

[Anonymous]

I agree with you, 16:20. If IVF cost $1000 a shot, I do think it'd be different. But for those AMA, I think the race of time may also be a factor.

Damn our health system!

People have abortions for all sorts of reasons that are lame in my book and many of those same women got to that point by very reckless or thoughtless behavior. Personally I'm not too unsettled by an embryo reduction in comparison.

[Anonymous]

Eek, I'm a previous poster but did not realize this:

"The procedure, which is usually performed around Week 12 of a pregnancy, involves a fatal injection of potassium chloride into the fetal chest. The dead fetus shrivels over time and remains in the womb until delivery. Some physicians found reduction unnerving, particularly because the procedure is viewed under ultrasound, making it quite visually explicit, which is not the case with abortion."

Why can't they do the reduction when they are still early embryos and not fetuses of several weeks??