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Multifetal Pregnancy Reduction
Reader's Questions and Answers: |
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NOTE: Answers provided are of a general nature only and in no way reflect a medical opinion or diagnosis. If you are in doubt about any aspect of your pregnancy, please consult your physician immediately.
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Feedback:
January, 2010
I am pregnant with twins after IVF. I had been asking my doctor to transfer only 1 embryo but doctor insisted on 2. I would like to reduce to one due to my own health issues, plus one embryo is half smaller than the other with a slower heartbeat at 8 weeks and all these weeks it was behind. Just concerned whether a doctor would agree to do the procedure.
From Lynda:
You didn't leave your EM address, so I hope this reaches you. Firstly, how come your doctor wouldn't listen to you? But what if he had listened and the embryo that took, was the one you indicate is now half as large? And what are your health issues that you cannot carry two babes? This is important and I am wondering, if they are severe as you note, your doctor would not have taken them into consideration when he transferred two embryos. There are doctors who reduce from twins but that such a reduction is unusual. Many women successfully carry twins, so that is the unusual part of it. Keep looking for a doctor who will perform the procedure, but know you have a small window to complete the process. Further, IF things are as you state, you might lose that embryo naturally, i.e. vanishing twin, which, if it is going to happen, usually occurs by week 12. I would not wait for that though if you are certain you wish to reduce and would find a doctor to do the procedure as soon as possible. Best wishes.
Feedback:
October, 2007
In your feedback June 2007 response you indicate that multifetal reduction can be done on one of a set of identicals. I am currently expecting triplets, 1 fraternal and 2 identical and was advised the only option was to reduce both the identicals (reduction of the identicals because of high risk associated with an identical pregancy vs. the single). Are you aware of any information that this is not true, that we could continue with a twin pregancy with one of the identicals and the fraternal?
From Lynda:
This is such a difficult question and I wish I had a magic wand to be able to accurately tell you what could/would/might happen in your situation. I can understand why you are being asked to consider reduction of the two identicals (monozygotics). If one only was reduced, it could affect its co-multiple as well as your whole pregnancy. Reducing the two gives your single child the best chance. However, we know that triplets can be safely carried and I know of several sets of triplets with a monozygotic and dizygotic (fraternal) combination as you are describing whom have had no problems at all. Including one of my friends whom is now in her mid-50s. She's a triplet and her brothers are monozygotic. Everyone was healthy and happy, even all those many years ago.
I am not in a position to say what would happen if you chose to reduce only one of your monozygotics because I do not know about your personal medical situation (do the babies share a single placenta and/or chorion? What is their particular uterine make-up? It makes a difference which is your situation.) and I am not medically trained. I can tell you that monozygotics have the same genetic make-up and your fetuses (all of them) are already aware of each other. The monozygotics are connected because they share the same genes and to lose one doesn't mean the other other couldn't be a healthy, happy adult but it could also mean that that child and adult s/he was to become, could be aware of ihis/her loss - as is expressed by some surviving co-multiples. Check out some of the stories of survivors on my Site. They could add another dimension to the situation for you and help you with your decision. www.multiplebirthsfamilies.com
No part of this decision is easy but you need to make the one that is best for you, your family and your babies. There are many reasons to choose to reduce: one (or more) baby has an severe anomaly, genetic situations, mother's health, crushing financial situation and so on. You are on the right track by doing your own homework and research and asking LOTS of questions.
Feedback:
September, 2007
As a parent how do I support my daughter's decision about selective reduction? I don't want to impose my ideas, but don't want to say the wrong thing either.
From Lynda:
You've asked an interesting question. Our job, as parents, is to raise a healthy, happy adult, able to make appropriate decisions. It is very difficult to "turn off the parenting switch" when they become of age (say over 20 years) as we are so used to making decisions for them, guiding, offering advice, sharing issues, and so on. You don't mention how many she is carrying and needs to reduce to. I think what I would do is take both her hands, look in her the eyes, tell her you love her and will support her and her partner in whatever decision they make. It is no easy decision to terminate one or more fetus, especially if the couple of been trying for some time to get pregnant. It works against what they have been trying for. They will have this decision hanging over them forever. I would communicate my support and indicate I was available to talk to whenever they needed. I would also make sure that I kept the decision to myself and not tell anyone else unless the parents led the way. I am sure they are going through h--l and back with this decision and to know they will still be loved and supported whatever they decide will be very helpful. Depending upon how many she is carrying and if they can be safely carried to term, you might also say, if you decide not to go through with the procedure, I will help you with the babies as you need. This lets them know, either way you are available.
Very best wishes to all of you. Nothing about this decision is easy.
Feedback:
June, 2007
I am two months pregnant with triplets. However, due to our financial conditions we want to have only one child. What is the possibility that the single child will survive if I selectively reduce the other two fetus?
From Lynda:
Hi, You have asked a very difficult question, with no easy answers. I will be upfront with you and give you the feedback I have on hand and I hope it will help you with your decision. Nothing about reduction is easy. If you have monozygotic babies (identicals) within the group or they could be identical triplets (this would be helpful to ascertain), they have a unique bond. The reduction is usually one of the babies the easiest to reach so the reduction could, essentially, be one of a matched pair. Financial bearings aside (and this is a realistic concern), it is possible to carry healthy twins. Will this bother either you or your husband in the future? What if you cannot have any others?
Perhaps the most important issue for consideration of what you are suggesting is that the reduced embryos will outnumber the viable embryo. This imbalance can, potentially, affect the complete pregnancy, i.e. the complete pregnancy is lost. I cannot speculate that this would happen to you, but this issue would need to be fully explored with your doctor. The prognosis is not usually good vis-a-vis the remaining embryo due to the imbalance.
Nothing about this issue is easy. Do your homework carefully and don't rely on just your doctors to give you feedback. Carrying triplets is a concern healthwise and they are usually early, carrying healthy twins is done all the time. See if your family/friends would help with twins, or the triplets. Many religious institutions will step in to help and support. Sometimes there are times to rely on others and perhaps this may be one of those times. Only you and your partner can ascertain what is best for your situation but it is extremely important that you BOTH agree with whatever decision is made. Do your homework, ask every question you can think of, talk to others whom have had the procedure and if you would like, I can connect you with a triplet family who decided to carry and has not looked back. This would give you another perspective and how they coped financially with 3 babies at once.
Please write me again if you need. I care and would like to support you in what ever decision you make.
Best wishes.
Feedback:
December, 2006
I have just had to have a multifetal reduction from 5 to 2 babies this past Tuesday. Is there a book/pamphlet to assist me in the grieving process of choosing to eliminate 3 of my children??
From Lynda:
Hello, I am so sorry to hear about your losses. The sadness and grief of loss in multifetal reduction (MFR) is very complicated and often underestimated by family, friends and professionals around us. For the parents, this procedure is difficult and conflicted, but also laced with love and caring as their choice is made with the best of intentions for all of their children. There is very little, if anything, written for parents. The Multiple Births Foundation in London, England has a leaflet. You can link to them off of my Site, www.multiplebirthsfamilies.com If you have difficulty contacting them, let me know and I will see what I can do.
If you would like to speak by phone, I am willing to speak to you. Let me know and I will give you my phone number. Another suggestion would be to connect with other parents whom have had this procedure and find out how they coped with a decision needing to be made when there is a conflict between the head and the heart. Don't make this journey by yourselves. Use as many community resources as you need, e.g. grief counsellor, connection with other parents, research, reading, therapy and such. This is a time to take and try to heal. Be gentle with yourself.
Enclosing peace and comfort.
Feedback:
Article:
27th April, 2005
Maybe a little more statistics. I need more help with my decision. What about other people's choices and real life experiences.
From:
From Lynda:
I am sorry that you are facing this horrible situation. I understand that you need as much information as possible. I offer a space to share personal stories and experiences but cannot post what I do not have. As soon as I receive a story which I can verify, I am pleased to post it in the hopes that it will help others, if only to know that you are not alone. If you would provide more personal information yourself, I possibly could hook you up with someone who has been where you are. If you would like to write me back with an EM address, I will see what I can do.
I enclose very best wishes as you struggle with this very difficult decision.
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