Selective Reduction

Sara - posted on 06/08/2010 ( 33 moms have responded )

9,313

50

586

With today's fertility treatments, many more women end up pregnant with high-order multiples. We see people like Kate and Octomom and see healthy children....however, many high-order multiple pregnancies do not end up that way.

As a woman, how do you feel about selective reduction to raise the odds of a healthy pregnancy and healthy babies? At what point would you do it, or would you carry the pregnancy as far as it could go and hope for the best?

Interesting article (long, so I won't copy/paste). Taken from Washington Post:
http://www.washingtonpost.com/wp-dyn/con...

MOST HELPFUL POSTS

Mary - posted on 06/11/2010

3,348

31

123

Spontaneous triplets do occur, but they are remarkably rare. The human body is qute simply not equipped for "litters". Multiple gestations of 3 or more carry great risks not only to the babies, but the mother as well. All of us on here already have at least one child, if not more. As Erin pointed out, a decision to continue a pregnancy of triplets or greater would have a huge impact on that child(ren). Almost all moms with such a pregnancy are put on bedrest by the 24 week mark (if not sooner). Now, I don't mean just laying around on the couch at home and still being able to "watch" your kid...I mean supine, 24/7, and usually the bulk of that is hospitalized bedrest, and possibly on tocolytic meds. If you (and the babies) are lucky, this will be true for 6-10 WEEKS. Then, you have not only the recovery from your c/section, but you have NICU babies that will be hospitalized for an unspecified amount of time.

Now, the fun really begins when they come home! I cannot, in my wildest dreams, imagine caring for, say, 4 infants at once. I have had quads right now, I have no idea how we would cope. My mother recently died, my 67 y/o dad is good, but - jeesh - that would be beyond him! My sister has 2 kids and lives over an hour away. My husband's entire family is 4-5 hours away. I cannot think of one single friend that doesn't either have a couple of kids of their own, or doesn't work full time. Obviously, my husband would NEED to work. Soooo...that would leave me at home, alone, with a toddler and 4 infants (some of whom may have special needs/issues). Forget about a nanny, with me no working, there is no way we could afford one. I'm a freakin nurse, and pretty unflappable, but I gotta say that is more than I think I could handle!

And as for Molly....dear God, what would that do to her? Mommy would never have time to sit and read her a story, or play on the slide, or all of the other fun, special things we do together. Her childhood would be irrevocably changed, and not in a good way. The mere thought makes my heart cringe.

Nope, I cannot imagine a scenario where I would not opt for a selective reduction. It just seems like common sense that it would be in the best interests of my body, my daughter, and those babies who lived on.

Mary - posted on 06/08/2010

3,348

31

123

I come at this from 2 differnt perspectives, both of which leave me in favor of selective reduction.



As and L&D nurse who works in a hospital with a Level III NICU, I have seen many, many woman pregnant with triplets and quads. The majority of triplets, and all of the quads, have been difficult pregnancies in which the woman are placed on bedrest by about the 20 week mark, are magged multiple times for pre-term labor, and, if they are lucky, end up delivering pre-term babies who may or may not have long-term developmental/physical deficits of varying severity. A small percentage of them will deliver pre-viability, and all babies are lost.



Scary, heart-breaking stuff.



As someone who went through multiple fertility treatments, it was something I had to consider in the last two cycles when deciding how many embryos to place. Egg production was never my issue, and every cycle I had at least 4 "grade A" embryos. We did transfer 4 those last two cycles, but only after extensive discussion with our doc about selective reduction. It hepled that I knew him personally, and his wife is one of the OB's I work with (and whose practice I go to). I'm only 5'2, so my chances of carrying more than twins to a good gestational age were not good, and I was more aware than the average patient about the risks involved. ANything above twins I wold have reduced, without question.



This is not to say it would have been easy...it would have broken my heart, and the risk of the entire pregnacy aborting as a result of this manipulation would have terrified me, but I would have done it for the sole purpose of giving the remaining fetus the optimal chance at surviving without severe complications. My then-husband was in full agreement with me on this. I never would have proceeded with transferring that many embryos had he not been. As it turns out, it was never an issue, as I never got pregnant with any of those attempts. (only now, as a happily remarried girl and mother of one, can I appreciate how truly lucky I was!)



A close friend of mine, also an L&D nurse, is currently 11 weeks pregnant with triplets. She also has a 3 year old daughter. She had a luteal-phase defect that made conceiving difficult. One round of clomid and carefully timed sex, and her she is. SHe is beyond overwhelmed and concerned, for she too knows all of the potential complications she faces as a 35 y/o small-framed girl. She's also tremendously concerned about the impact this will have on her daughter. Selective reduction is not an option with her deeply religious husband, who is simply thrilled (and clueless) about the prospect of triplets. My heart aches for her.

Jessica - posted on 08/11/2010

986

20

64

"Mary I don't think it is about living the situation, I think it's about your morals and beliefs and regardless of how many children Teresa has she knows what these are."

See, I think that's only half of it though. Of course, everyone has their opinions and morals and you can speak your mind until your face is blue. But I really think that until you are actually IN that situation, faced with those circumstances, you can't say for sure what you will or will not do, how you will feel. That is exactly the kind of emotionally intense situation in which people find themselves doing something they never thought they would, had they never had to deal with it personally.

I honestly can't say what I would do. I can't fathom being in that situation. I am inclined to say anything over three I would not attempt. I cannot see myself handling it. Not physically (I'm a small girl), and not three newborns, which may or may not have handicaps or other special needs issues, on top of my son. To be honest the thought of even having twins scares the crap out of me. But, actually making that decision to selectively reduce would kill me; I'm not sure I could ever really forgive myself.

Mary - posted on 06/08/2010

3,348

31

123

The problem, Kati, is that it cannot always be so controlled. Most pregnancies that are greater than twins are the results of either ovarian stimulation drugs, such as clomid, or IUI. In both cases, they are only stimulating the ovaries to make eggs (the number produced cannot be controlled) and bringing the sperm into proximity with them at the optimal time, either through intercourse or insemination. Truth is, your chances of having more than twins is LESS with IVF than with other fertility treatments. The reason IVF is not done exclusively is that it is both prohibitively expensive, and much, much more invasive and time-consuming.



I don't think anyone wants, or even truly expects triplets, quads, quints, or whatever. You are told the risks, but most couples never really believe it could happen to them. (I know my friend sure as hell didn't!). The problem is, once you are faced with multiples, you are placed in the position of making this choice. As I said, it would be extremely difficult, and emotional, but I also know that I would struggle with guilt if I didn't have a selective reduction, and all 3, 4, or 5 babies died, or were severely disabled, when I could have done something to give two babies greatly increased chance at not only life, but health.

Jaime - posted on 08/12/2010

4,427

24

197

Teresa, I don't think Mary is trying to convince you that you would have a different opinion if you were childless before having fertility problems. I think what she is saying is that no matter who you are, you can't truly know how you would feel about a situation until you are faced with it for the first time...regardless of your morals or your faith.

I'm aware that you are devoted to your faith, but you are also human...I think that's the fact that you might be discounting. I'm not saying you don't think about it, I'm saying that because you're human, you--like all of us, are prone to changing your mind in spite of your beliefs. I agree that we don't truly know how we will react to a new situation until we are faced with it. I don't think that changes for anyone no matter who or what you believe in.

This conversation has been closed to further comments

33 Comments

View replies by

[deleted account]

My morals don't change due to circumstances though. That is the fact that you are discounting which I was trying to explain.

Mary - posted on 08/12/2010

3,348

31

123

Teresa, while I don't discount the feelings of either you or your friend, BOTH of you did already have children of your own when the situations you mentioned arose. Sorry, but it just isn't a true comparison. It's simply not the same when you are childless.

Tracey - posted on 08/12/2010

1,094

2

58

We don't get the choice in the UK, no matter how many embryos are created only 2 are implanted.

[deleted account]

I know a woman who desperately wanted a baby even though she already had a couple. She refused to do IVF because of the fact that there would be unused embryos. She was able to adopt instead.

While I didn't exactly experience infertility, I do know what it is like to desperately want a baby and not know if it's going to happen. It took almost 3 years and 2 miscarriages to get my son. W/ my second miscarriage... the baby was dead around 6 weeks. I found out at would've been 8.... I still refused to have a D&C until my life was in danger because THAT is just how strongly I feel about not interfering w/ my pregnancies..... So, yeah, I think I can know pretty close how I would react if I was faced w/ this situation. ;)

Jaime - posted on 08/11/2010

4,427

24

197

I like what you said Jessica. I just re-read my previous comment for a third time and I am hoping it doesn't come across to anyone as insensitive. I understand that there are women out there desperately trying to conceive with little progress and my son was conceived by accident (or not planned I should say). I am truly grateful for my son, but from MY personal perspective if I hadn't got pregnant and didn't have him now and wanted a baby later on, I feel that I would have been open to adoption. But as you have pointed out...we often don't know how we will truly feel about a situation until we are faced with it. I don't envy the struggles that women face when going through fertility treatments, but with specific regard to selective reduction...I am inclined to think that I would be more open to reduction to better my chances at having just one or two healthy babies as opposed to 8 that might have a host of disabilities and disorders. I hope that makes sense.

Jessica - posted on 08/11/2010

986

20

64

"I'm not a fan of fertility treatments in general which I know upsets people . Humans were not meant to have litters."

^^ That's another kind of thing that's easy to say until you're in the situation where you cannot conceive a child. I have never been in such a situation, as I've concieved both times easily. But I know how much I have wanted to be a mother and can imagine how heartbreaking it would be if I were unable to conceive on my own. I agree that humans weren't made to have "litters" but I am glad there are options out there for people who want to have a child and can't on their own.

[deleted account]

I'm not a fan of fertility treatments in general which I know upsets people . Humans were not meant to have litters.

[deleted account]

Anna, I wish you all the best in your heartbreaking decision follow your heart and your decision will be right, good luck.

I'm with Teresa I could never/ would never have selective reduction it is taking a life which IMO is wrong. As somebody who was following the fertility treatment route (I have had a few treatments which hold small chances of multiples but only very small chances) I see all life as valuable so even if my children were disabled I would love and cherish them (I refused the triple blood test because if it had found there was something wrong I would not have aborted). If I had had to have IVF I would not have had more than 3 fetus implanted and luckily I never had to take clomid because I would not have wanted to from the research I conducted. Mary I don't think it is about living the situation, I think it's about your morals and beliefs and regardless of how many children Teresa has she knows what these are.

Mary - posted on 08/11/2010

3,348

31

123

Teresa, I'm really not trying to be unkind, but I need to point out, it is really easy for you, as a mother of 3, to say that you would never pursue fertility treatments that could result in higher order multiples. Trust me, as an L&D nurse with an extensive knowledge base, and someone whose Catholic upbringing has made abortion in ANY OTHER situation unthinkable...you just never know until you have lived it yourself.

Anna - my heart aches for you. I will hope and pray that you, and your pregnancy have the best possible outcome for ALL involved. There is no absolute right or wrong decsion for you...you do what you, your husband, and your hearts feel is best for you.

Jaime - posted on 08/11/2010

4,427

24

197

I think that makes the most sense to me Teresa. If you don't believe in selective reduction, then don't put yourself in the position to be faced with that decision. I understand that people might want a child badly, but if it's just about having and nurturing a child then adoption is the best option. If it's merely because you want to experience the pregnancy and produce biological offspring come hell or high water...I have a hard time not seeing this as selfish, despite the fact that I believe every choice we make is self-serving in some way.



I just want to add, after re-reading my comment...when I say "you" I'm speaking in general terms.

[deleted account]

I couldn't/wouldn't ever do it. Which is also why I would never choose any fertility treatments that could possibly result in higher order multiples. I couldn't knowingly eliminate any of my children regardless of circumstances.

Jaime - posted on 08/11/2010

4,427

24

197

I'm all for selective reduction. The point is to get pregnant and have a baby...not get pregnant with a soccer team and hope they all survive and if they do survive, hope that they all have normal functioning organs and such so that I don't have 8 children on dialysis.

User - posted on 08/11/2010

1

0

0

This is a question that I am plagued with right now. I am currently 6 weeks, 5 days. I went for my first ultrasound yesterday after a grueling 7 month trial with fertility medicine and timed intercourse. The doctor's first words to me were, "Oh, this isn't good, there is too much going on here". I had a total of 5 gestional sacks, 4 in which they were able to find heartbeats. I have follow-up appointments over the next two weeks to see if all four embryos are actually viable. However, if after 8 weeks they are, my DH and myself will have to look at our options. This is so heart-breaking. I have looked at both the options and the chances of having a successful quad pregnancy. This is also my first pregnancy, so I am even more at a loss. I want all of my babies to have the best possible chances, and it is a horrible place to be in now having to think about this. There really isn't a lot of support out there for women in this position. I just pray that DH and myself make the right choice, whether it be to try all four, or do selective reduction, but either way has the possibility of not ending well.

Ez - posted on 06/10/2010

6,569

25

237

Personally, I would still reduce the pregnancy to 3. I can not take the risk of something happening to me when I already have a child to consider. Not to mention the fact that the bed-rest and probable long-term hospitalisation required with a high-order multiple pregnancy would be completely unfair on my existing child.

Rosie - posted on 06/10/2010

8,657

30

321

what if you got pregnant naturally with 3 or more? what would you do then?

ME - posted on 06/09/2010

2,978

18

193

I would talk to my OB and maybe get a couple of opinions first...but, I would most likely reduce anything over 3...I wouldn't want to tho, and I am thankful that I have never been put in that situation!

Lindsay - posted on 06/09/2010

3,532

26

267

Honestly, I don't know what I would do unless I was in that situation personally. I would think if it were a case of 4 or more, I would reduce. It's not a decision I could go into lightly, whether that decision be keeping all of them or reduction. It would be based on my doctor recommendations and how she truly feels my body could handle it. I have had 2 very easy, complication free single pregnancies and births but in no way know how my body would handle a multiple pregnancy. It's a tough call really.

Sara - posted on 06/09/2010

9,313

50

586

As Mary said though, you IVF isn't notorious for producing high-order multiples, other fertility treatments, where you cannot select the number of embryos, are. I think that it would break my heart, but I would have no choice but to selectively reduce if it were more than 3, and depending on doctors advice, maybe even if it was triplets.

La - posted on 06/08/2010

0

0

63

I wouldn't allow more than 3-4 embryos to be implanted at any time and speaking without experience it is easy for me to say I would reduce anything more than 2. However, if I was actually in the given situation who knows what I would actually do or not do. Emotional can often override logic.

Shelley - posted on 06/08/2010

435

0

34

I think there should be more legislation in regards to how many can be implanted so that people don't have to make such hard decisions.
I would want to but i don't think i could

Sharon - posted on 06/08/2010

11,585

12

1315

Any more than 3 or 4 and I would selectively reduce.



Its hard to put myself in a baby desperate womans' shoes though - I would say i wouldn't allow more than 4 embryos to be implanted anyway.

Ez - posted on 06/08/2010

6,569

25

237

I would definitely reduce if I were carrying more than 3 babies. It would be horrible and stressful, but I have no doubt it would be the best option. If it were my first pregnancy I may feel differently.. not sure. But knowing the toll a 'normal' pregnancy takes on my body, and already having a child to care for, there is no way I could risk my health with a high-order multiple pregnancy. Not to mention the fact that the odds of a quads/quints pregnancy having a favourable outcome (ie, healthy babies) are not good.

Rosie - posted on 06/08/2010

8,657

30

321

i don't think i could do it. i would try to not have as many embryos implanted in the first place. i just couldn't risk my other babies during the procedure, and as well i couldn't get rid of the other ones. i'd torture myself wondering what they would be like all of my life. no way.

Zoe - posted on 06/08/2010

118

12

24

i am ot sure either, i think under 4 then no way i do not and will never believe in terminations unless it is for a medical reason. if there was 4 and up then if every thing was allright and there was no reason why i should reduce then no but if there was a medical reason then yes i would reduce. however i wouldn't be able to choose which child or children to terminate someone would have to do that for me .

Jocelyn - posted on 06/08/2010

5,165

42

275

I know that right off the bat, if it was more than 4, I would choose selective reduction. I wouldn't want to risk my life; I already have 2 kids, and they need to have a mom, I don't NEED to have 4 more kids. If it was three babies, I'm not sure what I would do; I would probably get all the testing they offered and if one of the babies had something wrong with it, than I would get rid of that baby.

Caitlin - posted on 06/08/2010

1,915

5

172

I think that any more than 4 and I wwould consider reduction. I hate the idea of abortion for myself, but I also hate the idea of having more than 4 unhealthy kids who may suffer the rest of their lives because of my decision not to reduce.

Join Circle of Moms

Sign up for Circle of Moms and be a part of this community! Membership is just one click away.

Join Circle of Moms