Multifetal Pregnancy Reduction

The topic of multifetal pregnancy reduction (MPR) is sensitive and can be upsetting to some. Still, we cover this topic to support the individuals and couples facing this difficult decision.

If you become pregnant with multiples, especially higher order multiples (triplets, quadruplets, or more), your doctor may talk to you about MPR. You, your doctor, and your partner can discuss the risks and benefits of MPR, finding a solution that offers the healthiest future to you and your babies.

Multifetal pregnancy reduction explained
Multiples are on the rise, at times increasing long-term health and developmental problems for moms and their babies. If you become pregnant with three or more babies, and are at high risk for complications, you may be asked to consider multifetal pregnancy reduction. This procedure reduces the number of fetuses in your womb to protect your health and your pregnancy. Although it is necessary at times, going forward with MPR can be emotional, complex, and ethically challenging.

What to expect
The multifetal pregnancy reduction procedure takes place in the first trimester or early in the second trimester. Your doctor may mention MPR to you if you are pregnant with multiples and experiencing one or more of the following scenarios:

  • Your health, or a fetus's health, is threatened.
  • You have a health condition putting your pregnancy at risk.
  • You are at high risk for preterm labor or at risk for losing one or more fetuses.

During the MPR procedure, a liquid is injected into the gestational sac of one or more fetuses. Your body will then absorb the fetus(es). Some bleeding may occur, but the other fetuses are usually not affected by the procedure.

Risks involved
While this procedure helps many couples, multifetal pregnancy reduction does not eliminate all pregnancy complications. You can still go on to experience complications with pregnancy and childbirth. Some women may:

  • Miscarry one or more of the other fetuses
  • Experience preterm labor or a stillbirth
  • Give birth to children with long-term health problems or disabilities

Currently, 4 to 5 percent of pregnancies that undergo MPR end with the loss of all fetuses.

Make the best decision
If you become pregnant with high-order multiples, and you and your babies are at risk, you may be asked to consider multifetal pregnancy reduction. The decision can be difficult. Consider each option, and ask yourself: how would I feel in the future if I choose Option A? How would I feel if I go with Option B? Speak with a maternal-fetal medicine specialist or seek guidance from a therapist or clergy member to help you throughout this painful process.

Lower your risk
To avoid the issue of multifetal pregnancy reduction entirely, ask your doctor how to reduce your chances of becoming pregnant with triplets, quadruplets, or more. Your doctor may be able to avoid MPR by:

  • Limiting the number of embryos transferred during in vitro fertilization (IVF)  
  • Canceling an ovulation induction cycle if you are at risk for high-order multiple gestation
  • Using the lowest dose of fertility drugs necessary

Current IVF guidelines encourage fertility doctors to transfer only enough embryos to help you give birth to a single, healthy baby. To achieve this goal, many experts are becoming more outspoken about the benefits of single embryo transfer for women that qualify.

Coping with a planned reduction
One in three pregnancies with multiples reduces down naturally. This means that some women pregnant with triplets end up giving birth to twins after one fetus spontaneously aborts during the pregnancy. In other words, multifetal pregnancy reduction can happen naturally. Other individuals experience MPR by choice, with understandable difficulty.

If you decide to move forward with MPR, you may have feelings of deep grief, sadness, or depression for months or years to come, like many women that experience a spontaneous abortion or miscarriage. To prepare yourself for a critical decision like this one, consider seeking counseling services when you start your fertility treatment journey. No matter how you proceed, be informed, accept your decision, and find peace with your choice during pregnancy and beyond.

 

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