Semin Reprod Med 2010; 28(4): 295-302
DOI: 10.1055/s-0030-1255177
© Thieme Medical Publishers

Multifetal Pregnancy Reduction: Evolution of the Ethical Arguments

Mark I. Evans1 , 2 , 3 , David W. Britt1 , 2 , 3
  • 1Comprehensive Genetics, Fetal Medicine Foundation of America, New York, New York
  • 2Mount Sinai School of Medicine, New York, New York
  • 3Department of Health and Sport Sciences, University of Louisville, Kentucky
Further Information

Publication History

Publication Date:
03 August 2010 (online)

ABSTRACT

Multifetal pregnancy reduction (MFPR) was developed over 20 years ago to rescue higher-order multifetal pregnancies and has become a major component of improving the outcomes in infertility therapies. By definition, MFPR will always be controversial, but opinions do not follow the traditional “pro-life/pro-choice” dichotomy that has sabotaged the more generalized abortion debate. If one defines success as a healthy mother and healthy offspring, clearly, with multiples, fewer are always safer. The ethical issues surrounding MFPR are for most people not a clear black-or-white but varying shades of gray. The ethical principle of proportionality takes precedence (i.e., trying to obtain the most good for the least harm while looking for areas of moral compromise to achieve the best outcomes).

REFERENCES

  • 1 Martin J A, Hamilton B E, Sutton P D et al.. Births: Final Data for 2006. National Vital Statistics Reports. Vol. 57, No. 7 January 2009. Hyattsville, MD; National Center for Health Statistics 2009
  • 2 Society of Assisted Reproductive Technologies. 2007 Statistics .Available at: http://apps.nccd.cdc.gov/ART/NSR.aspx?Selectedyear+2007 Accessed November 10, 2009
  • 3 Evans M I. The Truth about Multiple Births.  Newsweek. 2009;  153(9) 14
  • 4 Evans M I, Berkowitz R, Wapner R et al.. Improvement in outcomes of multifetal pregnancy reduction with increased experience.  Am J Obstet Gynecol. 2001;  184(2) 97-103
  • 5 Evans M I, Britt D W. Selective reduction in multifetal pregnancies. In: Paul M, Grimes, D, Stubblefield P, Borgatta L, Lichfield S, Creinin M Management of Unintended and Abnormal Pregnancy. London, United Kingdom; Blackwell-Wiley Publishing 2009: 312-318
  • 6 Evans M I, Kaufman M I, Urban A J, Britt D W, Fletcher J C. Fetal reduction from twins to a singleton: a reasonable consideration?.  Obstet Gynecol. 2004;  104(1) 102-109
  • 7 Wright V C, Schieve L A, Reynolds M A, Jeng G, Kissin D. Assisted reproductive technology surveillance—United States, 2001.  MMWR Surveill Summ. 2004;  53(1) 1-20
  • 8 2002 Assisted Reproductive Technology Success Rates. National Summary and Fertility Clinic Reports. Centers for Disease Control; U.S. Government Printing Office December 2004
  • 9 Wright V C, Schieve L A, Reynolds M A, Jeng G, Kissin D. Assisted reproductive technology surveillance—United States, 2001.  MMWR Surveill Summ. 2004;  53(1) 1-20
  • 10 Adashi E Y, Barri P N, Berkowitz R et al.. Infertility therapy-assisted multiple pregnancies (births): an on-going epidemic.  Reprod Med Online. 2003;  7 515-542
  • 11 Evans M I, Fletcher J C. Multifetal pregnancy reduction. In: Reece EA, Hobbins JC, Mahoney MJ, Petrie R Medicine of the Fetus and Its Mother. Philadelphia, PA; Lippincott Harper Publishing 1992: 1345-1362
  • 12 Evans M I, Littmann L, St Louis L et al.. Evolving patterns of iatrogenic multifetal pregnancy generation: implications for aggressiveness of infertility treatments.  Am J Obstet Gynecol. 1995;  172(6) 1750-1753 discussion 1753-1755
  • 13 Petterson B, Nelson K B, Watson L, Stanley F. Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s.  BMJ. 1993;  307(6914) 1239-1243
  • 14 Pharoah P O, Cooke T. Cerebral palsy and multiple births.  Arch Dis Child Fetal Neonatal Ed. 1996;  75(3) F174-F177
  • 15 Chapman G B, Elstein A S. Cognitive processes and biases in medical decision making. In: Chapman GB, Sonnenberg FA Decision Making in Health Care: Theory, Psychology and Applications. New York, NY; Cambridge University Press 2000: 183-210
  • 16 Steginga S K, Occhipinti S. The application of the heuristic-systematic processing model to treatment decision making about prostate cancer.  Med Decis Making. 2004;  24(6) 573-583
  • 17 Hamm R M. Theory about heuristic strategies based on verbal protocol analysis: the emperor needs a shave.  Med Decis Making. 2004;  24(6) 681-686, author reply 687
  • 18 Britt D W, Evans M I. Information-sharing among couples considering multifetal pregnancy reduction.  Fertil Steril. 2007;  87(3) 490-495
  • 19 Britt D W, Evans M I. Sometimes doing the right thing sucks: frame combinations and multi-fetal pregnancy reduction decision difficulty.  Soc Sci Med. 2007;  65(11) 2342-2356
  • 20 St John E B, Nelson K G, Cliver S P, Bishnoi R R, Goldenberg R L. Cost of neonatal care according to gestational age at birth and survival status.  Am J Obstet Gynecol. 2000;  182(1 Pt 1) 170-175
  • 21 Marlow N, Wolke D, Bracewell M A, Samara M. EPICure Study Group . Neurologic and developmental disability at six years of age after extremely preterm birth.  N Engl J Med. 2005;  352(1) 9-19
  • 22 Peterson B D, Newton C R, Feingold T. Anxiety and sexual stress in men and women undergoing infertility treatment.  Fertil Steril. 2007;  88(4) 911-914
  • 23 Bryan E. The impact of multiple preterm births on the family.  Br J Obstet Gynaecol. 2003;  110(Suppl 20) 24-28
  • 24 Garel M, Stark C, Blondel B, Lefebvre G, Vauthier-Brouzes D, Zorn J R. Psychological reactions after multifetal pregnancy reduction: a 2-year follow-up study.  Hum Reprod. 1997;  12(3) 617-622
  • 25 Burns L H. Psychiatric aspects of infertility and infertility treatments.  Psychiatr Clin North Am. 2007;  30(4) 689-716
  • 26 Institute of Medicine . Pre Term Birth: Causes, Consequences, and Prevention. Washington, DC; National Academic Press 2006
  • 27 Marlow N, Wolke D, Bracewell M A, Samara M. EPICure Study Group . Neurologic and developmental disability at six years of age after extremely preterm birth.  N Engl J Med. 2005;  352(1) 9-19
  • 28 Hack M, Taylor H G, Drotar D et al.. Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s.  JAMA. 2005;  294(3) 318-325
  • 29 Taylor C. Sources of the Self. Cambridge, MA; Harvard University Press 1989: 4-5
  • 30 Dworkin R. Life's Dominion. An Argument about Abortion, Euthanasia, and Individual Freedom. New York, NY; Knopf 1993 10-13 90-91
  • 31 Benjamin M. Splitting the Difference. Compromise and Integrity in Ethics and Politics. Lawrence, KA; University Press of Kansas 1990: 72-4
  • 32 Roe v Wade .410 US 113 1973:at 153. 
  • 33 Helgason C M. Professional obligations and abortion referral.  Pharos Alpha Omega Alpha Honor Med Soc. 2001;  64(1) 42-47
  • 34 Kalra S K, Milad M P, Klock S C, Grobman W A. Infertility patients and their partners: differences in the desire for twin gestations.  Obstet Gynecol. 2003;  102(1) 152-155
  • 35 Evans M I, Bottoms S F, Critchfield G C, Greb A, LaFerla J J. Parental perception of genetic risk: correlation with prenatal diagnostic procedures. Intl.  J Obstet Gynaecol. 1990;  31 25-28
  • 36 Beauchamp T L, Childress J C. Principles of Biomedical Ethics. 5th ed. New York, NY; Oxford University Press 2001: 358-59
  • 37 Robertson J R. Sex selection. Final word from the ASRM Ethics Committee on the use of PGD.  Hastings Cent Rep. 2002;  32(2) 6
  • 38 Britt D W, Risinger S T, Mans M K, Evans M I. Devastation and relief: conflicting meanings of detected fetal anomalies.  Ultrasound Obstet Gynecol. 2002;  20(1) 1-5
  • 39 Pector E A, Green J, Ehlers M et al.. Personal experiences of bereaved twins, parents of twins, and their carers.  Twin Res. 2002;  5(3) 236-244

Mark I EvansM.D. 

Comprehensive Genetics, 131 E 65th Street

New York, NY 10065

Email: Evans@Compregen.com

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