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Prenatal and Preimplantation Diagnosis pp 97–117Cite as

Medical Reasons for Pregnancy Interruption: Fetal Reduction

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Abstract

The procedure of fetal reduction (FR) was begun 30 years ago to salvage pregnancies of couples who, following fertility therapy, were “too successful,” i.e., pregnant with too many fetuses. FR has gone from a rarity performed in only the highest risk situations to now an integral fail-safe of infertility practice. Our understanding of the problems of multiple gestations and premature births has increased. Twins have complications 4–5 times that of singletons. Evaluation of fetuses before FR now allows more intelligent choices and improved resultant outcomes. We currently perform CVS in about 85 % of our cases, obtain FISH results overnight, and perform FR the next day. Decisions about which fetus(es) to reduce prioritizes anomalies, but can include fetal gender in the decision process, as couples now are just as likely to request females as males. In cases at risk for Mendelian disorders, sophisticated molecular analyses permit disease diagnoses before FR; paternity analysis also can be performed with these techniques. Ethical arguments have also evolved. As with many technologies in which the initial use was for only “life or death cases,” FR has moved onto “quality of life” issues. Reduction of twins to a singleton now compromises about 30 % of our cases.

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Acknowledgement

The authors wish to acknowledge the contributions to our thinking on this subject of John C. Fletcher, Ph.D., who, before his death several years ago, laid the foundation for the ethical analysis of this subject.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Mt. Sinai School of Medicine, 131 E. 65th St., New York, NY, 10065, USA

    Mark I. Evans M.D.

  2. Comprehensive Genetics, PLLC, 131 E. 65th St., New York, NY, 10065, USA

    Stephanie Andriole M.S., C.G.C. & Shara M. Evans M.P.H., M.Sc.

  3. FMFA, 131 E. 65th St., New York, NY, 10065, USA

    David W. Britt Ph.D.

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  1. Mark I. Evans M.D.
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  2. Stephanie Andriole M.S., C.G.C.
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  3. Shara M. Evans M.P.H., M.Sc.
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  4. David W. Britt Ph.D.
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Correspondence to Mark I. Evans M.D. .

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  1. New York, New York, USA

    Joann Paley Galst

  2. Department of Obstetrics and Gynecology; Department of Human Genetics, The University of Chicago, Chicago, Illinois, USA

    Marion S. Verp

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Evans, M.I., Andriole, S., Evans, S.M., Britt, D.W. (2015). Medical Reasons for Pregnancy Interruption: Fetal Reduction. In: Paley Galst, J., Verp, M. (eds) Prenatal and Preimplantation Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-18911-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-18911-6_5

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