When is twins too many?


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Folks, this raises a central ethical question to me. Your thoughts?

Tom Blackwell, National Post

Friday, Dec. 10, 2010

"Like so many other couples these days, the Toronto-area business executive and her husband put off having children for years as they built successful careers. Both parents were in their 40s — and their first son just over a year old — when this spring the woman became pregnant a second time. Seven weeks in, an ultrasound revealed the Burlington, Ont., resident was carrying twins. "It came as a complete shock," said the mother, who asked not to be named. "We're both career people. If we were going to have three children two years apart, someone else was going to be raising our kids. ... All of a sudden our lives as we know them and as we like to lead them, are not going to happen."

She soon discovered another option: Doctors could "reduce" the pregnancy from twins to a singleton through a little-known procedure that eliminates selected fetuses — and has become increasingly common in the past two decades amid a boom in the number of multiple pregnancies.

Selective reductions are typically carried out for women pregnant with triplets or greater, where the risk of harm or death climbs sharply with each additional fetus. The Ontario couple is part of what some experts say is a growing demand for reducing twins to one, fueled more by socio-economic imperatives than medical need, and raising vexing new ethical questions.

Experts question whether parents should choose to terminate a fetus just because of the impact the child would have on their lives, and note that even more medically necessary reductions can trigger lifelong angst and even threaten marriages.

The mother said the Toronto doctor who eventually did her reduction performs several a month."

A scientific abstract on In Vitro Fertilization which is the procedure that is the source of this issue:

Reducing twin pregnancy rates after IVF--elective single embryo transfer (eSET).

Milne P, Cottell E, Allen C, Spillane H, Vasallo J, Wingfield M.

Merrion Fertility Clinic, National Maternity Hospital, Holles Street, Dublin 2.


Multiple pregnancy is a major complication of IVF and is associated with increased maternal, fetal and neonatal morbidity. Elective single embryo transfer (eSET) during IVF, rather than the more standard transfer of two embryos (double embryo transfer or DET), has been shown to significantly reduce the multiple pregnancy rate associated with IVF, while maintaining acceptable pregnancy rates. Couples undergoing IVF in 2008 who met good prognostic criteria had eSET performed. Pregnancy and twinning rates were compared with those for similar couples in 2007 who had DET. Couples unsuccessful with a fresh cycle of treatment had subsequent frozen embryo transfer cycles with DET. The cumulative pregnancy rate was similar for each group. However there were no multiple pregnancies in the eSET group, compared to 4 twins of 5 pregnancies in the DET group. 96% of eligible couples agreed to eSET. ESET is successful in and acceptable to good prognosis Irish couples undergoing IVF.

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I don't see a problem. Going from two to one raises no more questions than going from one to none.

The one you abort will always be jealous of the one you didn't, but sibling rivalry is an old story.

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Not a decision I would make. If I had decided I wanted kids, both of us having stable careers, I'd keep them all regardless of the number. Now that this lady has had the procedure done, I can think of two uncomfortable issues.

1. What if the selected child has complications and passes?

2. How do you possibly explain to that child if they are ever made aware of the "procedure?"

This situation is definitely between a rock and hard place. Financially, they are well off to support kids, no health issues. Yet, ultimately, it's their decision to make. They might be okay with the decision now, but what about years from now. If I were in that situation, I would look to the youngest and always wonder what his/her sibling would have been like.

~ Shane

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