Reasons for Fetal Reduction & Termination

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Fetal reduction is a difficult topic to discuss and an event we hope you’ll never need to face. However, it is an important conversation to have and an area where you will need to be very truthful with your own emotions and limits before ever embarking on a surrogacy journey.

Understand that reductions are rarely done for non-medical reasons. Intended parents come to surrogacy with the intention of achieving pregnancy and having children. These are not unwanted or accidental pregnancies, as is the case in many of the estimated 1.2 million abortions completed in the United States every year. Simply stated: fetal reductions or abortions are not commonplace in surrogacy.  Even so, from time to time, the necessity for a fetal reduction will arise. Here are common reasons why a doctor or the intended parents may choose to reduce or terminate a pregnancy.

High Order Multiples

As a general rule of thumb, it is not advisable to transfer more embryos into your uterus than you’re willing to carry. For example, if you’re unwilling to carry triplets, you would be less likely to transfer three embryos at a time. Even so, from time to time, a transplanted embryo will split, creating identical twins. This often becomes an issue when it leads to more than two fetuses in the uterus at once. In the event that two embryos are transferred and one or both of them split into identical twins, the end result would be a triplet or quadruplet pregnancy. This is rare, but it can happen. Often, in these rare cases, the intended parents will choose to reduce the pregnancy. This is done for medical reasons and for the safety of both the fetuses and of the surrogate.

High order multiples carry increased risks of premature birth, birth defects, and low birth weights. They can also represent development complications in utero. The placenta can be less than 100% effective at providing enough oxygen to multiples, often leading to low birth weights and up to a 25% fetal death rate. Of the high order multiples who do make it to live birth, nearly 20% experience some form of long term handicap.

Additionally, in some instances identical twins can develop a condition called twin-twin transfusion. This condition, which is considered life threatening, occurs when blood flows from one fetus to the other through a connection in a shared placenta. It often leads to poor growth in one twin, and excessive fluid buildup in the other. This condition can also be dangerous to the carrier.

For the surrogate, high order multiples can place undue stress on the body and can lead to a greater risk of pre-eclampsia, diabetes, and ordered bed rest.

Abnormal Prenatal Testing Diagnosis

Many intended parents will complete genetic screening on embryos prior to transfer. This allows them to drastically lower the potential of an early trimester screening revealing severe genetic disorders. Even so, sometimes a screening will have less than favorable results and, following a potential amniocentesis, the intended parents can elect to abort the pregnancy.

An amniocentesis is believed to predict, with up to 99.4% accuracy, the presence of Down Syndrome, Trisomy 18, Spina Bifida, Muscular Dystrophy, Cystic Fibrosis, Sickle Cell Disease, Tay-Sachs, and Anencephaly. While not all of those diagnoses present an “incompatible with life” diagnosis, some intended parents may feel inclined to terminate the pregnancy due to a quality of life issue. We understand that this can be a polarizing issue, and can not stress highly enough that these diagnoses and any potential reductions in the result of diagnosis be discussed at match meeting.

This list is certainly not an all-inclusive look into the only scenarios in which it may be medically advised to reduce or terminate a pregnancy. It is important to discuss your opinions and feelings about reduction and termination openly with admissions and case specialists during your admissions and matching phases.

Dr. Kim Bergman

Kim Bergman, PhD, a licensed psychologist of 26 years, has specialized in the area of gay and lesbian parenting, parenting by choice and third party assisted reproduction for over two decades. Dr. Bergman has created a comprehensive psychological screening, support and monitoring process for Intended Parents, Surrogates and Donors. She is the co-owner of Fertility Counseling Services and Growing Generations and is a member of the American Society for Reproductive Medicine, the American Psychological Association, the Los Angeles County Psychological Association, the Lesbian and Gay Psychotherapy Association, and the Gay and Lesbian Medical Association. She is on the national Emeritus board of the Family Equality Council. Dr. Bergman writes, teaches and speaks extensively on parenting by choice. Along with co-authors, she published “Gay Men Who Become Fathers via Surrogacy: The Transition to Parenthood” (Journal of GLBT Family Studies, April 2010). Dr. Bergman’s is the author of the upcoming book, Your Future Family: An Essential Guide to Assisted Reproduction (Red Wheel Press 2019). Dr. Bergman created her own family using third party assisted reproduction and she lives with her wife of 35 years. Her two daughters are in college.