Selective termination: clinical experience and residual risks.
Assisted reproductive technologies have aided thousands of couples, but complications have resulted in multifetal pregnancies creating a bitter irony for infertility patients. In an effort to increase the rate of intact survival, we have successfully performed transabdominal first-trimester selective termination procedures on 22 pregnancies including one octuplet, five quintuplet, twelve quadruplet, and four triplet gestations. There have been eight sets of twins, and two singletons delivered, seven twin pregnancies are ongoing, and one early and four late losses of pregnancies. With experience we now counsel as to a high likelihood of a technically successful procedure, but we still have concerns for late losses. We have tried to balance the arguments about the direct harms of performing selective termination and the obstetric risks of not performing selective termination. We believe that selective termination should not be considered a "social" procedure. Our data do not yet make clear whether one, two, or three is the optimal number of embryos to leave. Therefore, on the basis of both current obstetric risk factors and ethical reasoning we will continue to support our protocol of optimally leaving twins.
Evans
M I
MI
Division of Reproductive Genetics, Hutzel Hospital-Wayne State University, Detroit, MI 48201.
May
M
M
Drugan
A
A
Fletcher
J C
JC
Johnson
M P
MP
Sokol
R J
RJ
D000028:Abortion, Induced / Q000379:methods*; D004992:Ethics, Medical; D005260:Female; D005307:Fertilization in Vitro; D005313:Fetal Death / Q000209:etiology; D015181:Gamete Intrafallopian Transfer; D006801:Humans; D010062:Ovulation Induction; D011247:Pregnancy; D011272:Pregnancy, Multiple; D037841:Pregnant People; D018570:Risk Assessment