title: Evolution of gender options in multiple pregnancy management.
abstract: OBJECTIVE
  Fetal reduction (FR) in multiples dramatically improves outcomes. We prioritize FR decisions for health and historically declined to factor gender. As male preferences apparently diminished, our bioethicist encouraged a re-evaluation.
  
  
  METHODS
  Three hundred ninety-six patients reducing triplets or twins were categorized as 3➔2, 3➔1, and 2➔1, Major (M) anomaly or minor (m) anomaly, same gender (SG), and those for whom gender preference (GP) was possible. Higher order and non chorionic villus sampling were excluded. FR decisions were prioritized by M anomaly, Suspicious, or m anomaly. If neither, we considered GP.
  
  
  RESULTS
  Of 319, 214 (67%) had either M/m or SG. Of those, 3➔2 with gender option: 71/79 chose male and female or had no preferences, one chose male/male, and seven chose female/female. We reduced monochorionic twins in 33/35 3➔1 cases. Of 20 with GP choice, 10 chose male and 10 chose female. Of 162 2➔1, 54 had M or m, 50 were SG, but of the 44 M/F twins, 20 chose male and 24 chose female.
  
  
  CONCLUSIONS
  There has been a cultural shift mostly preferring one of each or having no preference. When reducing to one, >50% prefer a girl. In addition to identifying abnormalities, chorionic villus sampling before FR expands patient autonomy.
authors.affiliation: Comprehensive Genetics and Fetal Medicine Foundation of America, Mt. Sinai School of Medicine, New York, NY, USA; Departments of Obstetrics & Gynecology, Mt. Sinai School of Medicine, New York, NY, USA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Evans
authors.forename: Mara
authors.initials: M
authors.lastname: Rosner
authors.forename: Stephanie
authors.initials: S
authors.lastname: Andriole
authors.forename: Avishai
authors.initials: A
authors.lastname: Alkalay
authors.forename: Juliana
authors.initials: J
authors.lastname: Gebb
authors.forename: David W
authors.initials: DW
authors.lastname: Britt
mesh_terms: D002755:Choice Behavior; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference / Q000706:statistics & numerical data; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D012743:Sex Preselection / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D014310:Triplets; D014427:Twins