Infertility treatments have allowed millions of couples to have their own children,
but resultant multiple pregnancies with their increased morbidity and mortality have
been a significant complication. Fetal reduction was developed to ameliorate this
issue. Over 30 years of publications show that fetal reduction has been highly successful
in substantially reducing both mortality and morbidity related to multiple pregnancies.
As with most radically new techniques, initial cases were in the “nothing to lose”
category. With experience, indications liberalize, and quality of life issues gain
relevance. The overall risks of twin pregnancy are not twice that of singleton pregnancy;
they are about 4 to 5 times higher. In experienced hands, the combination of genetic
testing by chorionic villus sampling followed by fetal reduction has made the outcomes
of most multiple pregnancies statistically equivalent to those of pregnancies with
lower fetal numbers. Use of microarray analysis to better determine fetal genetic
health before deciding on which fetus(es) to keep or reduce further improves pediatric
outcomes. With increasing experience and lower average starting numbers, the proportion
of fetal reductions to a singleton has increased considerably. Twins to a singleton
fetal reductions now constitute an increasing proportion of cases performed. Data
on such cases show improved outcomes, and we believe fetal reduction should be at
least discussed and offered to all patients with a dichorionic twin pregnancy or higher.
With the increasing reliance on elective single-embryo transfers, monochorionic twins,
which have much higher complication rates than dichorionic twins, have increased substantially.
Furthermore, monochorionic twins cannot be readily and safely reduced, so the adverse
perinatal statistics of elective single-embryo transfer are a major setback for good
outcomes. Although elective single-embryo transfer is appropriate for some, we believe
that for many couples, the transfer of 2 embryos is generally a more rational approach.
Key words
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Article Info
Publication History
Published online: October 23, 2021
Accepted:
October 19,
2021
Received in revised form:
September 24,
2021
Received:
June 2,
2021
Footnotes
The authors report no conflict of interest.
The study did not receive any funding.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
