What is Selective Reduction?
Selective Reduction, or selective termination, refers to choosing to abort a fetus, typically in a multifetal pregnancy, to decrease health risks and complications for either or both the surrogate mother and fetus(es). Selective reduction is most successful in early pregnancy and is often performed between nine and twelve weeks. It is a relatively simple procedure and can often be performed on an outpatient basis. Generally, a needle is inserted into the woman’s stomach or vagina and potassium chloride is injected into the fetus.
When is Selective Reduction Considered?
Under some circumstances, doctors may recommend the selective reduction of one or more fetuses to preserve the viability of the remaining fetus(es) and decrease health risks for the surrogate mother. When transferring multiple embryos at once, there is a higher chance of becoming pregnant with multiples. In cases where a multifetal pregnancy of three or more fetuses is reduced to two, the remaining two fetuses typically develop as they would have if they had been conceived as twins. Additionally, if testing reveals that the fetus has a medical or genetic abnormality that cannot be corrected and would significantly compromise the quality of life for the child, selective reduction may be considered.
What are the Risks?
About 75% of women who undergo selective reduction will go into premature labor. About 4-5% of women undergoing selective reduction also go on to miscarry one or more of the remaining fetuses. There is also an emotional risk to consider, so if selective reduction is chosen, a mental health professional should be consulted throughout the process.
Selective reduction is a very difficult decision because choosing not to may compromise the health and development of a fetus that has a chance to survive yet alternatively there may be moral or ethical implications. Although most surrogates and intended parents won’t be faced with the decision, it is a very important aspect of a surrogacy contract to make sure both parties understand each other’s views ahead of time.