Multiple pregnancy: Should I consider a multifetal pregnancy reduction?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Carry a pregnancy with three or more fetuses.
Have multifetal pregnancy reduction. This procedure reduces the number of fetuses.

This information is for women who are pregnant with three or more fetuses. It's also for their partners. For more information on in vitro fertilization, see:

Should I have infertility treatment?

Key points to remember

Having three or more fetuses raises the risk of miscarriage. About 25 out of 100 triplet pregnancies end in miscarriage.¹ This means that 75 out of 100 of these pregnancies don't miscarry. The risk of premature birth is also higher, which increases an infant's chance of illness, disability, or death in the first year.²
Having fewer fetuses lowers all risks. This makes it more likely that you will have a healthy pregnancy and a healthy baby or babies.
This procedure to reduce the number of fetuses can cause miscarriage of the remaining fetuses. The chance of this happening when triplets are reduced to twins is about 6 in 100 pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of these procedures.³ The risk is about the same as the chance of a miscarriage in any twin pregnancy.¹
Early genetic testing (chorionic villus sampling) and fetal ultrasound can help you find out if any of the fetuses has a problem. This information may help you decide about reducing the number of fetuses.
This decision may be emotional and complex. For some people, it raises ethical and spiritual concerns.

FAQs

What is multifetal pregnancy reduction?

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a pregnancy—usually from three, four, or five fetuses to two. This may help the two fetuses survive and help you have a healthy pregnancy.

This procedure is most often done early in a pregnancy, between the 9th and 12th weeks. It's often done after genetic testing to find out if the fetuses have any problems.

It's usually done through the belly. Using ultrasound as a guide, the doctor puts a needle into the uterus to the selected fetus or the umbilical cord. The doctor injects the fetus or the cord with a medicine that stops the heart.

Sometimes vaginal bleeding happens afterward. This is normal.

The dead embryo or fetus is absorbed by the mother's body. This is similar to what happens with vanishing twin syndrome.

What are the benefits of a multifetal pregnancy reduction?

Mother risk. The procedure reduces the mother's risk of problems. These risks include gestational diabetes, preeclampsia, and anemia. These risks increase with each added fetus.

Infant risk. The procedure also reduces the chance of miscarriage. It improves your chances of carrying your pregnancy longer and having one or more healthy babies.³

Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability. About 25 in 100 triplet pregnancies end in miscarriage.¹ This also means that 75 in 100 of these pregnancies don't end in miscarriage.

In one study, half of families with triplets had a child who died or was disabled. About two-thirds of families with quadruplets had a child who died or was disabled.²

Family life. The procedure may help the parent-child relationship. Interviews done 2 years after their pregnancies found that mothers who reduced their pregnancies to twins were less anxious, less depressed, and more satisfied with their parent-child relationships than the mothers of triplets were.⁴

Stress of infant care. Caring for three or more babies can be stressful, especially if any of them has health problems.

Cost of caring for multiples. The hospital care for three or more infants can be expensive. Because multiple babies have an increased chance of premature birth and illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring for the babies at home also could be costly. After they come home, premature babies often need medicines, medical equipment and supplies, and extra doctor visits.

**How does a triplet-reduced-to-twin pregnancy compare with a triplet pregnancy?** ³
	Twins after fetal reduction	Triplets (no fetal reduction)
Percent of babies born after 32 weeks, taken home	93 out of 100	About 79 out of 100
Premature birth before 32 weeks	10 out of 100	20 out of 100
Premature birth before 28 weeks	3 out of 100	About 8 out of 100
Miscarriage before 24 weeks	5 to 6 out of 100	11 to 12 out of 100
One or more fetal deaths during the pregnancy	About 3 out of 100 live births	About 9 out of 100 live births.

What are the risks of multifetal pregnancy reduction?

The risks of reducing the number of fetuses include:

Miscarriage of the other fetuses. About 6 in 100 triplet-to-twin procedures lead to miscarriage.³ (This is about the same risk of miscarriage for any twin pregnancy.¹) This also means that 94 in 100 triplet-to-twin procedures don't cause a miscarriage. The miscarriage rate seems to be about the same when reducing from 3, 4, or 5 fetuses, but it is higher when reducing from 6 or more.⁵
Emotional risks for you, especially if the pregnancy miscarries. Some parents who go on to have a healthy pregnancy view the reduction as sad but medically needed. Others who have had a reduction followed by a healthy pregnancy say they felt grief, guilt, and depression about their decision. But this usually decreases with time.⁴
Infection of the belly or uterus. This is rare.

Some couples choose to implant fewer embryos to reduce the chance of a pregnancy of triplets or more, rather than consider having this procedure.

2. Compare Options

	Have fetal reduction	Carry three or more fetuses
What is usually involved?	You will have an ultrasound test to make sure that the fetus or fetuses to be reduced are in their own amniotic sac. Separate sacs reduce the chance of miscarriage. A different procedure may be done if the fetuses are in the same sac. It's done in the doctor's office. It takes only a few minutes. You will be watched at the doctor's office afterward to make sure that the remaining fetuses are doing well.	You will see your doctor more often during your pregnancy. You will likely see a perinatologist. This doctor takes care of women who may have a problem in their pregnancy. You may have more tests than you would in a pregnancy with one fetus.
What are the benefits?	Having fewer fetuses reduces the risk of miscarriage, stillbirth, premature birth, and disability. You have a lower chance of problems in your pregnancy, such as gestational diabetes, preeclampsia, or anemia. These risks increase with each added fetus. It may help your family life. One study found that mothers who reduced their pregnancies to twins were less anxious, less depressed, and more satisfied with their parent-child relationships than mothers of triplets were.⁴	You won't have the grief, guilt, and depression that some parents have about reducing the number of fetuses You have a lower risk of infection.
What are the risks and side effects?	You could miscarry the remaining fetuses. When reducing from a triplet to a twin pregnancy, the miscarriage rate is about 6 in 100 pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of these procedures.¹ The risk of miscarriage is about the same as the chance of a miscarriage in any twin pregnancy.¹ You could have an infection in your belly or uterus. This is rare. Some parents have grief, guilt, and depression about reducing the number of fetuses. But this may decrease with time.⁴	Carrying triplets or more increases the risk of miscarriage. The risk is about 25 out of 100 pregnancies.¹ This means that 75 out of 100 of these pregnancies don't miscarry. The risks of stillbirth, premature birth, and disability are also higher. Multiple pregnancy increases the mother's risk of problems such as gestational diabetes, preeclampsia, and anemia. These risks increase with each added fetus. Mothers of triplets report being more anxious, more depressed, and less satisfied with their parent-child relationships than mothers who reduced their pregnancies to twins.⁴

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Return to the topic:

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When my husband and I learned we were expecting three babies, we were thrilled. However, along with that news we heard about the risks for them and me. I'm already at risk for pregnancy problems, since I've had gestational diabetes before. So, we decided to have a multifetal pregnancy reduction. What convinced me was the knowledge that the miscarriage rate is higher for triplet pregnancy than it is for the twins after the procedure. And it went well for us. We took the risk, and the babies and I are doing well. "

— Pam, age 37

"Because of my age, our fertility doctor encouraged us to have four embryos transferred for my in vitro. We were surprised that all of them took and were worried about the risks. After talking for a few days about having a multifetal pregnancy reduction, my husband and I decided not to have one. We were more comfortable with letting nature take its course. And it did—by the second trimester, two were gone, and I was carrying twins. "

— Maya, age 43

"We knew right away that carrying five babies was not going to work for them or me. So, I had a multifetal pregnancy reduction. Then, I miscarried. Even though it seemed like the obvious course to take, I'll never stop feeling terrible about it. "

— Jenny, age 39

"I just couldn't bring myself to have a multifetal pregnancy reduction, even though my doctor told me that my pregnancy was high-risk. I'll never know whether it would have gone better if I'd had the procedure, but trying to carry the four babies didn't go well. One died after birth, and now we have the challenge of raising triplets, one of which is disabled. "

— Joelle, age 35

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

More important

Equally important

More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

More important

Equally important

More important

My ethical and spiritual values would allow me to have fetal reduction.

My ethical and spiritual values wouldn't allow me to have fetal reduction.

More important

Equally important

More important

I don't think I can take care of a child with a disability.

I can take care of a child with a disability.

More important

Equally important

More important

I can't afford to raise three or more children.

I have the resources to raise several children.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Fetal reduction

Having triplets or more

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Does a fetal reduction lower the chance that your remaining baby or babies will have a disability?

Yes
No
I'm not sure

You're right. A fetal reduction lowers the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.

2. Is your risk of having a miscarriage higher with a fetal reduction than it is with having triplets or more?

Yes
No
I'm not sure

You're right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.

3. Do both choices have emotional side effects?

Yes
No
I'm not sure

You're right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

Decide what's next.

1. Do you understand the options available to you?

2. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Yaron Y, et al. (1999). Multifetal pregnancy reductions of triplets to twins: Comparison with nonreduced triplets and twins. American Journal of Obstetrics and Gynecology, 180(5): 1268–1271.
Strauss A, et al. (2002). Multifetal gestation—Maternal and perinatal outcome of 112 pregnancies. Fetal Diagnosis and Therapy, 17(4): 209–217.
Wimalasundera R, et al. (2003). Reducing the incidence of twins and triplets. Best Practice and Research Clinical Obstetrics and Gynaecology, 17(2): 309–329.
Garel M, et al. (1997). Psychological reactions after multifetal pregnancy reduction: A 2-year follow-up study. Human Reproduction, 12(3): 617–622.
Stone J, et al. (2002). A single center experience with 1,000 consecutive cases of multifetal pregnancy reduction. American Journal of Obstetrics and Gynecology, 187(5): 1163–1167.