THE CURRENT STATUS OF MULTIFETAL PREGNANCY REDUCTION

The number of women conceiving three or more fetuses has increased dra matically as a result of successful infertility therapy with ovulation -inducing agents and assisted reproductive technology. Higher-order mu ltiple gestations have an increased risk of premature delivery and its attendant sequelae of increased neonatal mortality or irreversible mo rbidity. Multifetal pregnancy reduction is a procedure designed to dec rease the increased propensity to deliver very prematurely in these pa tients by reducing the number of live fetuses they are carrying. The p rocedure has proved to be both safe and effective, and pregnancies red uced to twins proceed as if that were the number of fetuses originally conceived. Nevertheless, this invasive procedure does have the potent ial to result in loss of the entire pregnancy and causes considerable emotional distress for some couples who view it as their ''least bad'' alternative. The medical benefits of performing multifetal pregnancy reduction in women with four or more fetuses seem fairly well establis hed, but this is less true for triplets. Serious attention should be p aid to reducing the number of higher-order multiple pregnancies result ing from infertility therapy. In the meantime, when three or more fetu ses have been conceived, multifetal pregnancy reduction offers a reaso nable option to patients whose only choices in the past were either to accept the risk of delivering extremely prematurely or to terminate t he entire pregnancy.