How is the risk of multiple pregnancy reduced?
There exist a number of methods, the application of which may help to reduce the risk of multiple pregnancy. To these methods belong the limiting of the embryo number, which are transferred into the uterus and applying the blastocyst transfer technique.
It is possible to limit the number of the embryos, which are transferred into the uterus to two or to one in order to reduce the risk of multiple pregnancy. It is believed that in case if there are more than four embryos created, the transferring of two embryos will achieve the same pregnancy rate to three embryos, however, the risk of having multiple pregnancy will be reduced to some extend.
Moreover, there has been the new legislation in some countries, in accordance to which the restriction to a single embryo transfer is imposed for women, who are younger than 36 years and who undergo their first treatment cycle.
What are the options available to a couple of intended parents and to a surrogate mother, if an ultrasound scan diagnoses a high order of multiple pregnancy?
There exist several ways out of a situation of multiple pregnancy, it is scanned during the first trimester. To the most widespread strategies may be referred: a “wait and see” approach, elective fetal reduction or abortion.
Wait and see
There is the tendency in about 20% of multiple pregnancies, when one or more fetus gets absorbed in a spontaneous way – the term “vanished fetus” usually describes the phenomenon. As a rule it occurs during the first trimester of pregnancy – before the 12th week. However, it should also be noted that the older is the surrogate mother, the more chances she has to have vanishing fetuses.
Elective fetal reduction
It is also possible to reduce the number of fetuses in case of a multiple pregnancy with the help of a specific technique, called the multifetal reduction. This way triplet pregnancy may be converted into a twin or even into a singleton pregnancy, thus, the risk of miscarriage reduces as well as the risk of having complications during the delivery process does. The multifetal reduction procedure is applied in case of three or more fetuses, and it is usually conducted between 10 – 12 pregnancy weeks, however, it is possible to be performed up until the 24th week of pregnancy.
The very procedure involves the injection of potassium chloride, which is made into the heart of a fetus, and which results into the death of the fetus. The injection is guided with the help of an ultrasound. The dead fetus gets absorbed by the body, and other fetuses keep on developing.
There exist a lot of ethical and medical concerns around the elective fetal reduction technique. In addition, there is a number of complications, which may possibly be caused by the procedure. To the most common of them may be referred: preterm delivery – this occurs in about 75% of multifetal pregnancy reduction pregnancies; miscarriage of the fetuses, remained – occurs in more than 10% of multifetal pregnancy reduction pregnancies, and maternal infection is also possible to occur, however, it is quite a rare phenomenon. Moreover, elective fetal reduction technique does not restore any risks of obstetrics complications to the levels, which are usually expected in single pregnancies.
Termination of pregnancy
There are cases, when the surrogate mother along with the couple of intended parents has to decide to terminate multiple pregnancy, if there is a threaten to the surrogate mother’s health or life.
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